Northeast Regional Cancer Plan 2015 - 2019

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.

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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.

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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.

Northeast Regional Cancer Plan 2015- 2019

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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.

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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