Understanding the link between health systems and cancer survival: A novel methodological approach using a system-level conceptual model

Objectives: Cancer outcomes are determined by a range of health system-, service delivery- and patient-related factors, although their contribution and relative importance will vary across populations and systems, an issue that is not well understood. This study aims to develop and demonstrate potential uses of a conceptual (‘logic’) model that visualises the pathways across the entire patient journey through cancer care services, identifying key factors that might be amenable to system-level interventions to enhance cancer outcomes. Methods: A rapid review of the literature on the relationships between broad health system factors and cancer survival in high-income countries was supplemented with data from a stakeholder survey (n = 128) exploring perceptions of how system factors might impact outcomes. Collating this information, we developed a detailed conceptual model depicting causal pathways along which survival might be influenced at different stages of the patient journey, further informed by input from clinicians and researchers regarding its possible uses and development. Results: The model illustrates where aspects of the health system are likely to impact directly or indirectly along the cancer patient pathway. It depicts the complex interactions between structures, information systems, health professionals, processes and outputs: acting in often non-linear and cyclical ways that influence outcomes. Potential ‘breakpoints’ along the journey are highlighted, where, without effective co-ordination, patients risk falling through the cracks with adverse impacts on outcomes. Conclusions: The model provides a novel way to extend existing descriptions of cancer survival variation, and to convene stakeholders to identify key points where health services could be adapted to improve outcomes.