Skip to main content

Table 1 Key elements of each case

From: The role of scientific evidence in decisions to adopt complex innovations in cancer care settings: a multiple case study in Nova Scotia, Canada

  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
  1. PET positron electron tomography, IMRT intensity-modulated radiation therapy, MSI microsatellite instability, MRS Medication Resource Specialist
  2. *There were two options for accessing isotopes: purchasing from another province or making onsite with a cyclotron (which would require substantially more resources). Initially, isotopes were purchased from elsewhere, but a cyclotron was purchased and implemented approx. 4 years after PET implementation
  3. **Required government approval because these innovations were large capital expenditures, requiring substantial funding