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IntroductionTo address the challenges and leverage opportunities in obtaining a swift, accurate, and appropriately communicated cancer diagnosis, All.Can Canada embarked on a comprehensive assessment of how well Canada is doing in optimizing entry into cancer care. The purpose was to understand the current state of cancer diagnosis in Canada, including identifying outcomes that matter most to cancer patients, nominated practices in cancer diagnosis to adapt, spread, and scale, and areas of inefficiency that represent opportunities for improvement towards identified outcomes, in order to identify priority areas and concrete actions to inform the work of policymakers and other stakeholders. Aims Objectives Theory or MethodsFrom June 2020 to March 2021, a consultant with oversight by All.Can Canada’s patient-led, multi-stakeholder Steering Committee conducted research. First was a literature review identifying current Canadian practices which aim to reduce diagnosis inefficiencies; summarize what is known about the impacts of the determinants of health on diagnosis; and identify currently used metrics. Qualitative interviews with cancer survivors across Canada investigated diagnosis from their perspectives, including what matters most as they traverse the diagnosis process. A survey of providers across Canada investigated what they perceive to be inefficiencies in diagnosis and factors essential for a quality diagnosis process. Highlights or Results or Key FindingsIrrespective of cancer type, disease stage, or determinants of health, patients described the diagnosis process as taking place in three phases:Early – when people first try to interact with a provider over a suspicion of cancer until the first referral;Middle – when people undergo diagnostic testing to investigate; andFinal – when people arrive at a dedicated cancer facility until they receive their diagnosis.Across all phases, seven outcomes were identified as being critical to the quality of the diagnosis experience:- Swiftness of the process;- Concerns validated by primary care providers;- Excellent patient-provider communication;- Effective provider-provider communication;- Better information;- Integrated psychosocial support; and- Integrated care.Attainment of these outcomes resulted in a more satisfactory diagnosis experience, while failing to attain any of these outcomes had a negative, and oftentimes detrimental, impact.The research resulted in the start of a quality framework for Canadian cancer diagnosis.ConclusionsFindings demonstrate cancer diagnoses’ fragmented current state and integrated future state. Workforce capabilities, multi-sectoral collaboration, aligned payments and accountability, a national quality framework, and increased care coordination are required. Digital solutions are vital for rural residents and during pandemics. Anti-fragility means transforming cancer diagnosis systems to absorb shock and improve. Implications for applicability/transferability sustainability and limitations Findings are not necessarily generalizable to newcomers, racialized people, residents of the Territories, and Indigenous populations. Sample sizes preclude conclusions about jurisdictional disparities. Provider survey results are not necessarily representative of all provider groups across Canada. Provider responses to questions about inefficiencies could have been influenced by the COVID-19 pandemic.

Previous studies have documented the high patient and caregiver burden associated with atopic dermatitis (AD). Less is known about the factors-especially those related to treatment options and the delivery of medical care-that may relate to burden and unmet needs among patients and their caregivers.Our primary aim was to characterize and compare health-related quality of life, long-term control of symptoms, satisfaction with treatments, the financial burden, and the prevalence of patient-centered care among adult and pediatric patients with AD in 8 developed nations.We developed a 53-item anonymous online survey for adult patients and caregivers of children with AD (N = 3171; self-reported disease severity: 8.2% clear, 33.2% mild, 41.1% moderate, 17.6% severe). The survey included questions across 7 domains selected by a steering committee of 11 patient organizations that advocate for patients with AD in the 8 countries. We used validated instruments when available including the 5-level EuroQol five-dimensional questionnaire and the Atopic Dermatitis Control Tool. The survey was offered in 5 languages and promoted through social media and other communication channels of the patient organizations.The health-related quality-of-life scores for adult patients with AD (driven by 2 domains: pain/discomfort and anxiety/depression) were worse than those reported for asthma and type 2 diabetes in previous studies (0.72; 95% CI, 0.65-0.78). Patients and caregivers reported substantial financial impacts even in countries with government-funded health care systems, though the greatest impact was in the United States. In all countries, adults reported better control of symptoms than children, but neither group nor any nationality reported adequate control on average (rescaled mean, 57.5; 95% CI, 56.1-58.9), and control correlated negatively with disease severity. Similarly, satisfaction with treatments, which was moderate across countries on average, was much lower for respondents with more severe disease symptoms (F(3,3165) = 5.5; P.001). Patients who saw a specialist (a dermatologist or an allergist) instead of a general practitioner for AD care indicated better long-term control of symptoms (by 4 points on average on the 100-point scale; 95% CI, 2.6-5.4; P.001). Finally, self-management training and shared decision making were uncommonly reported by patients in all countries except by respondents from the United States, but both were associated with better long-term control of symptoms and higher satisfaction.The burden of AD, evaluated as health-related quality-of-life detriments, financial impacts, and uncontrolled symptoms, is significant and highest for patients with more severe atopic dermatitis who report greater challenges in achieving symptom resolution with existing treatments and approaches to care. The better outcomes associated with respondents who saw specialists suggest that patients, especially those with more severe AD, might benefit from medical care that is guided by providers with more in-depth knowledge of this complex condition. Finally, wider use of patient-centered care practices (specifically, self-management training and shared decision making) could improve outcomes and boost satisfaction with treatments for AD, though more research on this topic is warranted.

Healthcare reforms that do not address outcomes of importance to patients may not be poised to successfully deliver the ultimate objectives of improved outcomes and quality of life for patients. Value-based healthcare is a distinct approach to aligning diverse health-system stakeholders, including healthcare professionals, health system administrators and the pharmaceutical and medical devices industries, on delivering outcomes that matter to patients at the same or lower cost. This article examines existing pan-Canadian infrastructure, including quality improvement and data initiatives, to demonstrate a path forward for this international healthcare transformation movement in Canada.