• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Patient Experience with Diagnostic Assessment Program

Measure Desired Direction As of this Report
Patient experience with the DAPs  Black Arrow Up  Yellow Arrow Level
See Methodology and Approach to find out how the ratings are calculated.

Key findings

Diagnostic Assessment Programs (DAPs) exist across Ontario and were established to help coordinate consultations and investigations during the diagnostic phase of the cancer journey. They support patients through various aspects of diagnostic assessment and initial treatment planning, where required. Of those surveyed, most people (78%) who attended a DAP rated their overall care received during the diagnostic process as “excellent.”

What are DAPs?

  • To help improve the experience in the diagnostic phase of the cancer journey for both patients and healthcare providers—and to improve the efficiency and effectiveness of the overall healthcare system—Cancer Care Ontario has developed and supported the implementation of DAPs across the province for individuals suspected of having colorectal, lung/thoracic or prostate cancer. More programs for streamlined diagnostic assessment also have been introduced for other cancer types, based on regional needs.
  • The percentage of patients diagnosed with cancer who received their diagnosis through a DAP (based on 2015 projected total incidence) varies by type of cancer. In 2015, 49% of lung cancer patients, 13% of colorectal cancer patients and 9% of prostate cancer patients received their diagnosis through a DAP.
  • DAPs may be physical or virtual programs, and they are characterized by facilitated access to coordinated diagnostic services, multidisciplinary consultation, patient information resources, symptom management and psychosocial supports1.
  • Patient navigators play a key role in DAPs, working as patient liaisons to help navigate appointments and providing psychosocial support and symptom management. Patient navigators are specially trained in healthcare navigation including navigating through the cancer care continuum, and they work with all members of the healthcare team to identify and implement quality improvement initiatives that enhance the care and services provided to patients2.

DAPs in other jurisdictions

  • A systematic review of the literature identified several jurisdictions within and outside of Canada with programs similar to DAPs. Alberta, British Columbia and Nova Scotia were the other provinces where diagnostic programs were identified3.
  • The Canadian Partnership Against Cancer offers descriptions of several models of diagnostic assessment and patient navigation through Cancer View, its online repository of cancer-related resources across Canada.
  • Many DAPs in other jurisdictions provide one-stop and same-day diagnostic services. Some of these include DAPs in Australia, New Zealand and the United Kingdom3.

What is the DAP Patient Experience Survey?

  • The DAP Patient Experience Survey measures the impact of the program from the viewpoint of patients.
  • The survey is provided to patients who have received care through the DAP program, and it collects information on patient perception of their care during the diagnostic process based on 4 pillars: information and communication, emotional support, patient navigation, and overall rating.
  • From January to December 2015, the survey was completed by more than 1,800 people across the regional DAP sites. The number of respondents varied between the regions and disease sites that are shown. The response rate across all DAPs was 17%; therefore, results should be interpreted with caution.
  • The DAP Patient Experience Survey is a fundamental component in the evaluation of the DAP program; the results are used by Cancer Care Ontario as it works with local sites to improve the DAP program.

The figure below illustrates the 39 regional DAP locations within each region across Ontario

click to close graph
Close Graph

What do the results show?

There are now DAPs across all 14 LHINs in Ontario (Figure 1).

  • There are 39 DAPs in Ontario in 2015 (compared to 30 in 2012).
  • The number of patients referred to thoracic/lung and prostate DAPs from 2014 to 2015 increased by 8% and 18%, respectively. There was an 8% decrease in patient referrals to colorectal DAPs over the same time period.

More information is available on the Breast Screening and Assessment  page.

Overall, patients felt positively about the care they received during the diagnostic process (Figure 2).

  • Across all disease sites (colorectal, prostate and thoracic/lung), 95% of patients rated their care during the diagnostic process as “Excellent” (76%) or “Good” (19%).

Patients feel that primary care is kept aware of their journey through the diagnostic process (Figure 3).

  • Ninety percent (90%) of patients surveyed who visited their family doctor during the diagnostic process said that they “strongly agreed” or “somewhat agreed” that their family doctor was informed of their progress through the diagnostic process.

Patients feel informed and supported during the diagnostic assessment process (Figures 4 and 5).

  • From 2014 to 2015, patients continued to feel informed and supported by their healthcare team during the diagnostic assessment process.
  • Nearly all the patients surveyed (96%) responded that they felt comfortable talking about their worries and/or concerns with their healthcare team during the diagnostic process.
  • Similarly, nearly all patients surveyed (95%) agreed that the patient navigator helped them understand the tests they were going to have.

Why is this important to patient care?

  • Integrated and or­ganized diagnostic assessment services can result in better patient experiences, improved patient outcomes and reduced wait times. These services are managed by multidisciplinary teams with operational links to other specialty services3.
  • Emotional support is crucial to the overall patient experience and the quality of life for those undergoing testing for cancer. The uncertainty and fear associated with cancer suspicion often results in patient distress and anxiety, but navigational support can help patients cope with the emotional issues associated with testing for cancer2.

Find out more

View Notes

  1. Brouwers M, Oliver TK, Crawford J, Ellison P, Evans WK, Gagliardi A, et al. Cancer diagnostic assessment programs: standard for the organization of care in Ontario. Curr Oncol. 2009; 16(6):29–41.
  2. Cancer Care Ontario. Current state of diagnostic assessment programs: ESRS phase II report. Toronto: Cancer Care Ontario; 2013.