Pragmatic approach to quality metrics development in cancer.

60 Background: London Cancer aims to use transparency of service and quality measures to drive improvement in cancer care in North and East London and surrounding areas, serving our population of 3.5m people. Whilst the on-going implementation of the National Outcome and Service Dataset for UK is expected to take 18 months we have chosen to develop quality measures with the teams accountable to deliver the service by using available data from a variety of existent sources and illustrate this in value scorecards tracking the patient pathway. Methods: Building on an engagement exercise with patients, clinicians and charities in 2011 to identify which outcomes mattered most to patients, a small set of key pathways metrics was identified for each site specific cancer pathway board to monitor their progress in implementing integrated cancer care. Metrics were selected only if (a) clinically useful, in line with the current work plan and improvement effort; (b) accessible on a recurrent basis and requiring minimal manual effort; (c) facilitate the understanding of the patient pathway; (d) align with London Cancer objectives in improving survival, patient experience, and access to innovation and clinical trials. Pathway boards were invited to contribute with the intention to provide a pathway metrics value scorecards on a quarterly basis. Results: The first set pathway metrics scorecards, with 31 metrics, were published by June 2013. Key items include adherence to established best practice (16), data completeness (6), survival (3), pathway efficiency (3), and patient experience (3). Conclusions: Pathway metrics are reported at a system level, reflecting the care for our local population, against measures that are important to them and will allow visibility of success. Whilst current pathway metric development is limited by the availability of meaningful data we aim to build on the existing metrics in an iterative fashion. For this we are working with stakeholders to improve data quality.

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Improving Outcomes Through Principles of Best Practice Management: Australia's National Lung Cancer Framework

Journal of Global Oncology ◽

10.1200/jgo.18.97500 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 243s-243s

Author(s):

B. Daveson ◽

V. Milch ◽

J. Chynoweth ◽

L. Kable ◽

M. Austen ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Care ◽

Best Practice ◽

Cancer Control ◽

Communication Strategy ◽

Practice Management ◽

System Level ◽

Local Context ◽

Evidence Based ◽

National Implementation

Background and context: Lung cancer is estimated to be the fifth most commonly diagnosed cancer and leading cause of cancer death in Australia, representing 9.2% of all new cancer cases (n = 138,321) diagnosed and 18.9% of all cancer deaths (n = 48,586). The 5-year survival rate for those with lung cancer is 16%, compared with 68% for all cancers combined (between 2009 and 2013). Lung cancer is also the leading cause of cancer burden in Australia and patients affected by lung cancer may experience high levels of unmet need with associated psychological distress and decreased quality of life. Cancer Australia, Australia's national cancer control agency, developed the national Lung Cancer Framework: Principles for Best Practice Lung Cancer Care (Framework) to provide evidence-based, best practice information, strategies, tools and resources to support local adoption of the 5 principles for best practice management of lung cancer (principles): patient-centered care; multidisciplinary care; timely access to evidence-based care; coordination, communication and continuity of care; and data-driven improvements. Aim: The framework aims to improve the outcomes and experiences of people affected by lung cancer in Australia by supporting national uptake of the principles. Strategy/Tactics: Cancer Australia: • established a Lung Cancer Advisory Group to advise on strategies for national implementation of the framework and its principles • conducted a national lung cancer demonstration project, with advice from an Expert Steering Group, to demonstrate the delivery of lung cancer care according to the principles across a range of service delivery settings, and identify key factors contributing to ongoing delivery of best practice cancer care • completed systematic reviews for each principle to determine the effectiveness of the principles in improving lung cancer care processes and outcomes. Program/Policy process: To support national adoption of the framework and its principles, Cancer Australia: • developed a promotion and communication strategy for widespread national dissemination • convened a National Summit to bring together policy makers, clinical stakeholders and consumers to support local application of the principles, and drive optimal care for people affected by lung cancer • identified and communicated consumer, service, and system-level approaches to aid sustainable use of the principles. Outcomes: The evidence-based approach to the development of the framework and its principles identified ways to improve the healthcare system to achieve better outcomes for those affected by lung cancer in Australia. A coordinated approach to the delivery of the National Summit supported those involved in lung cancer care to share and adopt innovative and multilevel strategies for best practice care. What was learned: Embedding strategies to support implementation of the principles, responsive to local context, was key to enabling sustainable improvements in national lung cancer control.

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Validation of a real-time patient-reported experience measurement tool for cancer patients in Ontario.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.174 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 174-174

Author(s):

Lesley Moody ◽

Sarah Benn ◽

Luciano Ieraci ◽

Saurabh Ingale ◽

Simron Singh

Keyword(s):

Quality Improvement ◽

Real Time ◽

Patient Experience ◽

Cancer Care ◽

System Level ◽

Cronbach Alpha ◽

Ambulatory Oncology ◽

Patient Reported ◽

Multiple Variable ◽

Multiple Variable Regression

174 Background: Cancer Care Ontario (CCO) organizes and ensures quality cancer care for 16 million residents in Ontario. CCO's goal is to create a tool to enable reporting of the patient experience in real time. The study objective was to develop a validated real-time (close to or at point of care) patient reported experience measurement (PREM) tool to drive quality improvement, advance system planning and ensure cost effective resource allocation based on patients’ needs, wants and preferences in ambulatory oncology treatment phase. Methods: Consisting of 28 questions – 18 core questions; 2 open-ended responses; and 8 demographic questions the tool underwent cognitive testing with patient family advisors and was validated using a pilot at 6 cancer centres from April to August, 2015. It was administered using several delivery modes: tablets, patient portals, post cards and paper. The patient journey in visiting centres was conceptualized as containing the steps or domains of interest: arrival, appointment/consultation and overall experience. To validate the patient experience conceptual model, an exploratory factor analysis was performed and compared to CCO’s 8 domain patient experience model. Reliability and validity of the tool was tested using Cronbach’s alpha and multiple variable regression analysis in partnership with Ipsos Reid. Results: 557 responses (496 electronic and 61 paper) formed the basis of the analysis. The tool was shown to be both valid and reliable - an overall adjusted R2 value of 64% from multiple variable regression on overall patient experience; and an overall Cronbach alpha value of 0.83, respectively. Individual Cronbach alpha values ranged from: 0.69 for “appointment/consultation”, 0.55 for “overall experience” and 0.24 for patient “arrival.” Conclusions: Statistical analysis results were used to produce a final validated tool for deployment to systematically capture PREMs through an electronic system in Ontario, Canada in 2016.To our knowledge this is the first of its kind. Collection of real time PREMS will ensure local and system level planning and quality improvement in the cancer system are rooted in what matters most to patients and their families.

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Impact of COVID-19 pandemic on the oncologic care continuum: urgent need to restore patients care to pre-COVID-19 era

Journal of Radiotherapy in Practice ◽

10.1017/s1460396921000303 ◽

2021 ◽

pp. 1-11

Author(s):

Ernest Osei ◽

Ruth Francis ◽

Ayan Mohamed ◽

Lyba Sheraz ◽

Fariba Soltani-Mayvan

Keyword(s):

Cancer Care ◽

Healthcare Professionals ◽

Negative Impact ◽

System Level ◽

Care Continuum ◽

Cancer Services ◽

Number Of Patients ◽

Prevention Programmes ◽

Screening And Prevention ◽

The Impact

Abstract Background: Globally, cancer is the second leading cause of death, and it is estimated that over 18·1 million new cases are diagnosed annually. The COVID-19 pandemic has significantly impacted almost every aspect of the provision and management of cancer care worldwide. The time-critical nature of COVID-19 diagnosis and the large number of patients requiring hospitalisation necessitated the rerouting of already limited resources available for cancer services and programmes to the care of COVID-19 patients. Furthermore, the stringent social distancing, restricted in-hospital visits and lockdown measures instituted by various governments resulted in the disruption of the oncologic continuum including screening, diagnostic and prevention programmes, treatments and follow-up services as well as research and clinical trial programmes. Materials and Methods: We searched several databases from October 2020 to January 2021 for relevant studies published in English between 2020 and 2021 and reporting on the impact of COVID-19 on the cancer care continuum. This narrative review paper describes the impact of the COVID-19 pandemic on the cancer patient care continuum from screening and prevention to treatments and ongoing management of patients. Conclusions: The COVID-19 pandemic has profoundly impacted cancer care and the management of cancer services and patients. Nevertheless, the oncology healthcare communities worldwide have done phenomenal work with joint and collaborative efforts, utilising best available evidence-based guidelines to continue to give safe and effective treatments for cancer patients while maintaining the safety of patients, healthcare professionals and the general population. Nevertheless, several healthcare centres are now faced with significant challenges with the management of the backlog of screening, diagnosis and treatment cases. It is imperative that governments, leaders of healthcare centres and healthcare professionals take all necessary actions and policies focused on minimising further system-level delays to cancer screening, diagnosis, treatment initiation and clearing of all backlogs cases from the COVID-19 pandemic in order to mitigate the negative impact on cancer outcomes.

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Quality Measures for Symptoms and Advance Care Planning in Cancer: A Systematic Review

Journal of Clinical Oncology ◽

10.1200/jco.2006.06.8650 ◽

2006 ◽

Vol 24 (30) ◽

pp. 4933-4938 ◽

Cited By ~ 64

Author(s):

Karl A. Lorenz ◽

Joanne Lynn ◽

Sydney Dy ◽

Anne Wilkinson ◽

Richard A. Mularski ◽

...

Keyword(s):

Advance Care Planning ◽

Cancer Care ◽

English Language ◽

Basic Research ◽

Quality Measures ◽

Self Report ◽

Care Planning ◽

Cancer Management ◽

Patient Goals ◽

Advance Care

Purpose Measuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures and the evidence to support their use in pain, dyspnea, depression, and advance care planning (ACP), and to identify research gaps. Methods English-language documents were selected from MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO (1995 to 2005); Internet-based searches; and contact with measure developers. We used terms for each domain to select studies throughout the cancer care continuum. We included measures that expressed a normative relationship to quality, specified the target population, and specified the indicated care. Dual data review and abstraction was performed by palliative care researchers describing populations, testing, and attributes for each measure. Results A total of 4,599 of 5,182 titles were excluded at abstract review. Of 537 remaining articles, 19 contained measures for ACP, six contained measures for depression, five contained measures for dyspnea, and 20 contained measures for pain. We identified 10 relevant measure sets that included 36 fully specified or fielded measures and 14 additional measures (16 for pain, five for dyspnea, four for depression, and 25 for ACP). Most measures were unpublished, and few had been tested in a cancer population. We were unable to describe the specifications of all measures fully and did not search for measures for pain and depression that were not cancer specific. Conclusion Measures are available for assessing quality and guiding improvement in palliative cancer care. Existing measures are weighted toward ACP, and more nonpain symptom measures are needed. Additional testing is needed before the measures are used for accountability, and basic research is required to address measurement when self-report is impaired.

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Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada

JCO Oncology Practice ◽

10.1200/op.21.00170 ◽

2021 ◽

pp. OP.21.00170

Author(s):

Simron Singh ◽

Ashley Farrelly ◽

Catherine Chan ◽

Brett Nicholls ◽

Narges Nazeri-Rad ◽

...

Keyword(s):

Health Care ◽

Cancer Care ◽

Gynecologic Oncology ◽

Maslach Burnout Inventory ◽

Well Being ◽

System Level ◽

Survey Study ◽

Cross Sectional Survey ◽

Questionnaire Response ◽

Mental Health Patient

PURPOSE: Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada. METHODS: This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory. RESULTS: A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001). CONCLUSION: Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.

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The cancer care experiences of gay, lesbian and bisexual patients: A secondary analysis of data from the UK Cancer Patient Experience Survey

European Journal of Cancer Care ◽

10.1111/ecc.12670 ◽

2017 ◽

Vol 26 (4) ◽

pp. e12670 ◽

Cited By ~ 17

Author(s):

N. J. Hulbert-Williams ◽

C.O. Plumpton ◽

P. Flowers ◽

R. McHugh ◽

R.D. Neal ◽

...

Keyword(s):

Cancer Patient ◽

Patient Experience ◽

Cancer Care ◽

Secondary Analysis ◽

And Bisexual ◽

Experience Survey ◽

The Uk

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Expert Stakeholder Prioritization of Process Quality Measures to Achieve Patient- and Family-Centered Palliative and End-of-Life Cancer Care

Journal of Palliative Medicine ◽

10.1089/jpm.2020.0633 ◽

2021 ◽

Author(s):

Claire E. O'Hanlon ◽

Charlotta Lindvall ◽

Karleen F. Giannitrapani ◽

Melissa Garrido ◽

Christine Ritchie ◽

...

Keyword(s):

End Of Life ◽

Cancer Care ◽

Quality Measures ◽

Process Quality ◽

Family Centered

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Home-Based Pediatric Cancer Care: Perspectives and Improvement Suggestions From Children, Family Caregivers, and Clinicians

JCO Oncology Practice ◽

10.1200/op.20.00958 ◽

2021 ◽

pp. OP.20.00958

Author(s):

Lindsay A. Jibb ◽

Julie Chartrand ◽

Tatenda Masama ◽

Donna L. Johnston

Keyword(s):

Family Caregivers ◽

Pediatric Cancer ◽

Cancer Care ◽

Care Center ◽

System Level ◽

Pediatric Care ◽

Children With Cancer ◽

Key Informants ◽

Home Based ◽

Home Based Care

PURPOSE: Although the hospital remains the dominant site for delivering most pediatric cancer care, home-based care is increasingly provided. To effectively deliver comprehensive, relevant, and acceptable care in children's homes, the voices of these key informants must be considered. We examined the views of children with cancer, their family caregivers, and clinicians on home-based cancer care to identify necessary strategies to improve the delivery of care. METHODS: Children with cancer, their family caregivers, and multiprofessional clinicians who provide care at a tertiary pediatric care center or in the community participated in audio-recorded, semistructured interviews in French and English. Interviews were conducted until data saturation in each participant group was achieved. Interviews were transcribed, coded, and analyzed using thematic analysis. RESULTS: Thirteen children, 20 family caregivers, and 22 clinicians participated. Home-based care was endorsed as a means to improve child health-, family social- and financial-, and system-level outcomes. The success of a home-based model is built on care that addresses child and family informational, treatment and care, material, and psychosocial needs. Mechanisms to improve care include enhanced homecare agency-hospital-family communication, training for homecare nurses in pediatric cancer care, virtual solutions, and an expanded breadth of services provided in-home. Child-, family-, and system-related factors affect the delivery of optimal home-based care. CONCLUSION: Children, families, and clinicians value a model of pediatric cancer care that incorporates home-based services. The insights of these key informants should be reflected in the principles that become the basis of home-based cancer care best practices.

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