Table 2

Barriers to high-quality cancer care

Expert interviewsFocus groupsSite visitsCross-cutting themes
Timeliness of carePatient passivity and unclear accountability contribute to delays in careDelays in care during diagnostic period are especially distressingUnclear accountability contributes to delays during early cancer carePatient passivity and unclear accountability contribute to distressing delays in care
Coordination of careLack of coordination of care before and after treatmentBurden of coordinating care often falls on patients and familiesNo clear provider coordinating care before arrival at oncologyInadequate care coordination contributes to patient distress and delays
AccountabilityUnclear accountability for guiding carePrimary care providers feel unequipped to manage modern cancer careAccountability for guiding care unclear before and after therapyAccountability for guiding care unclear before and after therapy
Information needsLack of useful information contributes to passivity and problems in decision makingPatients overwhelmed by amount, complexity and conflicts in informationOrganisations varied widely in emphasis and resources devoted to educating patientsPatients and families not receiving useful information
Psychosocial supportHigh patient distress contributes to passivityInadequate emotional supportNonsystematic assessment of or attention to psychosocial issuesInadequate psychosocial assessment and systematic support
EquitabilityRacial, ethnic, socio-economic and geographic disparities in accessLack of health insurance a major barrier to receiving good cancer careLow income, uninsured patients face difficulties accessing critical servicesRacial, ethnic, socio-economic and geographic disparities in access to quality cancer care
Rural patients face major transportation barriers.
ReimbursementReimbursement doesn't reward services that provide information or supportUnaffordable out of pocket costs for patients complicating decision makingReimbursement discourages patient-centred careReimbursement is an impediment to meeting patient needs
Information technologyLimited use of IT in oncology practices a barrier to high-quality careWeb-based information confusing and untrustworthyLimited use of IT in oncology practiceIT playing little role in helping patients or practitioners