Northeast Regional
Cancer Plan 2015 - 2019
Northeast Regional Cancer Plan 2015- 2019
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Table of Contents
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Northeast Regional Cancer Plan 2015 - 2019
Introduction
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Building the Plan
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The Cancer Care Continuum
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Enabling the Plan
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The Ontario Cancer Plan IV 2015-2019
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Six Quality Dimensions and Related Goals
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Quality of Life and Patient Experience
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Safety
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Equity
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Integrated Care
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Sustainability
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Effectiveness
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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.
VISION Working together to create the best health systems in the world.
VISION Globally recognized for patient-centred innovation.
MISSION Together, we will improve the performance of our health systems by driving quality, accountability, innovation and value.
MISSION Improve the health of northerners by working with our partners to advance quality care, education, research and health promotion.
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.
Northeast Regional Cancer Plan 2015- 2019
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Building the Plan
The Cancer Care Continuum
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.
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 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.
Primary Care
Prevention
Screening
Diagnosis
Treatment
Recovery / Survivorship End-of-Life Care
Psychosocial & Palliative Care
Enabling the Plan To succeed with the implementation of this plan we will ensure that:
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. 4
Northeast Regional Cancer Plan 2015 - 2019
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.
The Ontario Cancer Plan IV 2015-2019: Together we will 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.
Brandy Bielaski, RN, laughs with her patient in the NECC chemotherapy suite. Northeast Regional Cancer Plan 2015- 2019
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“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
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
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Northeast Regional Cancer Plan 2015 - 2019
Quality of Life and Patient Experience Challenges in the Northeast The Northeast geography
Northeast Action Plans 1. Provide patients with easy
requires that patients and
access to their cancer care
families are able to access
health information.
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
their health care information wherever they are located to enable the choice of active participation in their care. Forty-three per cent (43%)1
2. Ensure palliative care is
of cancer patients visit the
available earlier and with
discussions and documentation to cancer patients.
emergency department in the
improved coordination
2.2
Implement early identification and palliative care support pathways
last two weeks of life. (Ontario
across settings (hospital,
and services in hospitals and cancer centres together with
minimum value is 34%)1.
cancer centre, home).
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
The Northeast has the highest
3. Decrease unplanned
rate (68%) of acute care hospital
emergency and hospital
emergency department.
visits in the province for breast
visits by better managing
3.2
Develop symptom self-management tools and support systems.
cancer patients after a course of
symptoms and side effects.
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
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chemotherapy treatment. Current Ambulatory Patient
4. Ensure patients can provide
Experience Surveys are not
feedback in real time
completed at the time of the visit.
about their experience at
Measures.
the cancer centre. 1
Cancer System Quality Index (CSQI) 2015.
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“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 Dupras
Member of the NECC Patient and Family Advisory Council
Safety Ontario Cancer Plan IV Goal: Ensure the safety of patients and caregivers in all care settings
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Northeast Regional Cancer Plan 2015 - 2019
Safety Challenges in the Northeast An increasing number of patients
Northeast Action Plans 1. Improve medication safety.
By 2019 we will: 1.1
Implement medication reconciliation for cancer patients
receive chemotherapy care in a
visiting the cancer centre.
distributed model (40%)2 that is
1.2
Improve oral chemotherapy safety through an
remote from the cancer centre, or as
enhanced model of care that supports patients
oral medication at home.
remotely. 1.3
Enhance community hospital chemotherapy site
supervising physician capability through standard
education.
Limited scope and timeliness of
2. Enhance microbiology
2.1
Develop molecular methods of testing for infections
microbiology services are available
service capabilities in the
affecting cancer patients including C. difficile, influenza,
in the Northeast which may result in
Northeast to better respond
viruses and mycobacteria (e.g. tuberculosis).
longer wait times for results to be
to cancer patient infections.
received and treatment initiated for immunocompromised cancer patients.
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Cancer Care Ontario Cancer Activity Level Reporting. iPort 2015.
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“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. Boyer
Member of the NECC Patient and Family Advisory Council
Equity Ontario Cancer Plan IV Goal: Ensure health equity for all Ontarians across the cancer system
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Northeast Regional Cancer Plan 2015 - 2019
Equity Challenges in the Northeast The Northeast has the largest
Northeast Action Plans 1. Implement the second
1.1
Build relationships: Aboriginal Relationship and
Aboriginal population in the province.
Northeast (NE) Aboriginal
Cultural Competency training will be completed by 50%
Cancer incidence is increasing and
Cancer Plan, guided by
of cancer centre staff.
survival is worse for Aboriginal
the NE Aboriginal Cancer
1.2
Implement palliative care early identification and
people compared with other
Advisory Committee.
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.
province, resulting in inequitable
2.2
Develop and implement French symptom self-
access to services when they are only
management tools and support systems.
Ontarians.
The Northeast has the highest francophone population in the
offered in English.
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By 2019 we will:
2. Enhance francophone services.
3
North East Local Health Integration Network Integrated Health Services Plan 2016 – 2019.
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“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 Giddings
Member of the NECC Patient and Family Advisory Council
Integrated Care Ontario Cancer Plan IV Goal: Ensure the delivery of integrated care across the cancer care continuum
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Northeast Regional Cancer Plan 2015 - 2019
Integrated Care Challenges in the Northeast Only 65% of cancer patients
Northeast Action Plans 1. Clearly define
By 2019 we will: 1.1
Ensure new patient-centred models for the interdisciplinary
report that they know the
interdisciplinary care
ambulatory clinics at the cancer centre will be functioning.
next step in their care.4
pathways.
1.2
Implement well defined care plans tailored to individual patient
needs.
Pathology and laboratory
2. Enhance pathology
services provided outside
and laboratory
of the region can impact
services available
continuity of care.
within the region
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
through collaborative approaches. Geography in the Northeast
3. Collaborate with
increases patient reliance
primary care
practice to improve cancer screening rates.
on primary care providers
providers.
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.
throughout their cancer care.
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NRC Picker Ambulatory Oncology Patient Satisfaction Survey Q2, 2015. iPort.
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“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’Daiskey
Members of the NECC Patient and Family Advisory Council
Sustainability Ontario Cancer Plan IV Goal: Ensure a sustainable cancer system for future generations
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Northeast Regional Cancer Plan 2015 - 2019
Sustainability Challenges in the Northeast Complex haematology care is
Northeast Action Plans 1. Develop a sustainable
By 2019 we will 1.1
Remodel complex haematology care to reduce
primarily provided in the inpatient
model of care for
reliance on very few physicians and shift inpatient care
setting by only a few physicians.
complex haematology
to the outpatient setting where it is safe and effective.
2.1
Support organizations and providers to align or
in the Northeast. New quality based procedures that
2. Align clinical pathways
are planned for introduction will be
with Quality Based
modify clinical pathways with Quality Based Procedure
driven by best clinical evidence which
Procedure funding
funding guidelines to ensure effectiveness of care and
may require changing current practice.
guidelines.
optimize resource use.
3.1
Assess the smoking status of patients of the NECC
and offer active smokers smoking cessation services.
Twenty-one per cent (21%) of people
3. Enhance smoking
in the Northeast are smokers as
cessation services at the
compared to 18% for Ontario. Tobacco
NECC.
use remains the main cause of premature death and disease.5 4. Improve Northeast Cancer screening rates in the
screening rates by
4.1
In collaboration with regional partners and Northeast
Northeast are below provincial targets
reducing barriers.
residents, examine the barriers to cancer screening and
with 40% of eligible people overdue
where possible, develop and implement solutions to
for colorectal cancer screening, 42%
overcome barriers to cancer screening.
of women not screened for cervical cancer and 41.5% not screened for breast cancer.6 5
North East Local Health Integration Network Integrated Health Services Plan 2016 – 2019.
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Regional Scorecard Q3, 2015. iPort.
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“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 Petz
Member of the NECC Patient and Family Advisory Council
Effectiveness Ontario Cancer Plan IV Goal: Ensure the provision of effective cancer care based on best evidence
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Northeast Regional Cancer Plan 2015 - 2019
Effectiveness Challenges in the Northeast Physicians are geographically dispersed across the region.
Northeast Action Plans 1. Establish Physician
By 2019 we will 1.1
Align Breast, Colorectal, and GI Endoscopy Communities
Communities of Practice to
of Practice with Quality-based Procedure clinical
support enhanced provider
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
quality through education, process improvements and standards of care implementation.
Travel burden is a barrier in access to new and emerging technology.
2. Enhance technology to provide regional access.
HSN. 2.4
Develop genomics capabilities to provide access to
emerging personalized medicine testing in the region.
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www.hsnsudbury.ca
www.ncfsudbury.com
Northeast Regional Cancer Plan 2015 - 2019