Cancer patient pathways in Denmark as a joint effort between bureaucrats, health professionals and politicians—A national Danish project
Introduction
Often bureaucrats, health professionals and politicians look upon the health sector in different ways and work independently of each other. In Denmark, as indeed internationally, patient pathways are frequently developed solely by health professionals and the consequence may be major difficulties in implementing the pathways on a national scale because of lack of agreement and resources. In this article we describe how national Danish Cancer Patient Pathways (CPPs) were developed and the impact it has had on the health system.
Denmark has a higher incidence of cancer and poorer cancer survival rates than many other European countries [1], [2], [3]. In 2006 and 2007 several case stories of cancer patients experiencing delayed diagnosis or delayed treatment with fatal consequences were published. A national survey investigating cancer patients perceived experiences [4] showed that every fifth patient experienced waiting times at the hospital and, based on patients’ comments, waiting time was considered to be a very important issue.
In August 2007, the Danish Prime Minister announced that cancer should be treated as an acute condition and a subsequent political agreement [5] between the government and the responsible health regions required national CPPs for all cancer types to be ready by the end of 2008. The National Board of Health (NBH) was given the task to facilitate the process of developing the national CPPs.
Section snippets
The Danish health care system
Denmark is a developed industrialised Nordic country with a population of approximately 5.6 million. The health system is publicly financed. The national level is responsible for the overall policy, the legal and economic framework for health care and for coordinating and supervising. Five health regions are responsible for both primary and secondary health services and for implementation of national initiatives such as CPPs [6].
The first National Danish Cancer Plan [7] was published in 2000.
The development and implementation of Cancer Patient Pathways
In 2007 convincing scientific evidence on the negative impact of waiting time for patients with head and neck cancer [9] was presented to Danish decision makers including politicians at a national conference arranged by the DMCGs and the Danish Cancer Society. Furthermore, it was shown that system delay accounted for a substantial part of the total delay [10]. Danish health professionals were increasingly worried that waiting lists were partly responsible for the poor survival rates.
In Denmark
What was the outcome and why did we succeed?
The ultimate aim of CPPs is to increase the Danish cancer survival rates and decreasing system delay is of importance in achieving this goal. However other equally important goals were to improve the health status of the cancer patients and increase client satisfaction by ensuring treatment as fast as possible, ensure continuity of care and reduce patient distress caused by unproductive and unexplained waiting times.
In a discussion paper published in 2009 in the British Journal of Cancer [13]
Provenance
OA, ZH and HP have all participated in the development of Danish Cancer Patient Pathways as employees in the National Board of Health (NBH). OA and HP have been responsible for the process of developing and formulating cancer pathways and ZH has been responsible for the monitoring system.
OA is Consultant, Senior Medical Officer, MD, DMSc., MHM and is specialist in Paediatrics and has been Head of a Paediatric Department for 10 years. He is at present responsible for the cancer field in the
Conflict of interest
All authors have declared no conflict of interest.
Acknowledgements
We thank Professor Liselotte Højgaard, MD, DMsc., for inspiring discussions during the preparation of the manuscript.
References (19)
- et al.
Tumor progression in waiting time for radiotherapy in head and neck cancer
Radiotherapy and Oncology
(2007) - et al.
European Journal of Cancer
(2009) - et al.
European Journal of Cancer
(2008) - et al.
Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer benchmarking Partnership): an analysis of population-based cancer registry statistics
Lancet
(2011) - National Survey of Danish Cancer Patients perceived experiences. A questionnaire of 19455 patients. Developed by Enhed...
- Danish Regions [Danske Regioner]. Aftale om gennemførelse af målsætningen om akut handling og klar besked til...
- Health Act [Sundhedsloven]. https://www.retsinformation.dk/Forms/R0710.aspx?id=130455;...
- The Danish National Board of Health [Sundhedsstyrelsen]. The National Cancer Plan. Copenhagen: Sundhedsstyrelsen....
- The Danish National Board of Health [Sundhedsstyrelsen]. The National Cancer Plan II. Copenhagen: Sundhedsstyrelsen....
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