Continuity of care for adult patients with cancer in hospital settings: A scoping review protocol

Objective: To identify and map evaluated interventions on continuity of care for adult patients with cancer in hospital settings. Introduction: The care pathway for patients with cancer involves multiple healthcare encounters with healthcare professionals in several hospital settings. A care pathway in hospital settings calls for attention on how to attain continuity of care. Continuity of care is associated with a decline in healthcare utilization, improvements in aspects of quality of life and lower need for supportive care. Considering the importance of continuity of care for patients with cancer in hospital settings, there is a need for an overview of interventions on continuity of care for patients with cancer in hospital settings. Inclusion criteria: This scoping review will consider research studies that evaluate interventions examining continuity of care in outpatient and inpatient hospital settings and includes adult patients (≥ 18 years) with cancer. Interventions initiated by hospital before, during and preceding after hospitalization or at outpatient visit will be included. Research studies that evaluate interventions on continuity of care qualitatively or quantitatively and explicitly include continuity of care in the objective or results of the study will be included. Methods: The scoping review will be conducted in accordance with the methodology developed by the JBI and will search the following databases: PubMed, CINAHL, Embase and Cochrane Library. Keywords: Cancer; Continuity of Care; Hospitals; Interventions Introduction The number of people surviving cancer is increasing due to advances in diagnostics and treatment (1–3). As a consequence of growing medical knowledge, the care pathway for patients with cancer is increasingly complex because it involves multiple healthcare encounters in hospital settings (4,5). Patients often receive treatment and care by various healthcare professionals, such as specialist surgeons, radiographers, radiologists and cancer care nurses, who are located in different departments and units within hospital settings (2,3,6). A care pathway in and across several departments involving a variety of contacts with multiple healthcare professionals requires knowledge on how to attain continuity of care for patients with cancer in hospital settings. Continuity of care can be challenging to define, and existing definitions overlap with related concepts and terms (7,8). However, the theoretical framework of Haggerty et al. (5) has previously been found useful to explore continuity of care among patients with cancer (3,6,9,10). Therefore, this scoping review adheres to the definition provided by Haggerty et al. (5), in which continuity of care is understood as the extent to which a series of health services are experienced by the patient as connected, coherent and consistent with the patient’s medical needs and personal circumstances (5). The definition describes continuity of care as a multidimensional construct and outlines that three types of continuity exist in all healthcare settings: informational, management and relational continuity (5). Informational continuity is the use and transmission of information between healthcare professionals and events concerning both medical issues and the patient’s preferences, values and context. Management continuity is how the healthcare system coordinates and relates to consistent, coherent management of the health condition as it concerns the delivery of services in a complementary, timely and appropriate manner. Relational continuity describes the ongoing relationship between patient and healthcare professionals and is characterized by the development of trust and predictability (5,11). A systematic review shows that continuity of care is associated with improved patient satisfaction and a decline in hospitalization and emergency visits (12). Furthermore, interventions addressing continuity of care among adults with chronic diseases can significantly improve different aspects of quality of life, including physical function, general health and social function (13). In patients with cancer, continuity of care has been shown to reduce the need for supportive care (2), whereas lack of continuity of care is associated with medical errors medication continuity error, test follow up errors and work-up errors (14). One of the main challenges in cancer care is the lack of continuity in the services needed by patients throughout their trajectory of care (5,10,15). Provision of continuity of care can be impeded by a number of factors, such as challenges in transfer of information, quality of interpersonal relationships and coordination of care (10). Surveillance, teamwork, communication and documentation are of great importance for patients’ experiences of continuity of care (16). Although the importance of continuity of care in cancer care has been acknowledged in previous literature (3,6,15,17). It has also been recognized as difficult to achieve due to fragmentation in care, discontinuity or gaps in care and treatment, and care being provided by different professionals in different settings (11,18). By nature, cancer care is fragmented and characterized by diverse clinical features, treatment phases and outcomes (3). Therefore, there is a need to address how to support continuity of care in patients with cancer by identifying and mapping interventions to improve continuity of care. Studies show that patients with cancer have multiple needs (2,6). Different strategies and interventions have been tested to improve continuity of care in terms of reducing care needs, improving communication, empowerment and patients’ experiences with care for patients with cancer within hospital settings (19–22). The interventions include telephone consultations and teleconsultations (23,24), use of assessment tools (20,25) and the use of patient navigators and pivot-nurses in provider-centered interventions (21,22). The diverse interventions address different types and dimensions of continuity of care (5). Telephone consultations and teleconsultations primarily focus on improving management continuity, provider-centered interventions focus on improving relational continuity, and assessment tool interventions address informational continuity. Thus, the interventions are heterogeneous and address different types of continuity of care for patients with cancer in hospital settings. Therefore, there is a need to provide an overview of the existing interventions and the type of continuity addressed to inspire the future development of interventions and improve continuity of care for patients with cancer in hospital settings. A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis was conducted in November, 2022, and no current or in-progress scoping reviews or systematic reviews on the topic were identified. Other reviews related to the topic either focus on continuity of care across settings (3,26), exclusively focus on one type of continuity of care (27), or are limited to the effects of one intervention type on continuity of care (15). The Cochrane review of Aubin et al. (28) is the most comprehensive and relevant systematic review. However, the objective of the review is to evaluate the effectiveness of interventions to improve continuity of cancer care in the follow-up period, focusing on the continuity of care after discharging back to primary physician. As such, previous systematic reviews on the continuity of care for patients with cancer have predominantly focused on improving continuity across sectors, mainly between primary care, hospital settings and healthcare providers (3,26). Less research attention has been given to providing an overview of evaluated interventions aimed at improving the continuity of cancer care in and across hospital settings. However, continuity of care within and across hospital settings is essential for patients and can be impeded by numerous factors. Therefore, the objective of this scoping review is to identify, and map evaluated interventions on continuity of care for adult patients with cancer in in- and outpatient hospital settings. Review questions Which interventions on continuity of care have been evaluated in adult patients with cancer in hospital settings? What are the characteristics of the identified interventions (e.g. type of continuity addressed (cf. Haggerty et al. (5), population, hospital setting, length of intervention, healthcare professionals involved)? How have interventions on continuity of care been measured and evaluated? Inclusion criteria Participants This study will consider research studies that include adult patients (≥ 18 years) with any type of cancer. Concept This scoping review will consider research studies that evaluate interventions examining the continuity of care for patients with cancer in hospital settings. Interventions refer to all initiatives, projects, programs, strategies, models, approaches, processes, structures etc.. Research studies that evaluate interventions on continuity of care qualitatively or quantitatively and explicitly include continuity of care in the objective or results of the study will be included. Context This scoping review will consider studies that focus on continuity of care interventions in inpatient and outpatient hospital settings. Interventions initiated by hospital before, during and preceding after hospitalization or at outpatient visit will be included. Research studies that evaluate interventions on continuity of care qualitatively or quantitatively and explicitly include continuity of care in the objective or results of the study will be included. Studies focusing on continuity of care in other health care settings than hospital will be excluded. Types of sources This scoping review will consider primary research studies examining continuity of care in evaluated interventions regardless of study design, which include but are not limited to qualitative, mixed-method, and quantitative study designs. As only evaluated interventions will be eligible, protocols, editorials, viewpoints, letters, and conference proceedings will be excluded. Reference lists of existing reviews that meet the inclusion criteria will be reviewed for eligible studies. Methods The scoping review will be conducted in accordance with the methodology developed by the JBI (29) and reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (30). Search strategy The search strategy will aim to locate published primary research studies. An initial search of PubMed (National Library of Medicine) and CINAHL (EBSCO) was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles and the index terms used to describe the articles were used to develop a full search strategy for PubMed (National Library of Medicine) (Appendix I: Search strategy), Cochrane Library (John Wiley and Sons), CINAHL (EBSCO), and Embase (Elsevier). Afterwards, a comprehensive full search strategy tailored to each information source will be developed and performed. Search terms and relevant synonyms related to the population, concept, and context of interest will be used to identify relevant articles using database-specific controlled vocabulary terms (e.g., MeSH in PubMed) combined with text words. The full search strategy will include combinations and variations of keywords relating to the participants, concept, and context of interest. Consequently, the keywords hospital, hospitalization, inpatient, and outpatient will be supplemented by keywords covering these alternative hospital settings. References in the studies selected for inclusion will be reviewed for eligible evidence sources. In addition, a cited reference search of the studies selected for inclusion will be conducted. Studies published in English, Danish, Swedish, or Norwegian will be included. The literature does not indicate a certain time when the literature on continuity of care for patients with cancer emerged; hence, no time limits will be applied to the search. Prior to finalizing the scoping review, the search will be rerun in all databases to identify new eligible studies. Source of evidence selection Following the search, all identified citations will be collated and uploaded into Mendeley - Reference Management Software (Elsevier, USA), and the duplicates will be removed. Afterwards, all citations will be uploaded to the Rayyan software to assist the screening process (31). The screening process will be conducted according to the JBI manual (2conceptconconoo9). To ensure consistency across the review team in the study selection process, the reviewers will perform a pilot test by reviewing the same random sample of 25 titles/abstracts using the eligibility criteria and discussing discrepancies and potential modifications of the eligibility criteria. The title/abstracts will be screened for eligibility by two independent reviewers. Disagreements between reviewers at the title/abstract screening will not be resolved, as any information source considered eligible by at least one of the reviewers will move forward to full-text screening. The full text of selected citations will be assessed in detail against the inclusion criteria by two independent reviewers. Reasons for exclusion of full-text papers that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at any stage of the selection process will be resolved through discussion or by a third reviewer. The results of the search will be reported in full in the final scoping review and presented in a PRISMA-ScR flow diagram (30). Data extraction Data will be extracted from papers included in the scoping review by two independent reviewers using a modified version of the JBI data extraction tool (29) (see Appendix II). The extracted data will include specific details about the population, concept, context, methods, and key findings relevant to the review question. The draft data extraction tool will be further modified and revised during the process of extracting data from each included paper. Modifications will be detailed in the full scoping review. Prior to the data extraction phase, the developed extraction form will be pilot tested by two reviewers on at least two included information sources to ensure the consistency and extraction of all relevant data. Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. Authors of the papers will be contacted to request missing or additional data when required. Data analysis and presentation The findings of the included sources will be extracted and descriptively mapped. The total number of interventions identified in diverse hospital settings will be presented as frequency counts. To provide a systematic overview of the existing literature, the following characteristics of each of the included studies will be presented in tables: study design; study setting and context; participant characteristics; intervention characteristics; evaluation method; measurement tools; and overall conclusions. Furthermore, for each intervention, we will identify which types of continuity of care are addressed by the intervention: informational, management, or relational continuity (5). A narrative description of the extracted data will be presented alongside the tables. References 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. 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