Interfaces Across the Cancer Continuum Offer Opportunities to Improve the Process of Care

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Abstract
There is little question that medical care delivery in the United States and Canada struggles to achieve its full potential to reduce morbidity and mortality (1,2). The Institute of Medicine's 1999 report titled Ensuring Quality Cancer Care and its 2001 report Crossing the Quality Chasm galvanized interest in improving cancer care specifically and health-care delivery in general (3,4). Although the chasm between what we know and what we do in medical care was described by the Institute of Medicine at the turn of the millennium, systematic assessment of quality has been a concern for more than a generation (4–6). Donabedian (7) wrote about the complexities of health-care quality in the early 1980s and defined it as the ability of the care system to deliver the health benefits of treatments while reducing their adverse consequences. In this supplement, we explore the processes involved with comprehensive cancer care and emphasize the interfaces between providers, providers and patients, and health-care organizations. Consistent with Donabedian's conception of the health-care process, these interfaces are affected by the structure of the environment in which they arise as well as by the practices, organizations, and communities where the processes occur. This concluding article summarizes how the supplement identifies the challenges at the interfaces of cancer medical care practice and proposes how further research regarding these interfaces could have implications for the goal of achieving a system of cancer care that is safe, effective, patient centered, timely, efficient, and equitable (4).
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