Objectives: This Technical Brief aims to identify: 1) frameworks that describe organizational context and process characteristics relevant to cancer care delivery research, and compare these frameworks to the Integrated Framework recently developed by National Cancer Institute staff Weaver, Breslau, and colleagues; 2) approaches used to improve understanding of how organizational characteristics are described, measured, and analyzed in the context of cancer screening, diagnosis, or treatment; 3) organizational context and process characteristics examined in studies assessing cancer care; and 4) evidence gaps and future research needs to advance the science of assessing the effects of organizational characteristics on cancer care.
Review methods: We integrated discussions with Key Informants and syntheses of evidence from searches of literature published from 2010 to 2023, using PubMed®, CINAHL®, SCOPUS®, PsycINFO®, and the Cochrane Central Register of Controlled Trials, as well as select grey literature.
Findings: We identified 17 frameworks that were developed or applied to examine the effects of organizational characteristics (including structures, context, and processes) on cancer care delivery. Our analysis of these frameworks supported the comprehensiveness of the Integrated Framework, although a few identified characteristics were not explicitly included in the Integrated Framework. We found 90 studies that take various approaches to describe, measure, and analyze organizational characteristics in the context of cancer care research. Of these, we identified 25 that tested associations between organization characteristics and screening, diagnosis, or treatment outcomes, and described measurement in detail. Cancer-related studies that include organizational measures have used a wide range of study designs and focused mostly on structural characteristics (e.g., type, size), total care models such as the patient-centered medical home, and processes of improvement project implementation and barrier assessment (such as guideline implementation). We identified specific organizational measures examined in the cancer care literature, noting little standardization of measures across studies and a need for multilevel inquiry. Our discussions with Key Informants and review of the literature indicated that many characteristics of healthcare organizations are relevant to cancer care delivery and useful to assess when precisely defined. Studies with stronger designs and more rigorous organizational measurement are needed to better determine the effects of organizational characteristics on the outcomes of cancer care.
Conclusion: Our findings suggest that the Integrated Framework generally covers relevant organizational context and process characteristics. The literature has a wide array of studies examining organizational characteristics, but few studies directly associate organizational factors with clinical outcomes. Research and collaboration are needed to improve measurement of organizational factors, to clarify our understanding of multilevel aspects of organizational context and process and how they affect care, and to standardize terminology and measures.