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Country/JA: Malta flag Malta
Action type: Program

Problem: Waiting time from general practitioner (GP) referral to the first consultation at hospital for patients presenting with highly suspicious signs and/or symptoms of cancer is lengthy and documented.

Objective: (1) To decrease referral waiting time to ideal timeframes, hence improving time to diagnosis, improving quality of life (reducing patients’ anxiety) and survival rates for the individual patients (potentially achieving earlier diagnosis); (2) To simplify booking systems and introduce prioritization processes for the identification of referrals that involve possibility of highly suspicious malignant disease.

Implementation status: Partially implemented

Key Contextual Factors

  • Programme is led by the Cancer Care Pathways Directorate (DCCP) within the Department for Health Services of the Ministry for Health.
  • DCCP is housed within the Sir Anthony Mamo Oncology Center and Mater Dei Hospital.
  • The related policy framework is the National Cancer Plan 2017-2021.

Key Components/Steps

  • Accessing health department strategic and stakeholder support and obtaining access to required funds.
  • Meetings with stakeholders to draft the business plan and map out the required IT pathway.
  • Development of the Fast-Tracking e-form that was designed to capture and include:
  • any already performed investigations and allow uploading of attachments (such as laboratory results and radiological images and reports);
  • a scoring tool for urgency;
  • any pre-referral professional advice given;
  • contact information for referring GP/physicians and involved patient.
  • Referring GPs are provided access to the system so they can follow and intervene (as necessary) the progress of the management of their cases.
  • A Fast-Track Coordinator has been recruited to manage the IT system and coordinate with GPs and other involved clinicians both at the primary and secondary health levels.
  • Piloting of the IT System (patient referrals with high suspicion of a colorectal cancer).
  • System launched to fast-track cancer referral for colorectal, lung, hematological, breast and prostate cancers.

The aim is to incrementally expand the referral system to include all other cancer sites/types

Main Impacts / Added Value

  • Provides quicker access to a hospital appointment, reduces patients’ anxiety from waiting too long for the first outpatient appointment, and may increase possibility of earlier diagnosis and initiation of relevant treatment.
  • Technical value: IT simplification of referral/booking pathway reduces steps that are not useful and introduces others that are more pertinent.
  • Societal value: increases social participation/connectedness through increased involvement and participation of GPs in the care of their patients (both at the start and also during the different phases of the cancer journey).

Lessons Learned

Success factors include:

  • Obtaining senior level officials’ support and buy-in from stakeholders.
  • Obtaining funds for the e-form design and testing.
  • Drafting the business plan and mapping the process and information that needs to be forwarded by the referrer, vetting professionals and other involved partners.
  • Frequent meetings with involved partners and meticulous testing is imperative to fine tune the system after prototype development.
  • Period of piloting with a few GPs before official launch and start of the scaling-up processes.
  • Meetings and on-line demonstration sessions with GPs are vital to gain buy-in for proper e-form use.

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References and Documentation