Northeast Regional Cancer Plan 2015 - 2019

Northeast Regional Cancer Plan 2015- 2019 1

Northeast Regional Cancer Plan 2015 - 2019

2 Northeast Regional Cancer Plan 2015 - 2019

Table of Contents

Introduction 3

Building the Plan 4

The Cancer Care Continuum 4

Enabling the Plan 4

The Ontario Cancer Plan IV 2015-2019 5

Six Quality Dimensions and Related Goals 5

Quality of Life and Patient Experience 6

Safety 8

Equity 10

Integrated Care 12

Sustainability 14

Effectiveness 16


Introduction

This Northeast Regional Cancer Plan 2015 - 2019 represents regional priorities that align with the Ontario Cancer Plan IV 2015 - 2019. It builds on the efforts of our last cancer plan and describes the specific areas where work is required to improve the quality of cancer care for patients and families in the Northeast.

By aligning with these directions the Northeast Cancer Centre (NECC) will strive to develop a system of:Cancer care that exceeds patient expectations.

To achieve the missions of Cancer Care Ontario (CCO) and Health Sciences North (HSN), the NECC will focus our efforts on our core purpose of:Improving patient and family experiences and outcomes for all cancer services in northeastern Ontario through integration, partnership and innovation.

VISIONWorking together to create the best health systems in the world.

MISSIONTogether, we will improve the performance of our health systems by driving quality, accountability, innovation and value.

VISIONGlobally recognized for patient-centred innovation.

MISSIONImprove the health of northerners by working with our partners to advance quality care, education, research and health promotion.


We have developed this Northeast Regional Cancer Plan 2015 - 2019 based on consultation with our partners, including patient and family advisors, our clinical leadership team, physicians and staff of the NECC and Algoma District Cancer Programs (ADCP), volunteers, partner hospitals and health units, and charitable organizations.

The Northern Cancer Foundation (NCF) provides financial support for patient care and research at the NECC. The NECC appreciates this ongoing support and recognizes the NCF as a critical factor in achieving better outcomes and experiences through this plan.

We also drew upon an extensive parallel consultation and planning process of the North East Regional Hospice Palliative Care Steering Committee to develop palliative care action plans.

Our Northeast (NE) Aboriginal Cancer Plan is being developed under the guidance of Aboriginal health leaders in the region who participate in the NE Aboriginal Cancer Advisory Committee.

The Cancer Care Continuum

Enabling the Plan

To succeed with the implementation of this plan we will ensure that:

1. Patient advice guides our improvement initiatives.

2. Lean approaches are used to increase value for patients and families through the relentless pursuit of the perfect process by reducing waste and variation. This approach to problem solving will stabilize and improve how we work.

3. Information technology is leveraged to share clinical information with providers and patients.

4. Patient reported experience and outcome measures identify problems needing improvement.

5. Partnerships with organizations and providers across the Northeast are strengthened.

Primary Care

Psychosocial & Palliative Care

Recovery / Survivorship

Prevention Screening Diagnosis Treatment

End-of-LifeCare

Building the Plan

This plan recognizes that patients and families interact with the cancer system at multiple points. Although these interactions can be described as discrete steps, it is often the transitions in care that require improvement. Improving transitions reinforces the importance of partnerships across care providers and settings to improve outcomes and experiences for patients.


The Northeast Regional Cancer Plan is built on the framework of the Ontario Cancer Plan IV’s six quality dimensions and related goals.

• Quality of Life and Patient Experience• Safety• Equity

• Integrated Care• Sustainability• Effectiveness

Specific challenges in the Northeast have been identified related to each of these goals. Action plans have been developed in response to these challenges that will contribute towards achieving the provincial goals.

The Ontario Cancer Plan IV 2015-2019: Together we will

Brandy Bielaski, RN, laughs with her patient in the NECC chemotherapy suite.


Quality of Life and Patient Experience

Ontario Cancer Plan IV Goal:

Ensure the delivery of responsive and respectful care, optimizing individuals’ quality of life across the cancer care continuum

“As a patient and caregiver, I’m pleased that the 2015 - 2019 Northeast Regional Cancer Plan will provide patients and families with the opportunity to be engaged and included throughout all aspects of their care. I believe it will improve their overall experience within the cancer system.”

- Paulette Lalancette Member of the NECC Patient and Family Advisory Council


The Northeast geography

requires that patients and

families are able to access

their health care information

wherever they are located to

enable the choice of active

participation in their care.

Forty-three per cent (43%)1

of cancer patients visit the

emergency department in the

last two weeks of life. (Ontario

minimum value is 34%)1.

The Northeast has the highest

rate (68%)1 of acute care hospital

visits in the province for breast

cancer patients after a course of

chemotherapy treatment.

Current Ambulatory Patient

Experience Surveys are not

completed at the time of the visit.

1. Provide patients with easy

access to their cancer care

health information.

2. Ensure palliative care is

available earlier and with

improved coordination

across settings (hospital,

cancer centre, home).

3. Decrease unplanned

emergency and hospital

visits by better managing

symptoms and side effects.

4. Ensure patients can provide

feedback in real time

about their experience at

the cancer centre.

Challenges in the Northeast Northeast Action Plans By 2019 we will:

1.1 Develop a secure internet patient portal.

1.2 Simplify processes for patient information access.

2.1 Offer standardized goals of care and advance care planning

discussions and documentation to cancer patients.

2.2 Implement early identification and palliative care support pathways

and services in hospitals and cancer centres together with

Community Care Access Centres (CCAC), primary care providers, and

residential/visiting hospices across the region.

3.1 Provide patients with urgent care access options other than the

emergency department.

3.2 Develop symptom self-management tools and support systems.

3.3 Implement patient-reported outcome measures to identify and treat

symptoms and side effects early.

4.1 Implement Real-time Electronic Patient-Reported Experience

Measures.

Quality of Life and Patient Experience

1 Cancer System Quality Index (CSQI) 2015.


Safety


Ensure the safety of patients and caregivers in all care settings

“I speak as a past patient who has been fortunate to get into the recovery and survivorship phase of the cancer trajectory. However, for some people, the disease will become a chronic and ongoing health issue that must be managed and for others, it may not be survivable. Better access to urgent care options, offering advance care planning, and expanded screening tools are among some solutions that will help give patients a greater quality of life and better overall satisfactory experiences.”

- Lianne DuprasMember of the NECC Patient and Family Advisory Council


An increasing number of patients

receive chemotherapy care in a

distributed model (40%)2 that is

remote from the cancer centre, or as

oral medication at home.

Limited scope and timeliness of

microbiology services are available

in the Northeast which may result in

longer wait times for results to be

received and treatment initiated for

immunocompromised cancer patients.

1. Improve medication safety.

2. Enhance microbiology

service capabilities in the

Northeast to better respond

to cancer patient infections.


1.1 Implement medication reconciliation for cancer patients

visiting the cancer centre.

1.2 Improve oral chemotherapy safety through an

enhanced model of care that supports patients

remotely.

1.3 Enhance community hospital chemotherapy site

supervising physician capability through standard

education.

2.1 Develop molecular methods of testing for infections

affecting cancer patients including C. difficile, influenza,

viruses and mycobacteria (e.g. tuberculosis).

Safety

2 Cancer Care Ontario Cancer Activity Level Reporting. iPort 2015.


EquityOntario Cancer Plan IV Goal:

Ensure health equity for all Ontarians across the cancer system

“Our daughter Harmony was diagnosed with Acute Lymphocytic Leukemia and our lives changed forever. We walked the cancer pathway for the next two years with much anxiety. Some of the anxiety came from the disconnect between our Anishinabek worldview versus our current medical model. One example is the importance that ceremony played when our daughter was initially diagnosed to ensure the spiritual helpers and Creator would hold our daughter in their hands providing the medical team with the wisdom to treat this disease. This need was not understood or supported by health care providers. In the Northeast, there is a deep importance of building cultural competency so that providers understand the unique needs and challenges that Aboriginal cancer patients and families face.”

- Roger A. BoyerMember of the NECC Patient and Family Advisory Council


The Northeast has the largest

Aboriginal population in the province.

Cancer incidence is increasing and

survival is worse for Aboriginal

people compared with other

Ontarians.

The Northeast has the highest

francophone population in the

province, resulting in inequitable

access to services when they are only

offered in English.3

1. Implement the second

Northeast (NE) Aboriginal

Cancer Plan, guided by

the NE Aboriginal Cancer

Advisory Committee.

2. Enhance francophone

services.


1.1 Build relationships: Aboriginal Relationship and

Cultural Competency training will be completed by 50%

of cancer centre staff.

1.2 Implement palliative care early identification and

symptom management guides with First Nations

primary care providers.

1.3 Pilot and evaluate symptom assessment and

management guides using mobile ISAAC with

Manitoulin Island communities.

1.4 Pilot Aboriginal self-identification measures to enhance

access to Aboriginal Navigator services.

1.5 Analyse cancer screening accessibility to identify

geographic barriers and potential solutions.

2.1 Actively offer services in French for every NECC and

ADCP patient.

2.2 Develop and implement French symptom self-

management tools and support systems.

Equity

3 North East Local Health Integration Network Integrated Health Services Plan 2016 – 2019.


Integrated Care


Ensure the delivery of integrated care across the cancer care continuum

“When cancer struck my family, one of the first outstanding things I learned from my experience as a primary caregiver was never to underestimate the impact of a cancer diagnosis – especially on children and young adults.

Access to psychosocial support is imperative to patients and their families throughout the course of treatment from cancer diagnosis to survival or end of life.”

- Patricia GiddingsMember of the NECC Patient and Family Advisory Council


Only 65% of cancer patients

report that they know the

next step in their care.4

Pathology and laboratory

services provided outside

of the region can impact

continuity of care.

Geography in the Northeast

increases patient reliance

on primary care providers

throughout their cancer care.

1. Clearly define

interdisciplinary care

pathways.

2. Enhance pathology

and laboratory

services available

within the region

through collaborative

approaches.

3. Collaborate with

primary care

providers.


1.1 Ensure new patient-centred models for the interdisciplinary

ambulatory clinics at the cancer centre will be functioning.

1.2 Implement well defined care plans tailored to individual patient

needs.

1.3 Ensure patient information will match their care plans and meet the

Accessibility for Ontarians with Disabilities Act (AODA) requirements

so that patients and families know the next step in care.

2.1 Ensure fewer pathology specimens will leave the North East Local

Health Integration Network (LHIN) for testing and analysis.

3.1 Integrate Cancer Care Ontario (CCO) clinical management tools into

practice to improve cancer screening rates.

3.2 Prepare for new CCO cancer screening guidelines and tests.

3.3 Design clinical pathways for cancer well follow-up care that reflect the

foundational concepts and competencies of primary care providers.

3.4 Implement early palliative identification and prognostic indicator

guide in primary care practices across the region.

Integrated Care

4 NRC Picker Ambulatory Oncology Patient Satisfaction Survey Q2, 2015. iPort.


Sustainability


Ensure a sustainable cancer system for future generations

“As cancer survivors, over the years we have seen improvements in cancer wait times, improved procedures and overall improved patient care. The caring staff and physicians at the Northeast Cancer Centre have worked collaboratively with patients, survivors and families to improve cancer screening, technology, and cancer treatment protocols. We look forward to this ongoing process improvement approach so that our future generation will have the care they require.”

- Anne Marie Muraska (pictured) and Martha O’DaiskeyMembers of the NECC Patient and Family Advisory Council


Complex haematology care is

primarily provided in the inpatient

setting by only a few physicians.

New quality based procedures that

are planned for introduction will be

driven by best clinical evidence which

may require changing current practice.

Twenty-one per cent (21%) of people

in the Northeast are smokers as

compared to 18% for Ontario. Tobacco

use remains the main cause of

premature death and disease.5

Cancer screening rates in the

Northeast are below provincial targets

with 40% of eligible people overdue

for colorectal cancer screening, 42%

of women not screened for cervical

cancer and 41.5% not screened for

breast cancer.6

Challenges in the Northeast Northeast Action Plans

1.1 Remodel complex haematology care to reduce

reliance on very few physicians and shift inpatient care

to the outpatient setting where it is safe and effective.

2.1 Support organizations and providers to align or

modify clinical pathways with Quality Based Procedure

funding guidelines to ensure effectiveness of care and

optimize resource use.

3.1 Assess the smoking status of patients of the NECC

and offer active smokers smoking cessation services.

4.1 In collaboration with regional partners and Northeast

residents, examine the barriers to cancer screening and

where possible, develop and implement solutions to

overcome barriers to cancer screening.

SustainabilityBy 2019 we will

1. Develop a sustainable

model of care for

complex haematology

in the Northeast.

2. Align clinical pathways

with Quality Based

Procedure funding

guidelines.

3. Enhance smoking

cessation services at the

NECC.

4. Improve Northeast

screening rates by

reducing barriers.

5 North East Local Health Integration Network Integrated Health Services Plan 2016 – 2019.6 Regional Scorecard Q3, 2015. iPort.


Effectiveness


Ensure the provision of effective cancer care based on best evidence

“Cancer is scary, but it is much easier to go through that journey when you know you are being listened to and have a say in how things are progressing. The doctors and staff at the Northeast Cancer Center worked hard and gave me the confidence I needed to work toward a positive outcome.”

- Lauri PetzMember of the NECC Patient and Family Advisory Council


Effectiveness

Physicians are geographically

dispersed across the region.

Travel burden is a barrier in access to

new and emerging technology.

1. Establish Physician

Communities of Practice to

support enhanced provider

quality through education,

process improvements

and standards of care

implementation.

2. Enhance technology to

provide regional access.

Challenges in the Northeast Northeast Action Plans By 2019 we will

1.1 Align Breast, Colorectal, and GI Endoscopy Communities

of Practice with Quality-based Procedure clinical

pathways and Quality Management Program priorities.

2.1 Expand Stereotactic Ablative Radiotherapy to liver,

spine and prostate cancers.

2.2 Implement interventional Radiological Ablative Therapy

for liver, lung and kidney cancers.

2.3 Make available Positron Emission Tomography (PET)/

Computed Tomography to patients in the Northeast at

HSN.

2.4 Develop genomics capabilities to provide access to

emerging personalized medicine testing in the region.


41 Ramsey Lake RoadSudbury, ON P3E 5J1Tel: 705-523-7100Toll-free: 1-866-469-0822

www.hsnsudbury.ca

41 Ramsey Lake RoadSudbury, ON P3E 5J1 Tel: 705-523-4673 (HOPE) Toll free: 1-866-985-4673

www.ncfsudbury.com

Documents

Northeast Regional Cancer Plan 2015 - 2019