Recent commentaries by oncology health professionals, patients, journalists and the Minister of Health about the state of cancer care in British Columbia (BC) have revealed significant challenges to delivering timely, high quality cancer care in that province. It is likely that these challenges are actually felt across the country, and are not unique to B.C. Oncology health professionals, including nurses are working to their maximum with the vision to deliver care that is person centred, compassionate, effective and timely, yet many would agree that the system in which they try to operationalize this care is in fact one of the barriers they must overcome.
While exceptional leadership and collaborative relationships across both the BC Cancer Agency and the Provincial Health Services Authority are essential to delivering timely high quality cancer care, other significant shifts must also occur. Much of the dialogue in the media has focused on timely access to care and containing costs, which are important, but other elements of high quality care must also be considered when looking for solutions. In fact, some have suggested this focus on timely access to cost contained care is a distraction from the real goal, that being maximizing value for patients. Instead, Porter and Lee (Leading Health Care Innovation, Harvard Business Review) suggest that organizing care around patient needs is more likely to achieve system transformation.
Nursing has long advocated for a transformed system of care that aligns resources with patient and family needs. Perhaps this time of reflection on how well the cancer care system in BC is performing is an opportunity for nurses to add their voice to solution-focused approaches to addressing the challenges.
As more cancer treatments are delivered in ambulatory settings where patients manage much of their cancer treatment effects at home, there may be opportunities to explore positioning of oncology health professionals, including specialized oncology nurses, outside of specialized cancer centres, into primary care and home care settings. Innovative models of care, such as the Infermiere Pivot enOncologie (known as “IPO” or “Pivot Nurses”) in Quebec have demonstrated improved quality of life and patient outcomes when Pivot Nurses care for patients from the point of diagnosis throughout their cancer treatment and care, and into the survivorship period. In this way, instead of tying oncology nursing resources to treatment systems, nurses are positioned where patients and families may benefit from their expertise most, as their needs change across the cancer trajectory.
In addition, nurses caring for cancer patients within the specialized treatment setting may be optimally positioned to practice to their full scope in a way that best meet patients’ needs in the context of the interprofessional team. Rather than working in silos, which further fragments care and can create workflow issues, a renewed focus on interprofessional care needs to be initiated.
As more patients survive cancer and experience long term effects as a result of cancer treatment, positioning specialized oncology nurses and/or Nurse Practitioners in primary care settings to care for the holistic needs of survivors after primary treatment ends may be beneficial to reduce the volumes of survivors still being seen in cancer treatment settings. With survivors’ renewed focus on health promotion, cancer prevention and the need for long term symptom management, oncology nurses’ skills and knowledge align well with survivors’ needs at this point in the cancer trajectory.
Sometimes missing from the design of cancer care systems is the voice of patients and families, including those who experience marginalizing conditions within society. While many organizations have begun to include patient engagement strategies, truly effective cancer care systems will not add patient/family voices in as an afterthought to an efficiency driven and access-focused system – rather, systems of care must be built around the beliefs, values, goals and needs of patients and families to achieve high quality care.
So instead of using our voice to add to the dialogue about enhancing access and infusing more resources, let’s pause and reflect on what we are championing better access to – It’s time for nurses to advocate for high quality care and to be very clear on how we may position our unique knowledge and skills to align with patient and family in a way that infuses value for them.
Links to Media
October 17, Gary Mason, Globe & Mail - http://www.theglobeandmail.com/news/british-columbia/sad-decline-of-bc-cancer-agency-must-be-addressed/article21154744/
October 20, Don Carlow, Vancouver Sun - http://www.vancouversun.com/health/Cancer+Agency+lost/10294565/story.html
October 21, Carl Roy, Vancouver Sun. http://www.vancouversun.com/health/Opinion+defence+Cancer+Agency/10311601/story.html
Nov 5, Gary Mason, Globe & Mail - http://www.theglobeandmail.com/life/health-and-fitness/health/leading-oncologists-take-aim-at-troubled-bc-cancer-agency/article21451692/
Tracy Truant is currently a doctoral candidate at the UBC School of Nursing and the President-Elect of the Canadian Association of Nurses in Oncology. She is a former professional practice leader at the BCCA Vancouver Centre and is currently conducting research on systems of care for cancer survivorship.
Sally Thorne is a professor at the UBC School of Nursing with a longstanding program of research in communication in cancer care. Former Board Chair of the BC Cancer Agency and Board member of the Canadian Partnership Against Cancer, she has been actively involved in cancer policy and strategy over many years.
Thanks to Dr. Thorne and Ms. Truant for a thoughtful, and timely, analysis of an important aspect of oncology care. It is a very critical time as numbers of patients increase amidst decreasing support in BC provincial health authorities for oncology nursing positions, both at the bedside and in leadership.