Background & Aims(s)
The Australian Optimal Care Pathway (OCP) for Lung Cancer are developed to improve survival by delivered evidence-based, timely and person-centred care. We aimed to synthesise Australian evidence on adherence to Lung Cancer OCP and associated contributing factors.
Methods
A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Five databases were searched using a search strategy. Australian primary studies involving adults with lung cancer that examined any component of the Lung Cancer OCP, published since 2014, were included. Title, abstract and full-text screening were undertaken independently by two reviewers. Data extraction was completed by one reviewer. Narrative synthesis was conducted.
Results
Thirty-five studies were included of the 511 identified through database search, with data from more than 30,000 patients with lung cancer and over 100 healthcare professionals and stakeholders. Presentation, Initial Investigation and Referral (22/35), and Diagnosis, Staging and Treatment Planning (28/35), and Treatment (25/35) were the most frequently evaluated OCP stages. Adherence to recommended OCP varied considerably. Timelines related to referrals, diagnoses and treatment commencement were the most commonly reported indicators of adherence. Delays were frequently reported for referral-to-diagnosis, and diagnosis-to-treatment commencement timelines. Poorer adherence was reported in regional, rural and remote settings, while some studies identified barriers affecting both Aboriginal and Torres Strait Islander Peoples, and socio-economically disadvantaged populations. Frequently reported barriers to adherence included delayed multidisciplinary team reviews, fragmented referral pathways, workforce shortages and service access.
Implications/Conclusion
Adherence to the Lung Cancer OCP varied across Australia, with recommended referral, diagnostic and treatment timeframes frequently not achieved. While systemic barriers for adherence were identified, future studies can examine factors contributing to inequity for socio-economically and geographically disadvantaged populations.