GETTING A SECOND OPINION

Whatisasecondopinion?HowtreatmentisplannedwithandforyouReasonsforaskingforasecondopinionHowdoIgetasecondopinion?

Patient Education The right information at the right time.

WHAT TO KNOW BEFORE GETTING A SECOND OPINION

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2CONTENTSIntroduction ...............................................................................................2What is a second opinion? ...........................................................................3How treatment is planned with and for you ..................................................3 Primary care .....................................................................................................3 Hospital care .....................................................................................................4 Multidisciplinary Cancer Conferences ...............................................................5Reasons for asking for a second opinion .......................................................6 1. Doubts about the diagnosis ..........................................................................6 2. You may not understand the information .....................................................6 3. You may not be happy with the recommended treatment ............................7 4. You may not like or feel comfortable with your primary care provider or specialist ....................................................................................7The Pros and Cons of getting a second opinion ..............................................8 How do I get a second opinion? ....................................................................9 Preparing for a second opinion ....................................................................9 Problems getting a second opinion ............................................................10Once you have the results of the second opinion .........................................10Payment for a second opinion or out of province care ..................................10

INTRODUCTION

A diagnosis of cancer is a challenging time. It is common to feel anxious, fearful and uncertain about the journey ahead of you. It is also common to look for information and question recommendations or plans that have been made with you about your care.

Your healthcare team is made up of professionals who are highly educated with expertise in their field. When planning care, they use National and International guidelines and standards and their clinical experience to recommend the best care for you. Some people may ask for another medical opinion.

3We have created this booklet to help you understand:

Themeaningofasecondopinion Thereasonstheyarerequested Theprocessforgettingone

WHAT IS A SECOND OPINION?

A second opinion is when you see another doctor or healthcare provider for their medical opinion on your diagnosis and treatment. It usually means you will travel to a different hospital or specialist.

You might ask for a second opinion if you are concerned about your diagnosis or the treatment that is recommended for you. Anyone can ask for a second opinion. You can have one within Ontario, or you may choose to seek one in another country like the United States.

HOW TREATMENT IS PLANNED WITH AND FOR YOU

Before asking for a second opinion, it is helpful to understand what happens when your healthcare provider makes a diagnosis and makes recommendations on your care and treatment. Making decisions can involve a team of professionals that provide expertise indifferentareasofhealthcare.Thesemayinclude:

PRIMARYCARE

ThismaybeyourfamilydoctororNursePractitioner.Theyseeyouearlyonwhenyouarefirsthavingproblemsorsymptoms.Theymayexamineyouandsendyoufortests.Theymayalsomakeadiagnosis,give you medication or recommend other treatment. Sometimes they may send you for more tests to help understand more about the problems you are having.

4IfyourfamilydoctororNursePractitionerthinksyouhavecancer,theywillmakearrangementstohaveyouseeaspecialist.Thetypeof cancer and tests results will help them decide which specialist to send you to.

HOSPITALCARE

Thismaybetheplacewhereyouhavetestsorseeaspecialist.Onceyou have been diagnosed with cancer, a team of specialists will work together to recommend and plan the care they feel is best for your cancer.Thisteamofspecialistscanincludea:

Surgeon Medical Oncologist (a doctor who specializes in treating cancer

with chemotherapy) Radiation Oncologist (a doctor who specializes in treating cancer

with radiation therapy) Radiologist (a doctor who specializes in reading scans and

x-rays) Pathologist(adoctorwhospecializesinlookingatcellsundera

microscope) NursePractitioner(anursewhospecializesinthetreatmentof

cancer) Nurse (a nurse who gives treatment support and information) Radiation Therapist (a team member who specializes in

supporting patients receiving radiation) Dietitian (a team member who specializes in supporting people

with cancer) Social Worker (a team member who specializes in supporting

people with cancer)

Before your cancer treatment is planned, one of the specialists will see you and they may arrange for you to have more tests. Tests are often ordered to find out the type and size of the cancer and if it has spread.Theteamwillthenreviewtheresults,discussyouroptionswith you and together you will plan for your treatment.

5When treatment is being planned, the team will consider:

thetypeandsizeofthecancerandwhetherithasspread treatmentguidelinesandstandardsforyourparticularcancer yourhealthandcondition yourconcernsandwishes

If you have a choice of treatments, you may need some time to make a decision about the treatment you wish to have and your care team will provide you with the time you need to make that decision. It is important to ask questions and talk about your concerns before treatment begins.

MULTIDISCIPLINARYCANCERCONFERENCES

For some cases, where a cancer diagnosis or treatment plan may not be clear, a team of specialists can review the case at a Multidisciplinary CancerConferenceorMCC.ThespecialistsattheMCCwillreviewinformation about your diagnosis and medical history and then recommend what the best treatment option is for you. Current research, best practice and clinical experience are all considered by the specialists when making a treatment recommendation. Depending on the type of cancer, the MCC usually includes a:

Surgeon Medical Oncologist (a doctor who specializes in treating cancer

with chemotherapy) Radiation Oncologist (a doctor who specializes in treating cancer

with radiation) Radiologist (a doctor who specializes in reading scans and

x-rays) Pathologist(adoctorwhospecializesinlookingatcellsundera

microscope and diagnosing the cell type) Nurse specialist (a nurse who gives you information and support

during treatment)

TheMCCisanotherwaythehealthcareteammakessurethebestcare possible is given to people.

6REASONS FOR ASKING FOR A SECOND OPINION

Although many people are happy with the diagnosis and treatment that has been mutually agreed upon, some people may still want a second opinion. Second opinions often result from a mutual misunderstanding about what is happening, or because a person doesnotknowwhattodo,orjustafearabouttheunknown.Themost common reasons for a second opinion are:

1.DOUBTSABOUTTHEDIAGNOSISSome people ask for a second opinion because they worry that their doctor or specialist did not make the right diagnosis. In this case, ask for more time or an appointment to talk to your healthcare provider or specialist about any concerns you have. It may help to write down concerns or questions you have and discuss them at your appointment. If you are unsure about any test results, ask for a copy and for an explanation about what they mean and how the diagnosis was made.

2.YOUMAYNOTUNDERSTANDTHEINFORMATION

Some people find it hard to take information in when they are anxious or upset. Ask for another appointment so that you can go through the information again before going for a second opinion. Many hospitals have a nurse specialist working with them who you can either see, or phone you after your appointment if you need more information. Also, bring a relative or friend with you so they can help you remember what was said.

3.YOUMAYNOTBEHAPPYWITHTHERECOMMENDEDTREATMENT

Some people look for, hear about or find information about better treatment being offered in other cities, provinces or countries. It

7is important to remember that even if you have the same type of cancer as someone else, the same treatment may not be right for you.Thisiswhytreatmentisplannedonanindividualbasis.Ifyouare concerned about your treatment, ask for another appointment to talk about your concerns or for an explanation about why the recommended treatment was made for you.

4.YOUMAYNOT LIKE OR FEEL COMFORTABLEWITHYOUR PRIMARYCAREPROVIDERORSPECIALIST

Some people ask for a second opinion because they find it difficult to talk to their healthcare provider or specialist. If you feel like this, be honest and try telling them that you are finding it hard to talk with them. Another option may be to see someone else on their team.

8THE PROS AND CONS OF GETTING A SECOND OPINION

Before you decide on getting a second opinion, you may want to think about some of the advantages and disadvantages.

PROS CONSYou feel more confident about decisions when there is more than one clinician suggesting the same treatment

A second opinion does not mean you will be seen or treated more quickly

You like another specialist more and have more confidence in what they say

Your treatment may be delayed by waiting to see another specialist

You are offered a different or newer treatment that may be part of a clinical trial

Thepersonyouseeforasecondopinionwill need to get information from your first specialist, which can delay things

You may be offered a wider choice of treatment

You will need to think about the effects delaying treatment has on the type of cancer you have or the outcome of treatmentYou may find it upsetting being given the same or different information about your diagnosis and treatment if it is not what you were hoping forIf you are offered different treatment, you may be asked to decide quickly. Some people find this difficult and worry about whether they will make the right decision. However, it is important to remember that there is no right or wrong decisionYou may have to travel a long distance to a different hospital to see another specialist and you may then need to have treatment at thathospital.Thismightnotbeeasyforyouor your family and may mean you have extra travelling costs. Also, if you seek a second opinion outside of Ontario, this may result in additional costs

9HOW DO I GET A SECOND OPINION?

Therearedifferentwaysofgettingasecondopinion. Youcanaskyour primary care provider or specialist to refer you for a second opinion.Peopleoftenworrythatthiswillupsetthespecialistorthatthey will be seen as a bad patient. However, many doctors and other specialists will be happy to refer you for a second opinion if it will be helpful. Remember it is your health, your ultimate decision and no one but yourself should make that decision for you.

Your spouse or family member can also ask for a second opinion on your behalf, but only with your permission.

When you make a request for a second opinion, any relevant medical information must be sent to the new doctor or specialist. This information will include your test results and other healthrecordsonfile. ThiscanbearrangedthroughtheHealthRecordsdepartmentonthe2ndflooroftheCancerCentre. Theremaybea fee associated with this request. A signed and written consent to release information will be required before any medical records can be shared with an entity/person outside of Windsor Regional Hospital.

If you decide to have your care or treatment with another specialist, you will need to make arrangements with them to do this. Speak with them about how to make these arrangements.

PREPARING FOR A SECOND OPINION

It can help to prepare for your appointment by thinking about what you want to get out of it. You could write down some questions and take them with you. It can also help to have someone else go with you.

Here are some questions you may want to ask at your appointment:

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Isthesecondopiniondifferentfromtheoriginaldiagnosisor treatment plan and why? DoIneedtreatment? ArethereothertreatmentsIcouldhave? Whatarethesideeffectsoftheseothertreatments? Whateffectwillthetreatmentshaveonmylife? Howmightothertreatmentsimprovemyhealth? HowlongwillIneedtobetreatedfor? WillIneedtohavemytreatmentatanotherhospital? Whatothercostsmaybeinvolved?

PROBLEMS GETTING A SECOND OPINION

If for some reason you find it difficult getting a referral for a second opinion, contact the hospital Patient Representative at: 519-254-5577ext.#52317.

ONCE YOU HAVE THE RESULTS OF THE SECOND OPINION

Once you obtain a second opinion and you would rather follow that advice, if different or for any reason, your care will be transferred to that new physician/organization. Your original physician will not be involved in your care unless specifically agreed upon your originalphysician.Thisavoidsconfusionofeveryoneinvolvedandassumptions that the other person was addressing a particular issue.

PAYMENT FOR A SECOND OPINION OR OUT OF PROVINCE CARE

If you want to obtain a second opinion and/or any treatment outside of Ontario (ie United States) and want it paid for by your Ontario Health Insurance Plan (OHIP) you must first obtain the PRIORconsentofOHIPthroughitsOut of Country Services - Prior Approval Program.

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NOTES________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please see http://www.health.gov.on.ca/en/public/programs/ohip/outofcountry/prior_approval.aspx for more information and how to applyforPRIORapproval.

If you obtain a second opinion and/or treatment outside of Ontario and then attempt to claim reimbursement after the fact it will NOT be reimbursed.

November 2013

2220 Kildare Road, Windsor, ON N8W 2X3519-254-5577 ext# 58611

www.wrh.on.ca/escrcp