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ESAS and MORE April 27, 2011

Stronach Regional Cancer Centre at Southlake. ESAS and MORE April 27, 2011. Objectives. Refresher on Edmonton Symptom Assessment System Symptom Management Guides Measure of success. CCO Identified Issue … Cancer Patient Symptoms Not Optimally Managed.

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ESAS and MORE April 27, 2011

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  1. Stronach Regional Cancer Centre at Southlake ESAS and MOREApril 27, 2011

  2. Objectives • Refresher on Edmonton Symptom Assessment System • Symptom Management Guides • Measure of success

  3. CCO Identified Issue…Cancer Patient Symptoms Not Optimally Managed • Inconsistency in cancer symptom management practices across province • Clinicians can fail to recognize 50-80% of patient concerns during consultation (Ruland et al, J Am Med Inform Assoc, 2010) • Adequate symptom management is not consistently achieved for cancer patients (Patrick et al, J Natl Cancer Inst, 2003) • Poor system outcomes ~ 40% visit ED last 2 weeks; dyspnea and pain among most common chief complaints ~ acute care LOS last 6 months (14 days) (CSQI, 2010; Barbera et al,J Can Med Assoc, 2010)

  4. OCSMC Targets Improvement in Cancer Patient’s Physical and Emotional Symptoms • To improve the quality and consistency of patient’s physical and emotional symptom management across the patient journey • Earlier identification and communication of symptoms • Improved symptom management • Improved collaborative care planning Purpose Approach • Implement and assist in adoption of common tools: ESAS, PPS, ECOG, symptom management guides, collaborative care plans

  5. OCSMC Targets Improvement in Cancer Patient’s Physical and Emotional Symptoms Purpose • Host and support ISAAC- electronic tool for ESAS • Establish and monitor improvement aims and regional targets • 90% lung cancer patients screened with ESAS • 65% all other cancer patients screened with ESAS (2010/11) Approach

  6. Ontario Cancer Plan 2011-2015 • Strategic priority #4 “Continue to assess and improve the patient experience” By 2015 every cancer patient in Ontario will receive care in a timely manner for physical and emotional symptom scores flagged through symptom screening.

  7. Edmonton Symptom Assessment Scale

  8. Patients Value Computerized Approach to Symptom Assessment…

  9. Information Captured in ISAAC Has Uses Ranging from Individual Patient Care to System Planning and Performance…

  10. Monthly Reports • Monthly reports show percentage of patients experiencing specific symptom • Identification of resources required to meet patients’ symptoms • Important for new Cancer Centre developing Palliative and Supportive Care Program • Future steps • Monitor effectiveness of symptom management

  11. Q3 2010- 11 SRCC Reports

  12. Q3 SRCC 2010-11 Report No targets set for PPS as yet

  13. ESAS and PPS Reports

  14. Need to Manage Symptoms • Have consistent approach to Symptoms • Provide Tools to use as Guide • Provide easy access to tools • Knowledge Transfer

  15. Guide Development • Symptom Management Working Groups • Literature search ~ conducted by Rebalance Focus Action Group of Canadian Cancer Control Strategy ~ Additional search within Ontario programs ~ Evidence-based, cancer-specific, clinical practice focus • Guidelines reviewed using AGREE tool • ADAPTE process used to endorse or modify elements of the chosen guideline

  16. The Tools

  17. Making Knowledge Available at Point of CareiPhone App Near Completion and Will be Available on iTunes

  18. How to Use the Guides • Save the link to your workstation PC or portable device www.cancercare.on.ca/toolbox/symptools/ • Select the symptom you are managing • Decide if you need a quick reference or need to study the topic more fully • Select the full guide, pocket version or algorithm

  19. What’s Next? • How do we know it is working? • Chart Audit • Every month 25 charts • One symptom • Look for interventions ~ Referrals ~ Further assessments ~ Decrease in symptom scores over time

  20. Summary of Symptom Management Guides • Variety of tools to help standardize assessment, documentation and management of the most common cancer related symptoms • Pain, Dyspnea, Nausea Vomiting and Delirium • More to come - Anxiety, Depression • Easily accessible • Perform Chart Audit to determine effectiveness of Guides and Care Plans

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