title: Documenting coordination of cancer care between primary care providers and oncology specialists in Canada.
abstract: OBJECTIVE
  To report on the findings of the CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum) Casebook project, which systematically documented Canadian initiatives (ie, programs and projects) designed to improve or support coordination and continuity of cancer care between primary care providers (PCPs) and oncology specialists.
  
  
  METHODS
  Pan-Canadian environmental scan.
  
  
  METHODS
  Canada.
  
  
  METHODS
  Individuals representing the various initiatives provided data for the analysis.
  
  
  METHODS
  Initiatives included in the Casebook met the following criteria: they supported coordination and collaboration between PCPs and oncology specialists; they were related to diagnosis, treatment, survivorship, or personalized medicine; and they included breast or colorectal cancer or both. Data were collected on forms that were compiled into summaries (ie, profiles) for each initiative. Casebook initiatives were organized based on the targeted stage of the cancer care continuum, jurisdiction, and strategy (ie, model of care or type of intervention) employed. Thematic analysis identified similarities and differences among employed strategies, the level of primary care engagement, implementation barriers and facilitators, and initiative evaluation.
  
  
  RESULTS
  The CanIMPACT Casebook profiles 24 initiatives. Eleven initiatives targeted the survivorship stage of the cancer care continuum and 15 focused specifically on breast or colorectal cancer or both. Initiative teams implemented the following strategies: nurse patient navigation, multidisciplinary care teams, electronic communication or information systems, PCP education, and multicomponent initiatives. Initiatives engaged PCPs at various levels. Implementation barriers included lack of care standardization across jurisdictions and incompatibility among electronic communication systems. Implementation facilitators included having clinical and program leaders publicly support the initiative, repurposing existing resources, receiving financial support, and establishing a motivated and skilled project or program team. The lack of evaluative data made it difficult to identify the most effective interventions or models of care.
  
  
  CONCLUSIONS
  The CanIMPACT Casebook documents Canadian efforts to improve or support the coordination of cancer care by PCPs and oncology specialists as a means to improve patient outcomes and cancer system performance.
authors.affiliation: Professor and Lead of Health Services Research in the Department of Oncology, a scientist with the Escarpment Cancer Research Institute, and an associate member of the Department of Clinical Epidemiology and Biostatistics, all at McMaster University in Hamilton, Ont. mbrouwer@mcmaster.ca.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Brouwers
authors.affiliation: Research Coordinator in the Department of Oncology at McMaster University.
authors.forename: Marija
authors.initials: M
authors.lastname: Vukmirovic
authors.affiliation: Assistant Professor in the School of Kinesiology and Health Studies at Queen's University in Kingston, Ont.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Tomasone
authors.affiliation: Giblon Professor and Vice-Chair of Research in the Department of Family and Community Medicine at the University of Toronto in Ontario and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research.
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
authors.affiliation: Assistant Professor in the Department of Surgery at Dalhousie University in Halifax, NS.
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.affiliation: Assistant Professor in the Department of Family and Community Medicine at the University of Toronto and Scientific Associate with the Knowledge Translation Research Network, Health Services Research Program, and Ontario Institute for Cancer Research.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: O'Brien
authors.affiliation: An epidemiologist in the Division of Cancer Care and Epidemiology of the Cancer Research Institute at Queen's University.
authors.forename: Melanie
authors.initials: M
authors.lastname: Walker
authors.affiliation: Assistant Professor and Education Scientist in the Department of Family and Community Medicine at the University of Toronto, a fellow of the Centre for Critical Qualitative Health Research, and a cross-appointed scientist with the Wilson Centre.
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
authors.affiliation: Head of Oncology Nursing and the Patient and Family Support Program at the Odette Cancer Centre of Sunnybrook Health Sciences Centre and Associate Professor in the Faculty of Nursing and Professor in the School of Graduate Studies at the University of Toronto.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fitch
mesh_terms: D002170:Canada; D003266:Continuity of Patient Care / Q000592:standards*; D006282:Health Personnel; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000628:therapy*; D013038:Specialization; D011795:Surveys and Questionnaires