1. Stronach Regional Cancer Centre at Southlake
ESAS and MORE April 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
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

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. Q SRCC Reports

12. Q3 SRCC 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

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

19. How to Use the Guides
Save the link to your workstation PC or portable device
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

20. 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

21. 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