Table 2 Suggested priorities for cancer services in remote and rural areas. Stage three scores (medians and percentages)
From: Providing cancer services to remote and rural areas: consensus study
Range (%) | Range (%) | ||||||||
|---|---|---|---|---|---|---|---|---|---|
Agreed items | Median | 1–3 | 4–6 | 7–9 | Equivocal or disagreed items | Median | 1–3 | 4–6 | 7–9 |
Diagnosis | |||||||||
Fast access to diagnostic services | 9 | 2 | 3 | 95 | One-stop diagnostic clinics | 7 | 5 | 26 | 69 |
Patient education on suspicious symptoms | 8 | 0 | 18 | 82 | |||||
Specialist oncology | |||||||||
Informed discussion with patients about treatment choices | 9 | 0 | 0 | 100 | Local specialist treatment (in hospitals in rural areas) | 7 | 16 | 30 | 54 |
Best possible specialist treatment | 9 | 0 | 2 | 98 | Opportunity to take part in clinical trials | 7 | 10 | 37 | 53 |
Avoiding treatment where there is little chance of benefit | 8 | 0 | 8 | 92 | Offering treatment however small a chance of benefit | 5 | 30 | 38 | 33 |
Fastest possible specialist treatment | 8 | 0 | 10 | 90 | |||||
Delivery of care | |||||||||
Chemotherapy administered by experienced staff | 9 | 0 | 7 | 93 | Intermediate care role for remote general practitioners (e.g. taking on tasks that traditionally have been hospital based, but not wholly specialist) | 7 | 0 | 28 | 72 |
Well-coordinated delivery of chemotherapy (blood sampled in primary care, drugs ready on arrival at hospital…etc.) | 9 | 3 | 7 | 90 | Regular specialist oncology presence at local hospital | 7 | 12 | 23 | 65 |
Local supportive care (blood tests, transfusions etc.) | 7 | 0 | 11 | 89 | Clinician with interest in oncology at local general hospital | 7 | 7 | 34 | 59 |
Agreed multidisciplinary protocols for chemotherapy in local areas | 9 | 3 | 10 | 87 | Most chemotherapy delivered at local general hospitals | 7 | 15 | 30 | 55 |
At least two trained chemotherapy nurses in each place (eg hospital) where it is delivered (cover for holidays/sickness) | 9 | 3 | 10 | 87 | Most chemotherapy delivered at the cancer center | 6 | 21 | 35 | 44 |
Link person at local general hospitals (eg specialist nurse) | 8 | 0 | 16 | 84 | Chemotherapy delivered at home | 5 | 28 | 35 | 37 |
Chemotherapy delivered at local community hospitals | 5 | 38 | 27 | 35 | |||||
Specialist outreach | |||||||||
Specialist oncology nurses to provide information, advice, and support for patients at home | 7 | 7 | 16 | 77 | |||||
Specialist clinics in local area (e.g. local general hospital and community hospital) for follow-up of patients with cancer | 7 | 5 | 23 | 72 | |||||
Specialist chemotherapy nurses to provide information, advice, and support for patients via telephone | 7 | 3 | 26 | 71 | |||||
Specialist clinics in local area (e.g. local general hospital and community hospital) for initial referral and diagnosis of suspected cancer | 7 | 11 | 27 | 62 | |||||
Specialist clinics conducted via telemedicine | 5 | 16 | 44 | 40 | |||||
Communication | |||||||||
Rapid two-way communication between specialist and primary care team | 9 | 0 | 0 | 100 | Copies of radiology reports direct to general practitioner (to enable the patient to be informed) | 7 | 7 | 23 | 70 |
Good communication links between center oncologists and local oncology team | 9 | 0 | 5 | 95 | Copies of pathology reports direct to general practitioner (to enable the patient to be informed) | 7 | 9 | 27 | 64 |
Results delivered as fast as possible (e.g. via general practitioner) | 9 | 3 | 12 | 85 | Results delivered by appropriate specialist (i.e. the specialist who ordered the test) | 7 | 5 | 42 | 53 |
Information on specialist treatment for general practitioners | 8 | 2 | 15 | 83 | Patient-held records | 6 | 9 | 54 | 37 |
Team working | |||||||||
Effective multidisciplinary team working in secondary care | 9 | 0 | 2 | 98 | Early involvement in cancer care by district nurses or practice nurses (e.g. taking blood, dressing wounds) | 7 | 2 | 20 | 78 |
Effective multidisciplinary team working in primary care | 9 | 0 | 3 | 97 | General Practitioners involvement throughout specialist phase of care (e.g. delivering results, routine monitoring, side effects) | 7 | 2 | 38 | 60 |
Good training and support for local oncology team | 9 | 0 | 7 | 93 | |||||
Good training and support for general practitioners and community nurses | 8 | 0 | 13 | 87 | |||||
Care (including follow-up) devolved to appropriately trained staff | 8 | 0 | 18 | 82 | |||||
Patient factors | |||||||||
Comprehensive information for patients/relatives | 9 | 2 | 2 | 96 | Patient choice on balance between local-and centre-based delivery of care | 7 | 11 | 23 | 66 |
Good transport to specialist centres | 9 | 3 | 2 | 95 | |||||
Good accommodation for patients/relatives at specialist cancer centres (for patients travelling long distances) | 8 | 2 | 3 | 95 | |||||
Flexible appointment times at specialist cancer centres (for patients travelling long distances) | 8 | 2 | 6 | 92 | |||||
Good facilities at local hospitals (for chemotherapy, outpatients, relatives' room) | 8 | 5 | 8 | 87 | |||||
