The Supportive Care Oncology Network Northeast Region: Moving Forward, Improving the

Patient Experience Utilizing Screening for Distress

Northern Health Research ConferenceNorthern Ontario School of MedicineJune 4 - 5, 2010 – Sudbury, Ontario

Sheila Damore-Petingola, MSW, RSWCoordinator Supportive Care Oncology Network-NE

Carole Mayer, Ph.D. (C), MSW, RSWProgram Leader & Administrative ManagerSupportive Care Program & Supportive Care Oncology Research Unit

Acknowledgements• Director of Epidemiology

– Mike Conlon, PhD

• Research Officers– Michelle Lessard– Katherine MacKenzie

• Funding Partners– Canadian Partnership Against Cancer-Cancer

Journey Action Group– Northern Cancer Research Foundation

Presentation Outline• Context

– Supportive Care Oncology Network-NE– Community Oncology Clinic Network

• Project Overview– Principals applied – Stakeholder engagement– Respecting cultural diversity– Participatory Action Research framework– Plan the delivery of psychosocial services– Implement an evaluation plan

• Conclusion

Context• The Regional Cancer Program - tertiary

cancer centre for cancer services in Northeastern Ontario

• The Supportive Care Program - meeting the psychosocial needs of patients and families affected by cancer

• The Supportive Care Oncology Network-Northeast Region (SCON-NE) – ensuring access to supportive care services in NEO

• Screening for Distress Project

James Bay

Cochrane

Kapuskasing

Timmins

Sudbury Sault Ste. Marie Elliot Lake

Sturgeon Falls

North Bay

New Liskeard

Kirkland Lake

Parry SoundMindemoya

Quebec

Blind River

Lake Superior

Lake Michigan Lake

Huron

U.S.A.

Northwestern Ontario

Chapleau

Huntsville

Bracebridge

Community Oncology Clinic

Network (COCN)

NE Local Health Integration

Network (LHIN-13)

LHIN-13

Principles

Expanding Screening for Distress in NEO

Educating health care professionals at the Community Oncology Clinic sites in NEO– Identifying patient distress– Quantifying the distress with validated

instruments – screening– Responding to distress by initiating

appropriate referrals for assessment and intervention

Distress as the 6th vital sign

TemperatureRespirationHeart rateBlood PressurePainDistress

-Screening is usually done to prevent disease

-Vital signs taken on ongoing basisScreening for Distress Workshop March 2008

ESASScreening Domains

Score 0-3

Score 4-6

Score 7-10

Severity of Scores

CPAC-Implementing Screening for Distress, the 6 th Vital Sign, 2009

Psychosocial

Practical

Physical

Problem Checklist (minimal data set)

PracticalWork/SchoolFinancesGetting to and from appointmentsAccommodationLegalChildcare

EmotionalFears/WorriesSadnessFrustration/AngerChanges in AppearanceIntimacy/Sexuality

InformationalUnderstanding my illness and/or treatmentTalking with the health care teamMaking treatment decisionsKnowing about available resourcesAwareness of traditional healing practices

Social/FamilyFeeling a burden to othersWorry about friends/familyFeeling alone

SpiritualMeaning/Purpose of lifeFaith

PhysicalConcentration/memorySleepWeight

Please check all of the following items that have been a concern or problem foryou in the past week including today:

CPAC-Implementing Screening for Distress, the 6 th Vital Sign, 2009

What is proposed for this project

• Who to Screen: All patients receiving chemotherapy at a COCN site (14 sites)

• When to Screen: First day for each cycle of chemotherapy

• How to Screen: Using computerized method when possible; other option paper copy

• Screening domains: Psychosocial, practical and physical

• Tool selection: ESAS and Canadian Problem Checklist

Stakeholder Engagement• Support from senior administrators from the

Regional Cancer Program (RCP)– Building on current mandate within the RCP and

Cancer Care Ontario (CCO)– Meeting the Canadian Council on Health Services

Accreditation standards• Workshop held in May 2009 with National

Leaders for COCN site managers and nurses• Engaging each COCN site through site visits• Selecting champions• Building a Working Committee

Respecting Cultural Diversity• Demographic and Health Profile for NE - LHIN

– Higher proportion of Aboriginals/First Nations/Métis than Ontario as a whole, 10% and 2% respectively

– Higher proportion of Francophones compared to Ontario as a whole, 24% and 4% respectively

(Population Profile at a Glance – NE LHIN http://www.nelhin.on.ca)

• Working Committee representation• Demographic questionnaire for each patient

being screened• All forms available in English and French

Participatory Action Research (PAR)

• Equalizing power imbalances in the project—seeking participants’ input

• Research process involves taking notice of the findings at different stages of the research which informs actions to be taken throughout the process (Nelson et al., 1998)

Plan the Delivery of Psychosocial Oncology Services at 14 COCN Sites

• Identification of resources within communities– Community hospitals– Community Care Access Centre

• Building a safety net– Use of telemedicine

• Provision of education and discussion forums– Eg. May 14/2010 workshop

• Next step– Developing referral pathways

EvaluationSupportive Care Oncology Research Unit

• Demographic form

• ESAS Scores

• Canadian Problem Checklist

• Nursing outcome form

• Completion of project March 31, 2011

Current Status of the Project• Workshop – Introduce the Project - May 2009• COCN Site Visits

– Sept-Oct 2009– Jan-May 2010

• Monthly Working Committee meetings– Initial meeting Oct 2009

• Workshop – May 2010 - to advance understanding of:– supportive care resources in NEO– national algorithms and guidelines in addressing distress

• All 14 COCN sites implemented screening – Nov 16, 2009 – June 1, 2010

Conclusion

• Implementing a standard of care to meet the psychosocial needs of cancer patients receiving treatment closer to home

• Learning from our COCN sites

• Team work, team work, team work!

For more information

sdamore-petingola@hrsrh.on.ca