Developing an expert consensus statement on emergency preparedness for cancer care delivery in Canada: a modified Delphi study

BACKGROUND: In response to the COVID-19 pandemic, health organizations around the world including those in Canada have developed guidelines to allow for cancer care delivery amid a public health emergency. In Canada many of these guidelines were developed during the pandemic and at a time when there were limitations in knowledge on the impact of certain policies on patient care. Built upon this foundation we aimed to establish expert-informed, consensus-based policy recommendations to improve the preparedness and resilience of cancer systems for future public health emergencies, using lessons learned from the COVID-19 pandemic and focusing on the Canadian cancer care systems. METHODS: We conducted a modified Delphi study using a two-round online survey administered to a Steering Committee composed of a purposefully sampled group of physicians and a patient advisor from across Canada. Participants rated their agreement with 23 Delphi statements across four domains: access to cancer surgery, virtual and home care, primary care, and institutional memory. These statements were developed through a focus group discussion with an Advisory Committee composed of Canadian health policy leaders during the COVID-19 pandemic and refined based on qualitative feedback. Consensus was defined a priori as greater than 70% agreement (6 or 7 on a 7-point Likert scale). RESULTS: Seven of the 15 individuals invited to be panelists of the Advisory Committee and 16 of the 29 individuals invited to be panelists of the Steering Committee agreed to participate. Ten of the 23 statements reached consensus, including strengthening interhospital collaboration for surgical access, identifying health services appropriate for virtual care, expanding at-home cancer screening, and reducing administrative burden through artificial intelligence. In contrast, proposals related to primary care reform and infrastructure expansion did not achieve consensus. Qualitative responses revealed that disagreement mostly centered on perceived jurisdictional responsibility and resource constraints. CONCLUSION: We identified expert consensus on ten priorities that extend beyond immediate recovery and support system resilience. These recommendations may offer a foundation for healthcare leaders to impact national and international policymaking.