The development of Team ACCESS represents a unique approach to cancer research, and specifically to CRC research. Prior to Team ACCESS, a formal research collaboration of this magnitude had not existed in NS, limiting the quality and breadth of CRC research conducted in the province. In addition, collaborations and partnerships have been established with local, provincial, and national cancer groups/organizations that further improve our research capacity by providing opportunities for dialogue on CRC and ongoing feedback, and thus contributing to our understanding of the issues that affect the cancer care system and the patients who use it.
Overall, Team ACCESS has made substantial contributions to CRC research. The first notable contribution being the development of research capacity in NS by assembling an interdisciplinary team, mentoring clinicians (with limited research experience), and training graduate students (MSc, PhD, and post-doctoral fellows) in cancer health services research. Second, by staging all CRC cases diagnosed in NS between 2001 and 2005, population-level stage data are available for a 5-year time period. Since treatment for CRC depends upon the stage at diagnosis , such data are vital to examining quality of care issues in CRC. Third, the creation of the Team ACCESS database linkage permits a thorough assessment of health system utilization in relation to CRC across the entire continuum of cancer care.
In addition to conducting research, Team ACCESS is focused on effecting change in the health care system through knowledge translation (KT) activities and collaborations with leaders in cancer research and cancer services. Specifically, we have taken an integrated KT approach by involving decision-makers in the development, conduct, and interpretation phases of research. We anticipate this approach will advance CRC care in the province in two ways: 1) by helping decision-makers facilitate changes in CRC programs and services based on the research findings; and 2) by helping researchers align their research questions and studies with issues relevant to the local decision-making communities.
These contributions illustrate how a team approach is essential to improving colorectal cancer services in NS. Our assessment of inequity in the colorectal cancer care system further exemplifies the importance of a team approach. Adopting a needs-based approach to inequity analysis, and moving beyond studying variations in care to understanding whether the variations are based on patients' needs or some non-need factors (e.g., sex, socio-economic status), has required expertise from a diverse team - specifically, researchers and analysts to facilitate database linkage, experts in inequity analysis and the specific analytic techniques (e.g., horizontal inequity index), oncologists with specific clinical knowledge (e.g., related to curative and palliative therapies) to help define need versus non-need variables and then appropriately interpret the findings, and individuals with knowledge translation experience to help translate the findings and their implications to the clinical and decision-making communities.
Our study of inequity moved beyond studying variations in care, to examining whether these variations in care are based on patients' needs or some non-need factors (e.g., sex, socio-economic status). This needs-based approach to inequity analysis has required expertise from a diverse team- researchers and analysts to facilitate database linkage, experts in inequity analysis and the specific analytic techniques (e.g., horizontal inequity index), oncologists with specific clinical knowledge (e.g., related to curative and palliative therapies) to help define need versus non-need variables and then appropriately interpret the findings, and individuals with knowledge translation experience to help translate the findings and their implications to the clinical and decision-making communities.
Our research has identified several limitations in data availability and capture in our province. Specifically, direct access to laboratory data was not available and chemotherapy data were incomplete. Regarding the latter, chemotherapy can be administered on an outpatient basis, often by nurses [8, 24], without an associated physician billing. We have performed a chart review to obtain complete chemotherapy data. Moreover, several of the databases are not population-based (i.e., CHRD, PCP, and PharmaCare), but rather are limited to certain jurisdictions or patient populations (e.g., those 65 years of age and older), limiting our capacity to report upon diagnostic imaging, palliative care, and medication use for the entire province.
Team ACCESS developed out of a recognized need to study and improve access to quality CRC services in NS. The significance of this team is underscored by the involvement of many key decision/policy-makers, clinical leaders, and senior researchers from other disciplines (e.g., epidemiology, database analysis, equity analysis) to work on this topic. We anticipate that the skills, tools, and knowledge generated from our work will also advance the study of other cancer disease sites in NS. Our approach may also be adapted to study other chronic conditions and understand issues regarding access to and quality of care, and their impact on outcomes, in these patient populations.