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Standards Development – work continues on many fronts

Cancer Care Nova Scotia, with the help and commitment of its partners, continues to make progress on many fronts under the umbrella of standards development. Since beginning to develop treatment standards for the management of rectal cancer, the work has evolved to include development of standards for the diagnosis and referral of patients who visit their doctor’s office with symptoms, which could be related to colon and/or rectal cancer; supportive care standards; and health professional and patient education standards. The work in all of these areas is intended to provide the foundation for improved cancer patient care and outcomes.

In February 2013, the Rectal Cancer Treatment Standards Working Group completed the first draft document of provincial standards for the treatment of rectal cancer. This document was circulated to senior leaders in the district health authorities, along with a link to an electronic survey and a request that the draft standards and survey be shared with all health professionals who have an interest in rectal cancer. The survey provides an opportunity for reviewers to comment on a section-by-section basis about the appropriateness of the proposed standards. This feedback will be carefully reviewed and the standards document amended accordingly by the working group. Following discussion of the feedback, the document will be revised with a goal of being completed by late Spring. Feedback that is deemed not to be within the scope of the Rectal Standards Treatment Standards Working Group will be brought to the attention of the Clinical Standards Oversight Committee.

Rectal cancer survivors will also have an opportunity to review the draft standards. Work is underway to design a process for patient, survivor and family feedback. The process will be tested with the draft Rectal Cancer Treatment Standards and will be fine-tuned, as necessary, and used as a template for patient, survivor and family feedback in the development of future standards.

While the Rectal Cancer Treatment Standards Working Group awaits feedback, the sub-committee working on standards for the diagnosis and referral of patients who are clinically suspicious for rectal or colon cancer (patients with symptoms) is close to having draft standards ready for review. The sub-committee will follow a similar process as the Rectal Cancer Working Group to get feedback. However, in addition to sending the draft document and survey to district health authority senior leaders for sharing with interested staff and physicians, it will also be sent to family physicians for review. Again, the questions will relate to whether the proposed standards are reasonable and valid for Nova Scotia. It is expected that the draft standards for the diagnosis and referral of patients who are clinically suspicious for rectal or colon cancer will be ready for review and comment by late spring 2013. The draft standards will also be shared with colorectal cancer patients, survivors and families for comment.

As the work above continues, so too does the work on developing supportive care standards, which will be included as part of all treatment standards. A decision was made to adopt the CAPO (Canadian Association of Psychosocial Oncology) Standards for Psychosocial Health services for Persons with Cancer and their families. These standards outline the supports that all cancer patients and their families should be offered. They include things such as: access to psychosocial oncology and supportive care services, screening for distress, and appropriate treatment throughout a patient’s cancer journey.

Once feedback from all stakeholders is considered, the final document will be submitted to the oversight committee. The next step is an impact assessment, which will likely occur in the Fall of 2013 to determine what is currently happening in the province and compare this against the standard to identify gaps. Following the Impact Assessment and discussion about proposed ways of closing the gaps, the Standards will be sent to Department of Health and Wellness for review and approval. Following approval, CCNS will work closely with district health authorities to phase in implementation.

In the meantime, CCNS will continue to work with health professionals to support implementation of the new clinical standards.

It is difficult to put a timeframe on the remaining steps leading to the implementation of standards of care for the management of rectal cancer; however we will continue to update you on our progress.

As this work continues, discussions are underway to determine the next clinical standard for development.


If you have questions or concerns about the development of Clinical Standards, please email us at or call us at 902-473-2936.

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