Cancer Care Nova Scotia enewsletter masthead

Developing Standards of Care at CCNS – A Progress Report

Developing Nova Scotia’s clinical cancer standards, beginning with rectal cancer care and outcomes is complex work, but Cancer Care Nova Scotia and a team of health professionals, administrators and cancer patients from across the province are making progress.

We have established an oversight committee to provide overall direction andJPanddoctor guidance to the development of Nova Scotia’s clinical standards in cancer care delivery. To date, the committee has discussed and agreed on a number of topics including a set of values to guide standard development, the need for an ethical decision making process, and ongoing communication and engagement opportunities as the work moves forward. The oversight committee has endorsed a working group that will focus on the development of standards of care for rectal cancer patients.

This approach includes the development of the draft standard based on the existing evidence, best practice, research and other information available in the literature.

In January 2012 the rectal cancer working group, co-chaired by Drs. Paul Johnson from Capital Health and Don Clark from Annapolis Valley Health, met to begin the process.

“Our goal in developing a standard of care for rectal cancer is to ensure that no matter where in the province a patient receives care, it is the best it can possibly be, says Dr. Johnson, a surgeon specializing in rectal cancer.

The working group is meeting every two weeks and already has reviewed the literature regarding pre-treatment staging standards elsewhere and compared this with current practice in Nova Scotia. Issues ranging from necessary and un-necessary pre-treatment staging (extent of the cancer) investigations to support diagnosis and resulting treatment to post treatment rehabilitation and supportive care are being discussed.

“The development of clinical standards for rectal cancer management involves a huge amount of detailed work,” says Dr. Clark, a general surgeon who has an interest in rectal cancer management. “Rectal cancer management has become very multi-disciplinary. As a result there are a number of issues that have to be addressed.”

Among those issues are: considering the barriers to meeting the proposed standard, ensuring Nova Scotians have access to care including specialized testing within the recommended timelines, and determining and providing recommendations to support decision making on equipment, financial and human resource implications such as continuing education needs. The oversight committee will also provide guidance on these issues.

For example, there are differing opinions in the literature about various investigations such as endorectal ultrasounds, however the evidence is clear that there is a role for the procedure in the diagnosis of the disease. Because endorectal ultrasounds are not universally available in districts throughout the province, the approved standards will have to address who needs these and other specialized procedures and where they should be provided.

“There have been concerns expressed that the purpose of developing clinical standards is to centralize care in one or two centres in Nova Scotia,” says Dr. Johnson.

“This is definitely not the case,” says Dr. Carman Giacomantonio, Chief Medical Director, CCNS. “In fact, it’s the reason that both the oversight committee and the working group have representatives from across disciplines and across the province. Once the standards are developed, we’ll need to take stock across the province and discuss how best to organize the care to meet the standard.”

The working group, notes Dr. Clark, will not only provide important insight into diagnosis, treatment, and care, it will offer up a province-wide understanding of these issues. “Rural specialists and health care providers and experts from a variety of disciplines such as pharmacy and nursing are part of the team. Cancer survivors are also at the table with us.”

The hope is to have a draft set of standards to share with the Oversight Committee by June 2012. Following endorsement of the proposed standards by the Department of Health and Wellness, the real work begins: engaging stakeholders throughout the province in the implementation of the standards of care for rectal cancer management and determining if these efforts result in enhanced patient care, better outcomes and a more sustainable health care system for all Nova Scotians.

We’ll keep you posted as our work on clinical standard development continues. In the meantime if you have questions, please contact Dr. Giacomantonio by phone at 902-473-6177 or by email at cdha.nshealth.


© 2017 Cancer Care Nova Scotia    Sitemap | Privacy                                                                                                        Report broken links and errors to