Rapid diagnostic pathways for prostate cancer: A realist synthesis

Introduction: The NHS Long-term Plan outlines a number of approaches to address delays and diagnose three out of four cancers at an early stage, and yet patients regularly experience delays to diagnosis. Attempts to address such delays include the implementation of a number of rapid diagnosis pathways (RDPs). This realist review explores rapid diagnosis pathways for prostate cancer, identifying approaches to RDPs, as well as generating theories regarding what works, for whom and under which circumstances. Methods: This is a realist evidence synthesis. The questions and approach are informed by patient and public involvement (PPI). We conducted a scoping review to generate initial programme theories and then refined these through further search processes. As a realist review, we do not focus on a specific data type or outcome, rather we include qualitative and quantitative data to inform theories comprised of contexts, mechanisms, and outcomes (CMO chains). Results: Six studies were included in our scoping review; twenty studies were included in the second review. The studies include qualitative and quantitative data. We identified three broad themes: Primary care, organizational factors, and patient experience. Conclusions/ Recommendations: We recommend the involvement of adjoining services (e.g. general practice and radiology) in the planning of prostate cancer RDPs and emphasize the importance of clear communication with patients.