A review of cancer-specific significant event analyses: evidence for improving patient care

Abstract

The problem
Recent years have shown a rise in the use of Significant Event Analysis (SEA) in cancer care; particularly relating to the events surrounding new cancer diagnoses. Cancer-specific SEA is quoted by multiple studies as a recommendation for improving early diagnosis and patient care pathways. The 2015-2020 national cancer strategy proposes that all General Practices should undertake annual SEAs of new cancer diagnoses. In 2016, the Royal College of General Practitioners (RCGP) launched a cancer SEA toolkit. Despite these developments, the role of SEA for improving and sustaining cancer outcomes remains a subject of debate. This review aims to consolidate existing knowledge on the use of SEA in cancer care.
The approach
Four electronic databases were searched for articles pertaining to significant events in cancer care from January 1990 to July 2019. Relevant studies were also identified through reference lists; citation tracking and a conference index search. Studies have been appraised according to three characteristics: nature of the significant event; methodology applied for exploring the significant event; and evidence of improved patient care. The review is currently ongoing and the completed results will be presented at the meeting.
Findings
Following the removal of duplicates, 1027 records were identified and systematically screened. Preliminary findings suggest the included studies to be clinically and methodologically diverse. Studies most frequently adopted a qualitative design; including thematic analysis of SEA documents and semi-structured interviews with patients and stakeholders. Several large multi-site studies provide descriptive insights into the events surrounding new cancer diagnoses, emergency admissions and referral processes. Selected patient and educational outcomes have also been reported by individual studies based on SEA as an intervention. These include an increase in suspected cancer referrals; improved team-work and self-reported changes in referral practices.
Implications
Learning from significant events in cancer care is a feasible and acceptable method for quality improvement among patients, health professionals and stakeholders. SEA encourages individual practices to successfully implement action plans. Findings from multi-site SEA provide insights into positive and negative aspects of patient care pathways; providing opportunities for collective learning and re-design of local/national cancer protocols. The majority of studies did not demonstrate evidence that SEA alone had resulted in improved patient care or cancer outcomes. Further research is required into the factors affecting system-level change following cancer-specific SEA and the impact on wider indicators for quality of care.