Priorities C O M M M I T T E D T O D E L I V E R I N G T H E H I G H E S T Q U A L I T Y C A N C E R C A R E T O T H E P A T I E N T S & F A M I L I E S O F T H E E R I E S T . C L A I R R E G I O N

A MESSAGE FROM OUR REGIONAL VICE PRESIDENTIt’s been a year of hard work rewarded by significant accomplishments. I am pleased to be able to briefly touch upon the following key developments:

SUCCESSES:Diagnostic Assessment Programs (DAPs) – Breast DAPs have opened at Bluewater Health and Hôtel-Dieu Grace Hospital, making coordinated and high-quality breast assessment accessible to everyone in Erie St. Clair (ESC). Bluewater Health is in the planning stages for colorectal, prostate and lung cancer DAPs. A pilot project, under the umbrella of the Regional Cancer Program, is also underway for patients diagnosed with colorectal cancer that will coordinate surgery and oncology treatment. The pilot project will link with hospital based colorectal DAPs in Essex and Kent Counties. Within DAPs, Nurse Navigators work closely with patients as they progress through diagnosis, helping them understand and prepare for the various tests and procedures they may experience and generally helping them navigate the sometimes complex cancer care system.

Colonoscopy Wait Times – Higher-risk colorectal cancer patients are seeing shorter wait times for colonoscopies. ESC exceeded regional targets with 71% of higher-risk patients accessing colonoscopies within provincial targets.

Cancer Surgery Wait Times – ESC still has one of the shortest wait times to cancer surgery within the province. Eighty percent of surgeries are completed within priority targets. Put another way, the majority of cancer surgeries are completed within 4 weeks.

Patient Experience – By establishing an ESC Regional Cancer Program (ESC RCP) Community Advisory Committee (see Art’s story under Goal 13) we have improved our access to a wider range of perspectives on the quality of care our patients receive. The Committee

brings together patients and caregivers, from across ESC, to learn from their stories and experiences. The more patients we reach, the greater the opportunity for understanding and improvement. To that end, the ESC RCP engages patients and caregivers in a variety of ways through surveys, focus groups, comment cards, internet resources, formal groups and informal discussions.

IMPROVEMENTS WHERE WORK IS STILL UNDERWAY:Cancer Screening – Our region’s participation in mammography screening is among the highest in the province. Screening for colorectal cancer has increased; 30 percent of our 50-74 year old population has had a Fecal Occult Blood test in the last two years. That’s good; 90 percent of colorectal cancers can be cured if found early enough. Unfortunately, the remaining 70 percent of this high-risk group is not taking advantage of this easy at-home test.

Our region’s participation in Pap tests is the lowest in the province. Like colorectal cancer, cervical cancer can also be cured if detected through regular screening.

Palliative Care – Community Palliative Care Teams (CPCTs) in Kent and Essex counties now join the well-established team in Lambton county to provide region-wide access to timely, coordinated and expert palliative services to patients and families in the community.

A successful new consultative Palliative Medicine Program has also been established at Windsor Regional Hospital which improves coordination of care between the Cancer Centre, Windsor Regional Hospital’s in-patient care programs and services delivered by our community partners across the region – all with a primary focus on managing pain and other symptoms.

CHALLENGES:Radiation Wait Times – Our wait times for Radiation Treatment are still among the longest in the province. We expect significant improvements by year end thanks to a “lean process” that identified efficiency opportunities, the addition of a fifth Radiation Oncologist, and replacement of a third radiation treatment machine with state-of-the-art technology.

Healthy Behaviour Scores – Our region’s scores are among Ontario’s worst. Our smoking rates are high, we drink too much alcohol, we do not eat enough fruits and vegetables and we are physically inactive. Given that 50 percent of cancers are preventable, the need to promote healthier lifestyles becomes more and more urgent.

CONTINUING OUR COMMITMENT:While we celebrate these successes and continue to tackle these ongoing challenges, one overarching fact remains: our total commitment to improving the cancer journey experience for patients and families throughout Erie St. Clair. The cancer care partners within the ESC RCP remain united in a single-minded pursuit of excellence that results in outstanding patient-centred cancer care.

–ClaudiadenBoerGrimaRegionalVicePresident

A P R I O R I T I z E D P L A NSIX STRATEGIC PRIORITIES TO IMPROVE CANCER SERVICES EVERY STEP OF THE WAY

Anat Ravid is the Erie St. Clair Surgical Oncology Program Clinical Lead. As an active cancer surgeon, she knows that smokers are at greater risk than non-smokers for complications following surgery. Smoking rates in Erie St. Clair (ESC) – among the highest in the province – match our higher rates of respiratory illness and lung cancer. That’s what makes an in-patient smoking cessation program a priority area for the ESC Regional Cancer Program.

Dr. Ravid would like more smokers to say “I quit.”

Interventionsthathelppeoplestopsmokinghaveledtoa15percentimprovementinthe

long-termsuccessfortobaccousersadmittedtohospital.Theyalsohelpreduce

readmissionstohospital.

Priority #1: C A N C E R R I S K R E D U C T I O N

Goals 1 & 2: Implement hospital in-patient smoking cessation strategies across Erie St. Clair

Design and implement an out-patient smoking cessation strategy. Pilot the strategy within two to three health care settings

WHATHealth care settings are uniquely positioned to identify patients who smoke and to help those who want to quit. Our program uses bedside education and counselling (when requested) in addition to recommendations for nicotine replacement or pharmacotherapy. When necessary, we’ll also refer patients to community programs for additional support. Hospital-based interventions have been widely recognized as “best practices.” Their proven success provides the opportunity to adapt the program to an out-patient setting.

WHY Smoking rates in Erie St. Clair (ESC) are among the highest in the province. Not surprisingly, we also have higher rates of respiratory illness and lung cancer.Hospital-based interventions have led to a 15 per cent improvement in the long term “quit rate.”

Daily smokers are 80 per cent more likely to be hospitalized than those who never have smoked. They’re at greater risk of post-operative complications requiring Intensive Care. Smokers are also at greater risk of post-operative wound-healing complications, including infections and impaired bone healing. Tobacco users represent 19 per cent of all hospital patients.

Encouraging and helping those who want to quit changes the picture dramatically. Benefits include:• improved quality and longer length of life

regardless of the age at which one quits • improved pulmonary function by

approximately five per cent within months of quitting smoking

• reduced risk of coronary heart disease by half within one year of quitting

• decreased the risk of oral and esophageal cancer by half within five years of smoking cessation

• reduced hospital readmissions and a 77 per cent relative risk reduction in mortality

HOWWork with cancer care partners to:• implement in-patient smoking cessation

programs within ESC hospitals• develop an ambulatory care smoking

cessation strategy• create pilot programs in two care settings

i.e. Surgery, Cancer Centre

Goal 3: Extend Your Health Matters™ to two workplace settings within each tri-county region

WHAT Your Health Matters™ is a cancer risk-reduction program that focuses on “modifiable risk factors” – the kinds of behaviours people can control and change. The program, which operates in workplaces, helps people identify behaviours that elevate their risk of cancer. It provides education and information about these risks, helps people plan behaviour change and provides tracking tools to monitor progress over time. The program also provides cancer screening services and, when necessary, referrals to helpful community-based programs and resources.

WHYHalf of all cancers can either be prevented or detected early, before they become serious health concerns. Prevention is, of course, the best solution and risk reduction remains the best prevention strategy. In many cases, the preventative lifestyle changes are fairly easy to make.

Despite all that, Erie St. Clair residents lag far behind the province, with “healthy behaviour scores” among the worst in Ontario. Compared to provincial averages, our smoking and alcohol consumption rates are higher and our physical activity and fruit and vegetable intakes are lower. We can do better and programs like Your Health Matters™ help.

HOWWork with cancer care partners to extend Your Health Matters™ to tri-county workplace settings.

“LungCanceristhemostfrequentlydiagnosedcancerinOntario.Itisdirectlycorrelatedtotobaccouse.Almosthalfofdailysmokerssaythey’verecentlytriedtoquitandwe’reworkinghardtohelpthemsucceed.”Dr.AllenHeimann,MedicalOfficerofHealth,Windsor-EssexCounty

HealthUnit.

Priority #1:C A N C E R R I S K R E D U C T I O N

( C O N T I N U E D )

Dianne George is a Nurse Manager of Community Health at the Kettle and Stony Point Health Centre. She’s seen the improvement in cancer statistics within aboriginal communities as more and more First Nations people have embraced the area’s improved screening, education and prevention programs.

Because these successes have demonstrated the value of greater outreach and education, ESC RCP, in partnership with Cancer Care Ontario, will develop and implement an Integrated Cancer Screening program to increase screening rates for breast, cervical and colorectal cancers in First Nations and Métis communities, on and off reserves.

Dianne sees the benefits of better screening

Priority #2: I N T E G R AT E DC A N C E R S C R E E N I N G

Goal 4: Work in partnership with Primary Care Providers to increase screening participation rates

WHATWe’re creating a more integrated approach to cancer screening by linking the three provincial screening programs for breast, cervical and colorectal cancer. Program elements include: • a common information technology system• consistent messaging• Primary Care Provider support for patient

screening, ensuring follow up of screening abnormalities

• combined screening promotion and performance measures

WHYBetter screening programs lead to earlier detection. As a result, treatments are less invasive and more effective and, importantly, death rates decrease

Colorectal cancer is 90 per cent curable with early detection and cervical cancer, after early detection of cervical cell abnormalities, can be prevented with HPV vaccine.

Our area’s residents do very well in mammography screening, with participation rates among the highest in the province. But

the percentage of females 50 to 69 years who are up to date for all cancer screening is very low at just eight per cent.

HOWRecognizing that Primary Care Providers are key influencers for their patients’ participation in screening, our program includes the following strategies:• strengthen Primary Care Network • provide education and follow-up to provider

participation reports• develop & distribute integrated screening

tools to assist providers

Goal 5: In partnership with CCO, develop and implement a ‘Never Screened/ Under Screened’ Integrated Cancer Screening initiative within First Nations and Métis communities across Erie St Clair

WHAT The First Nations & Métis Cancer Screening Project is a successful proposal, funded by Cancer Care Ontario (CCO), to increase screening for breast, cervical and colorectal cancers in First Nations & Métis communities, on and off reserves. The program will provide health education and a strong referral component that will link participants to easily

accessible cancer screening services. When necessary, this will include on-site screening and referral to community-support programs that can help people adopt healthy lifestyle changes.

The project builds on the success of the Your Health Matters™ program (see goals #1 and #2) by adopting practices that are proven to work well with under-screened populations.

WHYHard-to-reach populations like First Nations and Métis communities face unique barriers to participation in screening programs. Culturally sensitive strategies have proven effective in breaking down these barriers and increasing participation.

The project, which will roll out over two years, will provide education and improved access to screening for First Nations and Métis communities.

HOW• establish a regional Steering Committee to

oversee proposal development• develop and submit a proposal to CCO for

approval and funding• key activities to be identified within the

approved proposal

Priority #2:I N T E G R AT E D C A N C E R S C R E E N I N G

( C O N T I N U E D )

Hard-to-reachpopulationslikeFirstNationsandMétiscommunitiesfaceunique

barrierstoscreeningandparticipation.Culturallysensitivestrategieshave

proveneffectiveinbreakingdownthesebarriersandincreasingparticipation.

Priority #3: I M P R O V E PAT I E N T O U T C O M E S

When doctors discovered a suspicious mass in Carol’s lung, her family physician recommended the Lung Diagnostic Assessment Program. Thanks to the work of her DAP Nurse, the necessary appointments followed within days and she was able to meet with a surgeon within two weeks. Having the support of a knowledgeable “system navigator” helped her understand the diagnostic process and contributed to a more streamlined diagnosis.

Breast, colorectal, lung and prostate cancer are the four major cancers in our area. Expanding DAPs and ensuring access to quality diagnostic programs is a priority.

Carol knows why our focus on DAPs is so important

Goal 6: Implement & coordinate standards-based regional Multidisciplinary Cancer Conferences (MCC) for cancer surgery disease sites with a volume of 35 cases or more

WHATMCCs are regularly scheduled meetings where health care providers from a variety of disciplines - Surgeons, Radiologists, Pathologists, Oncologists and other specialists from all Erie St. Clair hospitals - come together to review individual cancer cases and make recommendations on the best treatment options.

MCCs ensure that cancer patients receive all of the most appropriate diagnostic tests, and treatment options/recommendations.

MCCs are currently based on specific disease sites within the body – breast, gastrointestional, genitourinary, lung, hepatobiliary, hematology and endocrine disease sites. Our program will now expand to include gynecology, head and neck and neurology disease sites. We will also increase the participation of hospitals and physicians in MCCs across ESC so more patients can benefit from this multidisciplinary approach.

WHYEvidence shows that, up to 43 per cent of the time, a patient’s treatment plan will change following an MCC review. Moreover, up to 95 per cent of all MCC recommendations are followed. The wider perspective of input made possible by MCCs clearly provides direct benefits to our patients.

HOW• increase MCC participation at all ESC

hospitals • phase in MCCs for all disease sites for which

35 or more surgeries are performed

Goal 7: Ensure regional access to organized Diagnostic Assessment Programs for the four major cancer sites: breast, colorectal, lung and prostate cancer

WHATWhen symptoms or findings suggest the possibility of cancer, patients want and need rapid assessment. That’s what Diagnostic Assessment Programs (DAPs) do, by providing:• a personalized contact for access to care • standardized care plans based on known best

practices• information/support for patients and their

families throughout the assessment process• ongoing program performance evaluation

The design for DAPs in ESC is unique. They are virtual programs that operate within existing community services and providers.

Expanding DAPs to include colorectal and prostate cancer patients will provide faster access to quality diagnostic programs. That’s a very good thing for patients, their families and for care providers.

WHYBeing assessed for cancer is an anxious time for patients, families and care providers. Poor coordination and lengthy wait times only make it worse.

Diagnostic Assessment Programs are designed to minimize those added strains by coordinating “the right tests at the right time by the right person.” Now, with a single referral, the entire assessment process is coordinated through a personalized point of contact. It works well; our existing DAPs (for breast and lung cancer) have provided significant reductions in wait times. Patients and caregivers agree that the programs improve the assessment process. They value the information, support and coordination provided through DAPs. More than 80 per cent say they are “highly satisfied” with the program.

With our DAP’s expansion to include colorectal and prostate cancer, many more patients will now enjoy the benefits of this successful program.

HOW• implement a colorectal DAP pilot program• design and implement county-based

colorectal DAPs• design and implement a regional prostate

DAP

Goal 8: Implement systemic standards of care across Erie St. Clair

WHATCCO has coordinated a province-wide plan for systemic treatment (chemotherapy). This plan ensures all cancer patients requiring chemotherapy have access to the same standard of treatment, available at locations as close to home as possible.

WHYAs Ontario’s population ages in coming years, the number of people diagnosed with cancer is expected to increase – estimates range from 11 to 17 per cent by 2012/13. More and more people will require cancer treatment that includes chemotherapy. This demand may affect wait times.

With the introduction of newer, more successful and more complex drug combinations to treat a wider variety of cancers, there is a greater need for education and care delivery standards.

Priority #3:I M P R O V E PAT I E N T O U T C O M E S

( C O N T I N U E D )

DiagnosticAssessmentPrograms(DAPs)helppatientsandtheirfamiliesunderstandthediagnosticprocessandcontributetoamorestreamlineddiagnosis.Morethan80percentofpatientswithintheESC

DAPsarehighlysatisfiedwiththeprogram.

New training and certification requirements for care providers will:• enhance the safe handling and administration

of cytotoxic drugs • ensure patient safety

The standards extend to all ESC sites delivering chemotherapy programs.

HOW• enhance pharmacist/pharmacy technician

services• implement Cancer Care Ontario’s Systemic

Collaborative Initiative across ESC• achieve wait time targets

Goal 9: Design and develop a regional scorecard consisting of core indicators to support the provision of unique data at a regional, organizational and service level

WHATThe ESC Regional Cancer Program uses a very successful “scorecard system” to track the quality of cancer care at a regional level. Now, our regional partners will have a new scorecard to track their work at an

organizational or service delivery level. Together these scorecards will provide regular snapshots of our regional cancer care system, allowing us to compare our performance against targeted benchmarks. Doing so will help us identify opportunities for quality improvement which, in turn, will result in an improved cancer care experience for patients, families and their supporters.

WHYScorecards identify performance strengths and weaknesses, reveal quality improvement opportunities and help us evaluate the effectiveness of our operational strategies. By allowing us to compare performance standards across the region, we can ensure that our patients across ESC have access to the same quality of care, regardless of where they live.

HOW• determine core indicators common to all

ESC hospitals• determine unique organizational indicators

related to cancer care service provision

HardtoreachpopulationslikeFirstNationsandMetiscommunitiesfaceuniquebarriers

toscreeningandparticipation.Culturallysensitivestrategieshaveproveneffectiveinbreakingdownthesebarriersandincreasingscreeningparticipation.

Priority #3:I M P R O V E PAT I E N T O U T C O M E S

( C O N T I N U E D )

Priority #4: G E N E T I C S C R E E N I N G & C O U N S E L L I N G

Teresa’s family has a history of breast cancer. When her younger sister was diagnosed, doctors recommended that Teresa undergo genetic screening to determine if she too was predisposed to cancer. The results were positive, leaving her with a difficult decision. Today, after undergoing preventative surgeries, she’s a vocal advocate of genetic screening. It has given her, she believes, a more confident future with her husband and young children. Genetic counselling is available at Windsor Regional Hospital, or at London Health Sciences Centre. Wait times in Windsor are six months compared to just two in London. That’s why improving access to cancer genetic screening and counselling is a priority.

Teresa is a vocalsupporter ofgenetic screening

Goal 10: Improve access to cancer genetic screening & counselling for Erie St Clair residents

WHATHereditary cancers account for five to ten per cent of all cancers. For members of the affected families, genetic screening can help identify those who are at greater risk, often in advance of symptom onset.

Genetic counselling is the first step in identifying those for whom genetic screening is an appropriate approach.

WHYWe’ve learned a lot about genes and cancers in the last 10 years. We know that genetics play an important role in the incidence of cancer and that screening can, for some families, be part of an important pre-emptive strategy. There are currently three cancers for which genetic counselling may be useful: breast, ovarian and colorectal.

The South West Medical Genetics Program provides these services to patients in ESC. Residents can access the services through monthly satellite clinics at the Cancer Centre at Windsor Regional Hospital or anytime at London Health Sciences Centre. Unfortunately, wait times for patients who prefer local care are long – six months compared to two months for those willing to travel to London.

The volume of referrals from ESC suggests this is an underutilized service for those who are at higher risk.

HOW• deliver community and physician education

re. cancer genetics and counselling/screening services

• implement a High Risk breast screening program within Ontario Breast Screening Program (OBSP)

• explore the potential of establishing a regional genetic High Risk breast clinic

GeneticScreeningsaveslivesbyalertingpatientstocancerrisksearlyon.Hereditarycancersaccountfor5%-10%ofallcancers.

Priority #5: C A N C E R S E RV I C E D E S I G N & D E L I V E RY

Shortly after being diagnosed with breast cancer, Lise connected with Shannon Bellaire, one of the Nurse Practitioners with the Cancer Program at Windsor Regional Hospital. Lise credits Shannon with greatly simplifying and easing her journey through treatment. From being available to answer questions and discussing alternative therapies, to helping her quickly access prescription drugs, Shannon made the experience more relaxed and responsive to her personal needs.

The challenge in designing or improving services is to understand the complete patient experience. In doing so, we will define the roles of the cancer care delivery team members and maximize our resources to deliver the right care to the right person, at the right time and in the right place – all the while supporting the patient in self-managed care.

Lise appreciates the support of her Nurse Practitioner

Goal 11: Establish a philosophy of patient centred care as a key driver of cancer services design and delivery

WHATPatients are our reason for being. Their experiences, along with those of the public and health care staff, provide valuable information that can and should be used to improve our services.We will continue to work to better understand the needs and concerns of our patients. We will build a patient-centred model of care that ensures patients’ needs remain front and foremost and that care providers organize and work together to provide patients with the right care, at the right time, by the right person.

WHY Our challenge is to go beyond consultation, compliments and complaints. We want to truly and fully understand the complete patient experience and to use this insight when re-designing our services. “The biggest untapped resources in the health system are not physicians, but users. We need systems that allow people and patients to be recognized as producers and participants, not just receivers of systems.”

HOW • capture patient experiences in the form of

shared stories and use this knowledge to design or improve services, resulting in more appropriate, efficient, cost-effective and sustainable services

• define the role/scope of the members of the cancer care delivery team

• maximize provider resources to deliver the right care to the right person, at right time, at the right place

• support the patient as an active partner in their self-managed care

Goal 12: Facilitate and/or provide professional education for clinicians

WHAT Our goal is to support attendance at, or create opportunities for, clinical education and knowledge exchange. These opportunities may take a variety of forms – from self-directed learning activities and journal clubs to formal conferences and seminars.

WHY When care providers maintain their competencies and remain abreast of new knowledge and new directions in cancer care,

patients are assured of their expertise and of their ability to deliver quality care.

Emerging technologies, care standards and guideline developments often necessitate additional training and certification. CCO holds all cancer service providers accountable to meeting standards of quality and performance. Professional bodies also hold health care practitioners accountable for their ongoing learning and maintenance of expertise.

HOW• provide and/or ensure access to professional

education opportunities for clinicians

Priority #5:C A N C E R S E RV I C E D E S I G N A N D D E L I V E RY ( C O N T I N U E D )

Everythingaboutthecaredeliverysystemshouldfocusonimprovingthepatient

experience.HavingaccesstoqualifiedandcompassionateNursePractitionersis

justonewayservicedeliveryisimproving.

Priority #6: I M P R O V E PAT I E N T E X P E R I E N C E

Art’s family is all too aware of the realities of cancer, in part because of his own diagnosis. After completing his treatments, he decided to use his experiences to contribute to cancer services planning and joined the Erie St. Clair Regional Cancer Program Community Advisory Committee.

Patients are uniquely able to provide insights and suggestions for quality improvements. By talking to patients in a variety of ways – through surveys, focus groups, comment cards, internet, formal and informal discussions – we obtain valuable feedback that helps us improve our patient-focused care.

Art draws on his own experience to help others

Goal 13: Ensure that patient and family voices influence and guide our quality care improvements

WHATIt’s important to know how patients and families feel about the care they receive through our programs. We are expanding our existing feedback mechanisms to provide more ways to share their stories and experiences. Some people prefer a quick note written in a care setting while others are comfortable completing surveys or participating in focus groups. Still others want to become more actively involved, in an advisory capacity. By making it easier for everyone to become involved, at their comfort level, we obtain a broader and clearer picture of patient experiences. That feedback helps us identify opportunities for improvement.

WHYPatients remain the focus of all cancer care. The quality of their experience is the ultimate test of our efforts. By involving patients in our process reviews and development, our care teams gain a deeper and more meaningful insight into the patient impacts of their decisions.

HOW• establish and build an ESC Community

Advisory Committee• strengthen patient satisfaction survey and

focus group/feedback processes across ESC• model an experience-based design guide • ensure patient stories guide planning and

improvement initiatives

Goal 14: Establish a patient education framework that uses Oncology Interactive Navigator™ (OIN) as a key patient/family/provider resource

WHATThe Oncology Interactive Navigator™ (OIN) provides patients and families with information and linkages to evidence-based, disease specific, community support programs and services. The web based tool provides information on all stages of the cancer journey - from pre-diagnostic suspicions through survivorship or end of life.

OIN™ allows patients to get information about their disease in the comfort of their homes. That’s important, especially in the hours and days following diagnosis, when anxieties and fears are heightened.

WHYOur goal has been to connect patients with the OIN™ system as soon as possible after diagnosis (at the time of referral to the Cancer Centre and through surgeons at the time of diagnosis), for patients with melanoma and colorectal cancer. Now it will be expanded to include lung cancer and also be provided to patients referred to the Diagnostic Assessment Programs. So far, results have been promising:

• 38 per cent and 53 per cent of patients with colorectal and melanoma cancers (respectively) who received OIN™ information via their New Patient Referral package have accessed the OIN™

• Nearly 80 per cent of patients given information about OIN™ by their surgeon at the time of diagnosis have used the system

The site is authoritative and up to date, thanks to a team of experts from across Canada whose ongoing input reflects the latest evidence and practice. OIN™ also provides information on ESC community resources and services.

Patients commonly receive large volumes of repeated information that is overwhelming to sort through. OIN™ provides a user-friendly way to access information whenever it is needed, even late at night. And because it is also accessible to friends and family, OIN™ relieves patients from having to repeat information over and over and ensures that everyone supporting them has the same accurate information about the disease, the treatment and management of symptoms, etc.

HOW• Integrate OIN™ within DAP structure and

processes• Explore opportunities for expanding OIN™

to other disease sites

Goal 15: Roll-out Pain & Symptom Management Guidelines across ESC

WHATCCO has released pain and symptom guidelines that help care providers assess and manage patients’ symptoms.

Many assessment tools may be used but the primary tool consistently used in Ontario is the Edmonton Symptom Assessment System (ESAS). Patients or their caregiver are asked to complete an ESAS survey, both at the Cancer Centre and in the community.

ESAS assesses and tracks nine common symptoms experienced by cancer patients over time – pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath – rates their severity from the patient’s perspective, and alerts care providers to actions needed to better manage these symptoms.

WHYThe patient’s opinion of symptom severity is paramount. ESAS alerts the Health care Practitioner to symptoms that require relief and comfort. It also provides a standardized way to rank and communicate symptom severity.

Priority #6:I M P R O V E PAT I E N T E X P E R I E N C E

( C O N T I N U E D )

OurCommunityAdvisoryCommitteeallowspatients,familiesandotherconcernedpeopletoinformthegrowthanddevelopmentofourprogramsandservicesfromauniqueand

importantperspective.

CCO’s guidelines are based on evidence and best practice. They identify consistent and effective interventions to alleviate patient symptoms.

HOW• Deliver education sessions to care providers• Conduct audits to ensure adherence to the

guidelines

Goal 16: Continue to build a cross-sector, high-quality ‘system’ of Hospice palliative care for Erie St. Clair

WHATWhen active treatment is no longer the primary goal of cancer care, integrated palliative care is critical to ensuring that patient care is well-coordinated, their symptoms are well managed and that they are properly supported.

WHYA comprehensive ESC Hospice Palliative Care report was released in 2008. It included recommendations for improved quality, coordination and integration of

hospice palliative care services across ESC. Wide implementation of the report’s recommendations is now underway, including:• educational strategies for care providers • the formation of expert care teams • the development of accountability and

reporting systems• the planning for a full continuum of care

settings

Key goals of the program across ESC are:• better coordination of care among multiple

providers • development of interest and expertise in

Palliative Medicine among a larger group of Family Physicians

HOW• support advancement of a full continuum

of care settings and services for End of Life Care / Hospice Palliative Care in all three ESC counties

• support building and integration of Hospice Palliative Care programs in all care settings where patients die

• continue with Hospice and Palliative Medicine integration activities and projects

Priority #6:I M P R O V E PAT I E N T E X P E R I E N C E

( C O N T I N U E D )

Erie St. Clair Regional Cancer

Program

Communities Served

L a k E E r i E

L a k ES T . C L a I R

L a k E H U R O N

“Together we are committed

to minimize the impact of

cancer and improve the quality

of life for the residents of the

Erie St. Clair Region.”

2220 Kildare Road, Windsor, ON N8W 2X3519-253-3191 ext 58540

www.wrh.on.ca/escrcp