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Jill Theresa Marie Carman

Clinical standards – a roadmap for excellence in cancer care

Nova Scotia cancer patients expect and deserve the very best care that our health system can provide regardless of who they are or where they live. Although all health providers are dedicated to ensuring patients receive the highest quality of care possible, many factors challenge and indeed impact their ability to do so. Delivery of uniform health services across nine districts, and in a variety of settings, demands some changes in the way health professionals work. Currently, the coordination of care within and between health districts is challenging, often marked with delays, redundancies and inefficiencies. This leads to duplication of tests, unnecessary tests and additional visits that translate to higher costs for the system and in some cases, poorer outcomes for the patient.

Also, since the complexity of a patient’s illness rightly determines where, when and who will deliver the care, Cancer Care Nova Scotia (CCNS) and district health authorities need to carefully consider how best to (re)organize the system to assure services are appropriately structured and aligned to provide that care.

“The current challenges in delivering high quality and effective cancer care are clear to most who are part of the system,” said Dr. Carman Giacomantonio, Chief Medical Director, CCNS. “The solution(s) however, is somewhat less obvious. At CCNS, we believe the solution lies in the defining the standard(s) of care we want for cancer patients in Nova Scotia.”

A standard of care prescribes and defines the components and quality of care a patient with cancer in Nova Scotia can expect to receive. It addresses service provider education and roles, organizational structure and behavior, hospital system requirements and other issues related to providing and organizing care.

CCNS has much experience in standards development. Examples include the development and implementation of: infrastructure standards to support the safe delivery of chemotherapy; clinical practice guidelines to outline how specific cancers should be treated; and continuing health professional education to provide just-in-time knowledge and information to support quality care. The next logical step is the development of clinical standards.

CCNS is working with health providers and administrators across the province to develop clinical standards of care. Once the standards are developed, services will be realigned to support the standards. Following implementation, patient outcomes will be carefully monitored and evaluated against the standards.

As a provincial program of the Department of Health and Wellness, Cancer Care Nova Scotia’s primary mandate is to set and monitor clinical standards of care and create programs that facilitate implementation of those standards.
“Developing and implementing clinical standards will take time, energy and commitment from all of us within the health system,” said Dr. Giacomantonio, “However, it is the right and the necessary next step to assure that all cancer patients throughout Nova Scotia receive timely and appropriate treatment and care.”

The first step toward defining the standards of care for each of the many kinds of cancer is creation of an oversight committee to guide the development of clinical standards in order to ensure collaborative and cross-sectional representation of patients and providers. Members include representatives from district health authorities such as physician leaders, other health professionals and administrators. Expert working groups will also be established to review the evidence and consider best practices, while reviewing guidelines developed elsewhere, and adapting them where appropriate for Nova Scotia.
The first clinical standard of care that will be developed will focus on rectal cancer care and outcomes.

“Rectal cancer is a complex disease,” said Dr. Giacomantonio. “Recurrence rates are an important indicator of quality care in rectal cancer. To ensure the lowest recurrence rate possible, we need better integration of several services and disciplines such as endoscopy, diagnostic imaging, radiation oncology, medical oncology and surgery. By providing districts, physicians and all members of the care team with the right supports, we will ensure the best possible outcomes for patients.”

We will keep you posted as work on clinical standards moves ahead. In the meantime, if you have questions, please contact Dr. Giacomantonio by phone at 902-473-6177 or by email at .