BACKGROUND Diagnosis and surgical treatment decision making for thoracic cancers is complex. Moreover, there is demonstrated variability in how each province in Canada delivers cancer care, resulting in disparities in patient outcomes. Recently, the Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based standards for the care of thoracic surgery cancer patients. This study was undertaken to assess the degree to which these standards were currently met in practice and to further understand the determinants to their implementation nationally. METHODS This study was undertaken in two parts: (1) a national survey of thoracic surgeons to assess the perceived extent of implementation of these standards in their institution and province; and (2) formation of a focus group with a representative sample of thoracic surgeons across Canada in a qualitative study to understand the determinants of successful standards implementation. RESULTS 37 surgeons (33% response rate) participated in the survey; 78% were from academic hospitals. The top categories of standards that were under-implemented included (a) quality assurance processes, data collection and clinician audit and feedback, and (b) ongoing regional planning and workload assessments for thoracic surgeons, and (c) pathology turnaround time target of two weeks and the use of a standardized synoptic pathology report format. Enablers, barriers, and opportunities for standards implementation contextualized the discussion within the focus group. CONCLUSION Study results demonstrated variation in the implementation of surgery standards across Canada and identified the determinants to the delivery of high quality surgical care. Future work will need to include the promotion and development of quality improvement strategies and effective resource allocation that is aligned with the implementation of thoracic cancer surgery standards in order to improve patient outcomes.

中文翻译：

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国家胸外科标准实施：障碍、推动因素和机遇

背景 胸癌的诊断和手术治疗决策是复杂的。此外，加拿大各省提供癌症护理的方式存在差异，导致患者结果存在差异。最近，加拿大抗癌合作组织 (CPAC) 发布了泛加拿大基于证据的胸外科癌症患者护理标准。进行这项研究是为了评估目前在实践中满足这些标准的程度，并进一步了解在全国范围内实施这些标准的决定因素。方法 本研究分两部分进行：(1) 全国胸外科医生调查，以评估其所在机构和省份实施这些标准的感知程度；(2) 在定性研究中与加拿大各地胸外科医生的代表性样本组成焦点小组，以了解成功实施标准的决定因素。结果 37 名外科医生（33% 的回应率）参与了调查；78% 来自学术医院。未得到充分实施的最高标准类别包括 (a) 质量保证流程、数据收集和临床医生审核和反馈，以及 (b) 正在进行的胸外科医生区域规划和工作量评估，以及 (c) 病理学周转时间目标为 2周和使用标准化的病理学报告格式。标准实施的促成因素、障碍和机会使焦点小组内的讨论成为背景。结论 研究结果表明加拿大各地手术标准的实施存在差异，并确定了提供高质量手术护理的决定因素。未来的工作将需要包括促进和制定与胸癌手术标准的实施相一致的质量改进策略和有效的资源分配，以改善患者的预后。