Models of Care Toolkit

About this section

This section of the toolkit describes how innovative models of care can be used to enhance the scope of practice of cancer care team members.

Optimizing scope of practice

In cities and metropolitan centres cancer care is delivered by a multidisciplinary team that includes oncology specialists, physicians, nurses, pharmacists, therapists and other allied health professionals. While practice decisions ultimately rest with the primary oncologist, the patient and their family, there are opportunities within innovative models of care to engage other providers in the care team in decisions. For non-oncology providers, this may require a formal or informal change to professional scopes of practice as legislation, certification or health care centre allows.

By contrast, in rural and remote communities, cancer care is often supported by family physicians or other primary care teams with nurses, nurse practitioners and clinical practitioners in oncology (CPO). This reflects the availability of specialists within these communities and is considered a practical approach to care.

Models that limit routine cancer care to specialists can require patients to travel long distances to receive care. Ongoing staffing shortages, burnout, and attrition due to retirement, together with the challenge of recruiting and retaining people in certain professions increases pressure on cancer systems already under strain. These capacity issues are exacerbated by the COVID-19 pandemic.

Explore this section for models and examples of approaches for jurisdictional implementation.

Informing the models of care in this section

For information on optimizing scope of practice, the Partnership worked with McMaster Health Forum to conduct a rapid review to identify features of models that include an expanded scope of practice for clinical practitioners in oncology and nurses.

The importance of supporting nurses

icon three nursesExcessive demands placed on nurses is causing attrition, work-related stress and exhaustion, and potentially causing mental health disorder symptoms. This situation has been exacerbated during the COVID-19 pandemic. Persistent burnout and staff leaving the practice require innovative ways to use existing resources effectively, while ensuring safe and ethical work environments and providing mental health and wellness supports. Support resources are available through leading Canadian organizations including: the Canadian Association of Mental Health, the Canadian Mental Health Association, and the Canadian Centre on Substance Use and Addiction.

A note on terminology

In Canada, primary care doctors are eligible to receive additional training in cancer care. Depending on the province or territory and the type and level of specialized training received, they can be called clinical practitioners in oncology (CPO) or general practitioners in oncology (GPO). In this toolkit, the term CPO is used, which is inclusive of family physicians and general internists; however, other terms may be used to refer to this type of practitioner. For more information on practitioners who provide cancer services visit The Canadian Association of General Practitioners in Oncology’s website.

What do you want to see next?

Engagement with health system partners, care providers, and patient and family representatives, identified several professions that contribute to a high-quality, world-class cancer system. Optimizing the scopes of practice for nurses and clinical practitioners in oncology was prioritized to address the areas of highest urgency. There may be opportunity to look at full scope of practice models for other professions.

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