Cancer Partners Take Action to Deliver Person-Centred Cancer Care

The Canadian Partnership Against Cancer (the Partnership) will provide $8 million to cancer agencies and their partners across the country to improve the quality of life for people living with cancer. The initiatives, aimed at building new systems over the next five years, will focus on expanding use of Patient Reported Outcomes (PROs), and training health care providers on how to deliver palliative care for people with cancer.

This investment kicks off a series of new networks from the Partnership this year for ground breaking programs and initiatives looking to fix gaps in the cancer care system based on innovative and best practices.

Jurisdictions receiving funding include seven provinces and two territories. The initiatives will be implemented across different health care settings to benefit all patients. The Partnership will also work with funded Indigenous partners who have identified palliative care as a priority for action.

Five initiatives will be funded to implement or scale up PROs and standard screening tools in health care facilities that track and report on the presence and severity of cancer patient symptoms including pain, fatigue, anxiety and depression. Among these is an initiative led by the St. Mary’s Research Centre in Montreal, Quebec which will implement systematic electronic assessment of PROs using a mobile application in six cancer centres across the province. This initiative will be receiving funding for the second time to mature and spread it beyond its current uses.

Four initiatives will be funded focused on improvements that support more Canadians and their families having access to high quality palliative care at the right place and time based on the needs of the patient. One of these initiatives, led by Eastern Health, will provide inter-professional palliative care education to provincial cancer program staff and rural practitioners with the goal of better facilitating access to early and supportive palliative care for cancer patients in the province.

The funding of these initiatives represents another step in the Partnership’s efforts to shift Canada’s cancer system from disease-centred to person-centred – a system that considers a patient’s physical, emotional, psychological, spiritual and practical issues and recognizes the critical role of the patient as a partner in managing their own health. Two of the PROs initiatives are receiving renewed funding demonstrating the Partnership’s continuing commitment to “scaling up and spreading” successful system, organizational and regional level practices, with the long-term goal of creating a more seamless experience for Canadians living with cancer.

Jurisdictions to receive funding include:

Patient Reported Outcomes

British Columbia

Initiative Name: Improving Quality of Life and Palliative and End-of-Life Care Through Comprehensive Application of Patient-Reported Outcomes

Partners Involved: BC Cancer

Description: The focus of this initiative is on the early integration of a comprehensive ‘palliative approach’ to care for patients with incurable cancer. The approach is to enact the principles of early palliative care into cancer care, support comprehensive assessments of quality of life concerns through the use of patient reported outcome measures, and support staff education/skill development in a patient-centred way.

Alberta

Initiative Name: Improving Quality of Life Through Comprehensive Application of Patient-Reported Outcomes

Partners Involved: CancerControl Alberta, Alberta Health Services

Description: At CancerControl Alberta, a standard paper-based Patient-Reported Outcome (PRO) process has been in place since 2014 using the Putting Patients First (PPF) form. This form includes the use of the Edmonton Symptom Assessment System-revised (ESAS-r) tool, Canadian Problem Checklist, patient priority concern, and clinical response. In the last initiative with the Partnership, CancerControl Alberta designed a hybrid solution to enter PRO data from the paper-based PPF form into electronic medical records. Since the initiative, the organization has developed four interrelated PRO dashboards that function off this data. The next stage will involve scaling up and spreading the dashboards beyond the original test setting with the focus of ensuring meaningful use of new digital PRO outputs in clinical practice to drive quality improvement.

Quebec

Initiative Name: e-IMPAQc: Implementation and evaluation of an e-Health application for the systematic assessment of patient and caregiver reported outcomes in Quebec across the cancer continuum

Partners Involved: St. Mary’s Research Centre (Montreal West Island CIUSSS)

Description: The initiative will implement and evaluate the effect of systematic electronic assessment of patient-reported outcomes (PROs) and caregiver-reported outcomes (CROs) using a mobile application across six cancer centres in Quebec, and one pediatric centre. In addition, collected PROs and CROs data will trigger stepped-care referral and clinical care pathways that integrate evidence-based, self-management resources tailored to patients’ and caregivers’ experiences. Results will be linked to electronic medical records in real-time.

Northwest Territories

Initiative Name: Improving Quality of Life and Palliative and End-of-Life Care Through Comprehensive Application of Patient-Reported Outcomes

Partners Involved: Northwest Territories Health and Social Services Authority (NTHSSA)

Description: The focus of this initiative is to build capacity of health and social care providers across the Northwest Territories to identify and support palliative care early in the disease process. The objectives are to introduce best practice approaches for identifying individuals early in their palliative journey, educate care providers on the palliative approach to care, and provide 24/7 access to expert clinical support. In addition, this initiative aims to implement standardized care pathways, best practice protocols, and validated tools for supporting palliative care service delivery.

Yukon

Initiative Name: Improving Quality of Life and Palliative and End-of-Life Care Through Comprehensive Application of Patient-Reported Outcomes

Partners Involved: Department of Health and Social Services, Government of Yukon

Description: The primary goals of this initiative are to establish a Yukon-wide system for collecting and reporting ESAS-r for clients with palliative care needs, and for clinicians to use PROs to guide interventions. The education and training on the use of ESAS-r will be provided to a multitude of disciplines to guide clinical decision making and improve symptom management, along with education regarding the early identification of individuals who could benefit from a palliative approach to care. The idea is to have the ESAS-r available electronically so that patients can  report on their symptoms prior to  talking with their health care provider.

Early Integration of Palliative Care

Saskatchewan

Initiative Name: Early Integration of Palliative Care

Partners Involved: Saskatchewan Cancer Agency

Description: This initiative has six goals to improve care for patients: 1) develop a Palliative Care Community of Practice to link provincial services and provide a mechanism for early access to palliative care, 2) provide education sessions for healthcare providers to increase knowledge about the benefits of earlier integration of palliative care, 3) promote physician use of the “Surprise Question” assessment in determining patient needs for earlier palliative care, 4) standardize use and documentation of “Goals of Care” conversations, 5) encourage continued use of and documentation of the Edmonton Symptom Assessment System-revised (ESAS-r) tool in the province’s Pain and Symptom Management Clinic, and expand the use of ESAS-r to community homecare services, and 6) enhance telehealth services to palliative care patients and providers provincially to ensure rural and remote patients have access to high quality palliative care.

Prince Edward Island

Initiative Name: Early Integration of Palliative Care

Partners Involved: Health PEI

Description: This initiative builds upon the foundation of PEI’s Provincial Integrated Palliative Care program in effort to provide earlier integration and better access to high quality palliative care in many settings including home care, community care, long-term care, acute care, primary care, emergency services (EMS), cancer treatment centres, and First Nation communities. The overall vision is that all Islanders faced with life-limiting illness can access integrated, person-centered, quality palliative care in the setting of their choice. With a focus on education (including the public, providers, and patients/caregivers), integration, and collaboration, this initiative will support primary care providers to maximize their scope of practice and focus on providing early and seamless palliative care to their patients.

Nova Scotia

Initiative Name: Early Integration of Palliative Care

Partners Involved: Nova Scotia Cancer Care Program, NS Health Authority

Description: The vision of this initiative is to support early access to palliative care so that patients with a life-limiting illness will have the opportunity to benefit from the key elements of a quality palliative approach to care resulting in an improved patient and family experience. One outcome will be the development of a toolkit which will be used by additional primary care and specialty teams to continue the spread and impact of the work.

Newfoundland and Labrador

Initiative Name: Early Integration of Palliative Care

Partners Involved: Provincial Cancer Care Program, Eastern Health

Description: The vision is to standardize the philosophy of care using the Learning Essential Approaches to Palliative care (LEAP) curriculum for health care providers to improve access to early and supportive palliative care, and ultimately improve quality of life. LEAP training will be offered to practitioners in all regional cancer centres and linkages will be made with palliative care teams throughout the province. The approach is to conduct stakeholder engagement, review the current state in Newfoundland, review evidence and best practices across the country, and implement an electronic referral system for targeted cancer diagnoses.