Table 1 Key elements of each case
| Â | Innovation description | Main sources of evidence | Key resources and activities required for implementation | Decision process/length |
|---|---|---|---|---|
Case 1: PET | Nuclear medical imaging technology, often combined with CT imaging, to provide additional functional imaging detail Supported by scientific evidence for better cancer diagnosis, staging, and/or response to therapy for certain cancer types | Scientific evidence Patient experience | • Capital equipment purchase • Access to isotopes* • Expertise in PET scanning • Policy pertaining to use (only to be used for certain indications) | Formal requests/proposals to successive levels of system, ending with government**; required approval at all levels Decision process lasted approx. 8 years with adoption occurring in 2008 |
Case 2: IMRT | Type of radiotherapy that delivers targeted radiation to tumors, with better sparing of surrounding normal tissue Supported by scientific evidence for certain cancer types and indications | Scientific evidence Clinical experience Local data Data from other jurisdictions | • Integration with existing imaging modalities • Policy pertaining to use (only to be used for certain indications) • Education/training for all members of multi-disciplinary team | No formal request; informally adopted at departmental level Decision process lasted approx. 2 years with adoption occurring in 2005 |
Case 3: MSI testing | Molecular biology technique to (1) identify Lynch syndrome and (2) provide additional prognostic/predictive information in colon cancer Supported by scientific evidence | Scientific evidence Local data | • Expertise to perform testing • Policy pertaining to use (only to be used for certain indications) • Additional supplies (reagents) | Formal request/proposal to department; approved at departmental level Decision process lasted approx. 6 years with adoption occurring in 2012 |
Case 4: Barcoding | Technology in anatomic pathology to track cancer specimens from collection to reporting, and optimize patient safety Pre-post studies demonstrated significant error reduction | Scientific evidence Clinical experience Local data Data from other jurisdictions | • Capital equipment purchase • Education/training for all members of pathology team | Formal requests/proposals to successive levels of system, ending with government**; required approval at all levels Decision process lasted approx. 5 years with adoption occurring in 2014 |
Case 5: MRS | New staff position to optimize cancer patients’ access to non-intravenous prescription medications Limited scientific evidence to support innovation, through some descriptive data regarding institutional experiences in the US | Clinical experience Local data Data from other jurisdictions | • Social worker with expertise or willingness to develop expertise in medication access • Referral form/process • Evaluation framework and infrastructure | Ad hoc committee struck to address problem; recommendation approved at program level Decision process lasted approx. 2 years with adoption occurring in 2005 |