Visual Sensemaking of Cancer Diagnosis: Cancer Synthesis Maps
A recent presentation by CPAC’s Anubha Prashad at the UofT Cancer and Primary Care Research Network (Ca-PRI) Conference inspired a post to share the work publicly, now that it has been revealed at the conference. Full maps and a more detailed narrative of the study can be found at Design Dialogues.
OCAD University’s Health Design Studio team created four synthesis maps in collaboration with CPAC, the Canadian Partnership Against Cancer, for use in policy and patient discussions toward changing systems of cancer diagnosis to improve access and effectiveness. The two Diagnosis maps represent clinical diagnostic processes and the patient experiences associated with navigating the complexity of cancer diagnosis. Two Screening process maps were also produced from research with the CPAC Screening team, for breast and colorectal cancer screening.
The maps were constructed in an iterative design and research process by the Health Design Studio as part of a larger collaboration to identify evidence-based opportunities for system-level change in cancer diagnosis to improve patient experience and clinical practices across Canada. The maps integrate current knowledge from clinical practice and direct patient experiences, drawn from interviews and workshops with patient advisors, primary care physicians and cancer specialists.
The clinical process map, A Clinical System Perspective of Pan-Canadian Cancer Diagnosis, represents the complex steps of current pre-diagnosis practices for patients living within three geographic regions. Three cancer sites were chosen to show differences between typical cancers. The companion synthesis map, Patient Experience of Typical Cancers in the Canadian Context, presents three convoluted patient pathways for the same cancers. The Patient map is presented as a metaphorical maze, consistent with the psychosocial experience of patients struggling with these cancers, as informed by patient advisors in interviews and workshops.
The primary purpose of both maps is to demonstrate the relative real-world complexity of cancer diagnosis processes as understood by the stakeholders of diagnosis, the patients and clinicians. The maps reveal the variability of access to care across geographies, indicating location as one of the significant social determinants of health outcome. While other determinants such as socioeconomic status and community factors have significant influence as well, many leading proposals for system intervention address factors relevant to location. The recommended interventions (e.g. promising solutions to these systemic problems) are developed from emerging models of diagnostic practice for improving cancer outcomes in Canadian provinces and territories, as well as established best practices currently used in other countries.
Both maps show the same interval of a cancer lifecycle known as suspicion to diagnosis. This diagnostic interval is recognized as the period between a patient’s presentation of concerns to receiving a confirmed diagnosis from a cancer specialist, up to the point of entering treatment for that diagnosis. Both maps clearly indicate the point of transition to cancer treatment for the pathways.
The maps refer to a 3x3x4 framework that portrays: 3 typical cancers, 3 (inclusive of all) Canadian geographies, and 4 (all) entry points to diagnosis. In both maps three geographies are visually defined to inclusively group six location contexts that share common healthcare resources within each, as inclusively as possible:
Urban/Suburban — About (45%) of Canadians live in or near large cities, and the majority of health resources are located in large urban regions
Rural/Small Town — Small towns are smaller than 20,000 people and rural areas served by towns and regions
Remote/Northern — Includes remote settlements in northern areas of provinces and the territories
Both maps illustrate geographical inequity conservatively, whereby the process or journey is represented in realistic, close to median timeframes. The clinical map was based on generalizations from multiple inputs, and the patient map was primarily based on patient stories. Many cancer diagnosis cycles in Canada would have a longer duration than these cancer pathways; if care access and clinical processes were improved through recommended interventions, significantly shorter diagnosis intervals would be expected in these pathways.
