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 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)

OCSMC Targets Improvement in Cancer Patient’s Physical and Emotional Symptoms Purpose 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 Approach Implement and assist in adoption of common tools: ESAS, PPS, ECOG, symptom management guides, collaborative care plans

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

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.

Edmonton Symptom Assessment Scale

Patients Value Computerized Approach to Symptom Assessment…

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

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

Q3 2010- 11 SRCC Reports

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

ESAS and PPS Reports

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

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

The Tools

Making Knowledge Available at Point of Care iPhone App Near Completion and Will be Available on iTunes

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

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

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