Exploring barriers and facilitators to capturing cancer stage at diagnosis in a population-based cancer registry: A cross-sectional survey of health information managers/clinical coders and multidisciplinary team members.

Abstract

Background: Cancer stage is important to capture within population-based cancer registries (PBCRs) to facilitate recruitment to clinical trials, evaluate prevention programs, assess treatment impact, and forecast cancer service needs. However, capture of cancer stage at diagnosis in many PBCRs is low, stemming from missing data in cancer registrations from health services. This study aims to identify the barriers and facilitators faced by Health Information Managers (HIM)/Clinical Coders (CC) and key multidisciplinary team meeting (MDM) personnel when capturing cancer stage at diagnosis.

Method: A cross-sectional online survey was conducted with 167 HIM/CC and 58 key MDM personnel employed within Victorian hospitals. The survey included 8 descriptor questions, 12–14 5-point Likert questions and 2–3 free text questions. Free text questions were analysed using the Theoretical Domains Framework, while all other questions were analysed using descriptive statistics, Spearman rank or Kruskall-Wallis tests.

Results: For HIM/CC, barriers related to the theoretical domains of (i) environmental context and resources, with 87% of participants agreeing required information was not readily available, (ii) knowledge, with 46% of participants agreeing they worry about incorrectly coding stage and (iii) skills, with 42% of participants agreeing they were not confident and 37% feeling they had inadequate training. For key MDM personnel, barriers related to the theoretical domains of (i) environmental context and resources, with 50% of participants agreeing there were time constraints, and required information was not readily available (ii) goals, with 36% of participants agreeing capturing cancer stage is not a priority, and (iii) social/professional role and identity, with 36% of participants agreeing it was not their role to discuss and capture stage. Despite the barriers, over half of participants in both groups agreed recording stage at diagnosis was a vital task.

Conclusions: Resolving the barriers identified will require enhancing documentation available to, and the training received by, HIM/CC and encouraging MDM Chairs to ensure cancer stage is discussed and recorded adequately for all patients presented.