Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review
Evaluating diagnostic strategies for early detection of cancer : the CanTest framework. / Walter, Fiona M; Thompson, Matthew J; Wellwood, Ian et al.
I: BMC Cancer, Bind 19, Nr. 1, 586, 2019.Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review
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TY - JOUR
T1 - Evaluating diagnostic strategies for early detection of cancer
T2 - the CanTest framework
AU - Walter, Fiona M
AU - Thompson, Matthew J
AU - Wellwood, Ian
AU - Abel, Gary A
AU - Hamilton, William
AU - Johnson, Margaret
AU - Lyratzopoulos, Georgios
AU - Messenger, Michael P
AU - Neal, Richard D
AU - Rubin, Greg
AU - Singh, Hardeep
AU - Spencer, Anne
AU - Sutton, Stephen
AU - Vedsted, Peter
AU - Emery, Jon D
PY - 2019
Y1 - 2019
N2 - BACKGROUND: Novel diagnostic triage and testing strategies to support early detection of cancer could improve clinical outcomes. Most apparently promising diagnostic tests ultimately fail because of inadequate performance in real-world, low prevalence populations such as primary care or general community populations. They should therefore be systematically evaluated before implementation to determine whether they lead to earlier detection, are cost-effective, and improve patient safety and quality of care, while minimising over-investigation and over-diagnosis.METHODS: We performed a systematic scoping review of frameworks for the evaluation of tests and diagnostic approaches.RESULTS: We identified 16 frameworks: none addressed the entire continuum from test development to impact on diagnosis and patient outcomes in the intended population, nor the way in which tests may be used for triage purposes as part of a wider diagnostic strategy. Informed by these findings, we developed a new framework, the 'CanTest Framework', which proposes five iterative research phases forming a clear translational pathway from new test development to health system implementation and evaluation.CONCLUSION: This framework is suitable for testing in low prevalence populations, where tests are often applied for triage testing and incorporated into a wider diagnostic strategy. It has relevance for a wide range of stakeholders including patients, policymakers, purchasers, healthcare providers and industry.
AB - BACKGROUND: Novel diagnostic triage and testing strategies to support early detection of cancer could improve clinical outcomes. Most apparently promising diagnostic tests ultimately fail because of inadequate performance in real-world, low prevalence populations such as primary care or general community populations. They should therefore be systematically evaluated before implementation to determine whether they lead to earlier detection, are cost-effective, and improve patient safety and quality of care, while minimising over-investigation and over-diagnosis.METHODS: We performed a systematic scoping review of frameworks for the evaluation of tests and diagnostic approaches.RESULTS: We identified 16 frameworks: none addressed the entire continuum from test development to impact on diagnosis and patient outcomes in the intended population, nor the way in which tests may be used for triage purposes as part of a wider diagnostic strategy. Informed by these findings, we developed a new framework, the 'CanTest Framework', which proposes five iterative research phases forming a clear translational pathway from new test development to health system implementation and evaluation.CONCLUSION: This framework is suitable for testing in low prevalence populations, where tests are often applied for triage testing and incorporated into a wider diagnostic strategy. It has relevance for a wide range of stakeholders including patients, policymakers, purchasers, healthcare providers and industry.
KW - BIOMARKER DEVELOPMENT
KW - CARE-RELATED TESTS
KW - Cancer
KW - Conceptual framework
KW - DECISION-MAKING
KW - Diagnosis
KW - Diagnostic strategies
KW - Early detection
KW - HEALTH-CARE
KW - Primary care
KW - TASK-FORCE
KW - UTILITY
UR - http://www.scopus.com/inward/record.url?scp=85067307432&partnerID=8YFLogxK
U2 - 10.1186/s12885-019-5746-6
DO - 10.1186/s12885-019-5746-6
M3 - Journal article
C2 - 31200676
VL - 19
JO - B M C Cancer
JF - B M C Cancer
SN - 1471-2407
IS - 1
M1 - 586
ER -