Association between time-to-treatment and outcomes in non-small cell lung cancer: a systematic review.

BACKGROUND: National targets for timely diagnosis and management of a potential cancer are driven in part by the perceived risk of disease progression during avoidable delays. However, it is unclear to what extent time-to-treatment impacts prognosis for patients with non-small cell lung cancer, with previous reviews reporting mixed or apparently paradoxical associations. This systematic review focuses on potential confounders in order to identify particular patient groups which may benefit most from timely delivery of care. METHODS: Medline, EMBASE and Cochrane databases were searched for publications between January 2012 and October 2020, correlating timeliness in secondary care pathways to patient outcomes. The protocol is registered with PROSPERO (the International Prospective Register of Systematic Reviews; ID 99239). Prespecified factors (demographics, performance status, histology, stage and treatment) are examined through narrative synthesis. RESULTS: Thirty-seven articles were included. All but two were observational. Timely care was generally associated with a worse prognosis in those with advanced stage disease (6/8 studies) but with better outcomes for patients with early-stage disease treated surgically (9/12 studies). In one study, patients with squamous cell carcinoma referred for stereotactic ablative radiotherapy benefited more from timely care, compared with patients with adenocarcinoma. One randomised controlled trial supported timeliness as being advantageous in those with stage I-IIIA disease. CONCLUSION: There are limitations to the available evidence, but observed trends suggest timeliness to be of particular importance in surgical candidates. In more advanced disease, survival trends are likely outweighed by symptom burden, performance status or clinical urgency dictating timeliness of treatment.

What do General Practitioners think of written reflection? A focus group study.

BACKGROUND: Written reflection has become a key part of evidence for assessment for General Practitioners (GPs) and GP Specialist Trainees (GPSTs), as it is thought to enhance the reflective process and demonstrate on-going learning. However, the educational value of mandatory reflection has been questioned, and there is little evidence on the acceptability of written reflection to clinicians. AIM: To explore the views of GPs and GPSTs on the use of written reflection in the MRCGP and NHS appraisal. DESIGN AND SETTING: A qualitative approach with GPs and GPSTs from the South of England. METHOD: Three focus group discussions with 11 GPs and 14 GPSTs. Thematic analysis was used on the coded texts. RESULTS: There were diverse views on the value of written reflection. Some participants with particular learning styles found it useful; some viewed it as a 'tick-box' exercise and as a game. Some questioned its value as a tool for quality improvement. Its use may have opportunity costs on clinical work, other learning and leisure time. CONCLUSION: Written reflection produced strong feelings among participants. Research is needed to gauge how commonly these feelings are held, to allow informed decisions on the place of written reflection in education and assessment.