The role of organisational and resource factors in determining lung cancer outcomes

Adizie, Jana B (2020). The role of organisational and resource factors in determining lung cancer outcomes. University of Birmingham. M.D.

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Abstract

Lung cancer outcomes in the UK show significant variation which are not entirely explained by case mix. Differences in access to lung cancer services contribute. However, the specific factors that underlie the relationship between service organisation and disease outcomes are not known.

The systematic review highlights that co-ordinated access to specialist care is likely to be an important determinant of patient outcomes. In addition, a bundle of service factors, rather than an individual factor is a more robust proxy for hospital infrastructure quality. This hypothesis is explored through the creation of a novel organisational score. When adjusted for patient factors a higher score is associated with higher curative intent treatment rates, increased likelihood of patients receiving treatment within 62 days and improved one-year survival.

To achieve these improved outcomes national variation in the provision of services and workforce as well as gaps in the optimal care of stage III patients in England need to be addressed. As well as aligning units with national commissioning guidance, qualitative work into decision making suggests that clinician preconceptions and nihilistic attitudes also require consideration.

This work shows that inequity in access to essential services exists in the UK and this has a direct impact on patients.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):