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Identifying Factors Influencing Pancreatic Cancer Management to Inform Quality Improvement Efforts and Future Research: A Scoping Systematic Review

Gagliardi, Anna R. PhD*; Soong, Daniel MD; Gallinger, Steven MD, MSc*

doi: 10.1097/MPA.0000000000000484

Pancreatic cancer (PC) patients appear to receive suboptimal care. We conducted a systematic review to identify factors that influence PC management which are amenable to quality improvement. MEDLINE, EMBASE, and the references of eligible studies were searched from 1996 to July 2014. Two authors independently selected and reviewed eligible studies. Identified factors were mapped onto a framework of determinants of care delivery and outcomes. Methodological quality of studies was assessed using Downs and Black criteria. Most of the 33 eligible studies were population-based observational studies conducted in the United States. Patient (age, socioeconomic status, race) and institutional (case volume, academic status) factors influence care delivery and outcomes (complications, mortality, readmission, survival). Two studies implemented interventions to improve quality of care (centralization to high-volume hospitals, multidisciplinary care). One study examined system determinants (referral wait times). No studies examined the influence of guideline or provider characteristics. The overall lack of health services research in PC is striking. Factors and interventions identified here can be used to plan PC quality improvement programs. Further research is needed to explore the influence of guideline and provider factors on PC management and evaluate the impact of quality improvement interventions.

Supplemental digital content is available in the text.

From the *Toronto General Hospital, University Health Network, Toronto; and †Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.

Received for publication February 4, 2015; accepted June 12, 2015.

Reprints: Anna R. Gagliardi, PhD, Toronto General Research Institute, University Health Network, 200 Elizabeth Street, EN-228, Toronto, ON, Canada M5G2C4 (e-mail:

The authors declare no conflicts of interest.

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