Quality of care
Quality of care reasearch is in general about the question whether healthcare, either for individual patients or the population as a whole, contributes to the improvement of health outcomes, and whether it meets the latest medical knowledge and insights. Six domains have been defined by the Institute of Medicine (IOM) to evaluate the care provided, including safety, effectiveness, patient-centeredness, timeliness, efficiency, and equality. A multidisciplinary aproach is needed to fullfill these criteria, thereby including all healthcare professionals, even experts located out of the hospital, in providing the best possible healthcare.
Diagnostics
A correct and timely diagnosis is of utmost importance for patients. The next step in the treatment pathway, and the decision between treatment modalities, is largely based on the diagnosis, in which the specific disease characteristics and localisation of cancer are mapped as precisely as possible. These next steps are determined in deliberation with the patient. This can result as well in a decision that does not entirely fit leading guidelines, or in the decision not to treat at all.
Indications for the optimalisation of the diagnostic process can be found through research focussed on cancer diagnosis. For instance, delays in diagnosis can occur when symptoms are aspecific and therefore not linked to a cancer diagnosis. As patients generally appreciate a short lead time between diagnosis and treatment, care pathways can be evaluated to improve care. Furthermore, research can focus on the effect of a fast diagnosis on patient prognoses. Research can as well contribute to the implementation of new diagnostic techniques or the application of these techniques in population screening for oncology.
Decision-making
In oncology, decision-making is usually supported by multidisciplinary meetings, that can include surgeons, oncologists, radiotherapists, and other phycisians. These meetings result in treatment plans consisting of several treatment options, that can be discussed with the patient. During these meetings, physicians can employ several supporting tools, including guidelines, digital decision-trees, and/or prediction models. Patient preferences, explored by several available decision-making tools, can be included in the doctor-patient consultations as well.
Treatment
Cancer treatment is diverse and in general a combination of several treatment modalities that are applied sequentially or simultaneously, including surgery, chemotherapy, radiotherapy, endocrine therapy, targeted therapy, etc. The primary goal in treating localised disease is eliminating the tumour, while in patients with extended disease, the priority lies in slowing down the disease and promoting the patients quality of life.
Variation between hospitals in treatment supply can occur because of several reasons. First, some (complex) treatment modalities are only offered by specialised centers, that house sufficient expertise and services. IKNL researchers continuously evaluate quality of care and treatment outcomes in their scientific studies. Reports and meetings are yielded to feed back research conclusions and recommendations to physicians in all Dutch hospitals
Prognostics
At IKNL, cancer prognosis, or the future prespective of patients, is an important theme of research. It includes evaluation of variation in disease-free and overall survival, quality of life, and possible (late) effects of cancer or cancer treatment. By comparing different treatment outcomes, we can enable physicians in improving patient information provision about optimal treatment or follow-up care. This helps in shared-decision making between patients and physicians.