Implementation of integrated care for patients with cancer: a systematic review of interventions and effects.

Abstract

PURPOSE: To review integrated care interventions and their effects on the quality of care for patients with cancer. DATA SOURCES: Search in Medline and Cochrane Library databases from January 1996 to October 2006. STUDY SELECTION: Randomized controlled trials and controlled before-after studies in which the intervention focused on at least one of the three principles of integrated care: patient-centredness, organization of care and multidisciplinary care. DATA EXTRACTION AND RESULTS: Of the 1397 references, 33 studies were included and analysed. No study focused on all three principles of integrated care: 16 studies focused on patient-centredness (48%), 14 on the organization of care (42%), 1 on multidisciplinary care and 2 on both patient-centredness and organization of care. There was a large variation in interventions reported and in outcomes used for evaluation. Effective interventions to improve patient-centredness are the 'provision of an audiotape of the consultation to the patient', 'provision of information to patients' and 'use of a decision aid'. Effective interventions to improve the organization of care can be 'follow-up' and 'case management', especially by nurses and 'one-stop clinics'. CONCLUSION: To improve integrated care for patients with cancer, a multicomponent intervention programme is required focusing on patients, professionals and the organization of care. The promising interventions found in this review should be part of this programme. This programme should be evaluated using rigorous methods and unequivocal outcome measures linked to the intervention.