BSWRICS Supportive Care Strategic Plan 2009 2012 Supporting BSWRICS Strategic Plan 2009-2012 1
Contents: Introduction 3 Background 4 Supportive Care Environment 5 Policy Environment 8 BSWRICS Supportive Care Strategic Directions Action Areas 9 Action Plan 18 References 19 2
Introduction The BSWRICS Supportive Care Strategic Plan 2009-2012 builds on the Victorian Cancer Action Plan (VCAP). Supportive Care is one of the four key priority areas that was identified by the Victoria s Department of Health for cancer reform and service improvement at a statewide level. The Supportive Care Strategic Plan will outline the direction for BSWRICS over the next three years and focus on implementing and improving system-wide aspects of supportive care. Service Environment BSWRICS encompasses the whole of the Barwon South Western Region incorporating the local government areas of: Greater Geelong Queenscliff Surf Coast Colac-Otway Corangamite Moyne Warrnambool Southern Grampians Glenelg 3
Background The Region covers 29,637 square kilometres 1 and has a population of over 380,000 people 2. Two thirds of the population live in the Barwon sub region. This year there will be approximately 2200 new cases of cancer and approximately 5000 people will receive ongoing treatment for cancer 3. There are 10 sites that deliver cancer care of varying modalities. Stakeholders The following health services have a signed Memorandum of Understanding to form part of the BSWRICS: Balmoral Bush Nursing Centre Barwon Health Bellarine Community Health Casterton Memorial Hospital Colac Area Health Geelong Private Hospital Hesse Rural Health Service Heywood Rural Health Lorne Community Hospital Moyne Health Services Otway Health and Community Services Portland District Health South West Healthcare St John of God Health Care Geelong St John of God Health Care Warrnambool Terang and Mortlake Health Service Timboon and District Health Service Western District Health Service Other Key Collaborators The Cancer Council Victoria National Breast Ovarian Cancer Centre Polo Ralph Lauren Pink Pony Campaign Deakin University Community Cancer Support Groups across the Barwon South West Region McGrath Foundation Regional Palliative Care Consortia Victorian Cancer Agency Victorian Integrated Cancer Service - Supportive Care Special Interest Group Leukaemia Foundation United Way 1 Demographic profile Barwon South Western, Department of Human Services, www.dhs.vic.gov.au/operations/regional/bsw/regional-informaiton/demographic-information 2 Australian Bureau of Statistics, 2006 census. www.abs.gov.au/websitebds/d3310114.nsf/home/census+data 3 BSWRICS incident and mortality report 1982 2007, Cancer Epidemiology Centre, Cancer Council Victoria 4
Supportive Care Environment BSWRICS Supportive Care Strategic Plan aligns with the Victorian Supportive Care Policy and aims to assist health services to respond to the needs of patients and carers across the Barwon South Western Region. Supportive care is an umbrella term that encompasses five inter-related domains of care: physical, social, psychological, spiritual and information. Cancer patients and their families may require support by a range of health disciplines to deal with the impact of being diagnosed with cancer. 4 BSWRICS will support health services to address supportive care needs and deliver supportive care interventions, according to the Fitch tiered model below 5 (Figure 1). The model emphasizes that patients require different levels of support and that only some people may require more specialized services and interventions. Figure 1 4 Department of Human Services (DHS), 2009, Providing optimal cancer care: Supportive care policy for Victoria, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. 5 Adapted from Fitch, M. 2000, Supportive care for cancer patients. Hospital Quarterly, Volume 3, No. 4: 39-46. Reproduced with permission from Peter MacCallum Cancer Centre. Sourced from www.sccv.org.au 5
Five year survival rates for all cancers have been improving. The Victoria s Cancer Action Plan has the aspirational goal to increase five-year survival to 67% by the year 2015: 6 (Figure 2) Projected survival gains: optimised care Projected survival gains: optimised care Five-year survival from cancer, Victoria 1990 to 2004 with projections to 2015 5 year survival (%) 75 70 65 60 55 54% 58% 61% 74% 50 If survival continues to increase at the current rate, by 2015 the 5-year survival for Victorians with cancer will be 67%. 45 If a further 10% improvement in survival can be achieved by implementing the actions in the plan, by 2015 the 5-year survival for Victorians with cancer will be 74%. 0 1990 1995 2000 2005 Year 2010 2015 67% Figure 2 If survival continues to increase at the current rate, by 2015 the five year survival for Victorians with cancer will be 67%. If a further 10% improvement in survival can be achieved by 2015 the five year survival for Victorians with cancer will be 74%. This predicted growth in the number of survivors means that longer term supportive care of this group will become increasingly important. BSWRICS Supportive Care Strategic Plan will aim to assist health services to support the ongoing needs of survivors and their families. The training of cancer workforce in early screening and identification of patients supportive care needs will ensure that patients and families are offered adequate supportive care interventions at the start of their cancer journey. This has been shown to lead to faster recovery and reduce the possible long term effects of cancer treatment. 7 The Cancer Coordination Project (CCP) conducted 2006-2008 collected information on the needs of 215 cancer patients from the BSW region. Data analysed from the CCP 2006-2007 suggested that the greatest needs identified by cancer patients were access to reliable information and emotional support. 8 (Figure 3) 6 Department of Human Services (DHS), 2008, Victoria s Cancer Action Plan 2008 2011, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. 7 National Breast Cancer Centre (NBCC) and the National Cancer Control Initiative (NCCI), 2003, Clinical practice guidelines for the psychosocial care of adults with cancer, National Cancer Control Initiative, NSW. 8 Stowers, M., Williams, M. (2008) Improving the cancer patient journey: the impact of a regional cancer coordination model, The Australian Journal of Cancer Nursing 6
The results of this project informed the initial BSWRICS Cancer Services Plan 2006-2008 and guided our earlier strategies to address the ongoing psychological and informational needs of the regional patients. Patient needs identified through the BSWRICS Cancer Coordination Project 2006-2008 Patient Needs 120 100 80 60 40 20 0 Unknow n Emotional support Social (eg family, carer, financial) Liaise/advoce on behalf of client Information request Referral Other Figure 3 Outcomes to patients, teams and health services The aim of the BSWRICS Supportive Care Strategic Plan is to collaborate with the health services in the region to create better experiences for cancer patients and carers. Outcomes for patients, teams and health services include: Better clinical decision making supported through the expansion of Multidisciplinary Care and Supportive Care Teams across the region. Improved access to information for patients through the Cancer Link Nurses and expansion of available cancer education centres and electronic resources. Enhanced coordination of care through the Cancer Link Nurse network. Training of cancer workforce to initiate screening, early identification and management of supportive care needs of cancer patients and their families. This has been shown to have an overall positive effect on the cancer patient journey by reducing levels of anxiety and depression. This in turn can lead to improved treatment compliance, fewer post-hospital complications and faster recovery from hospital. 9 9 Department of Human Services (DHS), 2009, Providing optimal cancer care: Supportive care policy for Victoria, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. 7
Policy Environment Victoria s Supportive Care Strategic Policy 2009-2012 was released in May 2009. The BSWRICS Supportive Care Strategic Plan 2009-2012 has been developed to promote a population-based, person-centered approach to the provision and enhancement of supportive care for patients within the region affected by cancer. It will provide a framework to achieve the supportive care targets of Victoria s Supportive Care Policy focusing on training of workforce and supportive care screening. This Strategic Plan will strive to progress the Department of Health s four strategic directions for supportive care in Victoria. - Action Area 1. Identifying the supportive care needs of people affected by cancer - Action Area 2. Capacity building for optimal supportive care - Action Area 3. Implementing supportive care screening into routine practice - Action Area 4. Addressing supportive care needs referral and linkage Four Strategic Directions for Supportive Care Action Area 1 Priority 1.1: Identifying the supportive care needs of the population affected by cancer Priority 1.2: Identifying the existing supportive care services within the ICS Priority 1.3: Identifying supportive care service gaps Priority 1.4: Planning a response to supportive care service gaps Action Area 2 Priority 2.1: Securing executive and clinical leadership to build supportive care capacity Priority 2.2: Developing a supportive care strategic plan that aligns with Department of Human Services policy and VCAP Priority 2.3: Building a supportive care network to facilitate referral and linkage, service development and quality improvement Priority 2.4: Extending the capacity of the workforce through building supportive care skills: effective communication, counseling, knowledge of the needs of cancer patients and knowledge of services Patient Centered Care Action Area 3 Priority 3.1: Identifying supportive care needs of those affected by cancer through the integration of supportive care screening into routine practice Priority 3.2: Training the cancer workforce in supportive care screening processes Action Area 4 Priority 4.1: Building supportive care partnerships to facilitate referral and linkage, service development and quality improvement. 8
BSWRICS Supportive Care Strategic Directions Action Areas Action Area 1: Identifying the supportive care needs of the population affected by cancer 1.1 Identifying the supportive care needs of the population affected by cancer. 1.2 Identifying the existing supportive care services within the ICS Initial area service mapping was completed 2005. A Supportive Care Audit of clinicians and consumers was conducted via interviews and surveys. This informed the initial BSWRICS Cancer Services Plan 2006-2008. A Federal Funded Grant in 2006 to explore needs of Support Groups was awarded to BSWRICS. Developed a Support Group Network in 2006. BSWRICS provides ongoing support for education, training, development of new support groups & maintenance of brochures. Development of the BSWRICS 2009-2012 Strategic Plan identified key action areas for future supportive care planning. 10 More in depth identification of supportive care services/needs/gaps at each regional health service will be conducted via the Cancer Link Nurse Model. Analysis of this data will inform service planning and capacity building among the supportive care workforce. The pilot Cancer Link Nurse data will be evaluated by December 2010. The South West Cancer Coordinator data will be evaluated by December 2010. 10 Barwon South Western Regional Integrated Cancer Service, 2009-2012 Strategic Plan, March 2010. 9
1.3 Identifying supportive care service gaps 1.4 Planning a response to supportive care service gaps The Cancer Coordination Project (CCP), 2006-2008 identified gaps in information provision, psychological/emotional support and access to cancer nurse specialists. The Psychosocial Assessment Tool for Supportive Care Interventions (PATSI) project indicated more extensive gaps in psychological and emotional support. Barwon Region participated in the PROSPECT Project conducted by Cancer Council Victoria. 11 (CCV) The preliminary report supported the findings from the CCP and the PATSI project. The BSWRICS Strategic Plan identifies the Awards and Achievements in Supportive Care 2006-2009. A consumer representative was recruited to the BSWRICS team in 2007. Consultation was attained on two projects. The consumer was involved in the development of the Consumer Directory Project which was launched in 2008. They also had direct involvement in the Bowel Cancer Peer Support Project (2007-2008). 12 BSWRICS consulted with consumer representative and other support groups during the development of the Support Care Team brochure. Established a Cancer Patient Information Centre (CPIC) in Aug 2008. Development of Supportive Care Brochure for the Andrew Love Cancer Centre in consultation with the SCT. 11 Carey, M.,Ieropoli, S., & White, V., PROSPECT Program, An ongoing survey of people experiencing cancer treatment. Centre of Behavioural Research in Cancer, Cancer Council Victoria, 2009. (Preliminary Report) 12 Cancer Council Victoria, Bowel Cancer Peer Support Project Report available on Cancer Australia Web Site. http://www.canceraustralia.gov.au/media/files/ca/about_us/final_report_model_for_bowel_cancer_peer_support.pdf 10
Development of Supportive Care Team Referral Form. Completion of a new Supportive Care Team Meeting screen to record recommendations from the meeting. The meeting screen is part of the CANMAP database which is linked directly to the Geelong digital medical record. This enables the recommendations from the meetings to be transferred directly across. Future expansion of CPIC hubs in regional health centers to improve access to resources and information provision. Future upgrade of the BSWRICS website & improved access to electronic resource materials for patients and families Work with MDM teams to explore ways of including supportive care in case discussion. 11
Action Area 2: Capacity building for optimal supportive care 2.1 Securing executive and clinical leadership to build supportive care capacity BSWRICS Continuum of care clinical reference group with supportive care clinicians guided the identification & development of supportive care initiatives (2006-2008). Representation from BSWRICS on initial DH Cancer and Palliative Care, Supportive Care Advisory Group, 2008. Aligned initial BSWRICS initiatives with Supportive Care Policy 2009. Formation of Supportive Care Team at Andrew Love Cancer Centre in 2009. Team consists of senior multidisciplinary allied health clinicians working in cancer care. BSWRICS Regional Consumer Advisory group will be in place by 2011 and will provide input into supportive care initiatives and the BSWRICS Consumer Strategic Plan. BSWRICS Regional Advisory Supportive Care Group will be in place by 2010 to provide input into supportive care initiatives. Supportive Care Strategic Plan to be endorsed by BSWRICS Governance Group on 12/07/2010. 2.2 Developing a supportive care strategic plan that aligns with Department of Human Services policy and VCAP The BSWRICS Supportive Care Strategic Plan aligns closely with the DH Supportive Care Policy and is structured around the four strategic directions of the policy. Strategies on how key actions on new VCAP targets will be met are also included within the plan. 12
2.3 Building a supportive care network to facilitate referral and linkage, service development and quality improvement BSWRICS established Regional Multidisciplinary Cancer Education Forums in 2006. This has led to a regional clinical education network across public and private health services. The education forums promote current practices in supportive care & professional development. They are endorsed by the Cancer Council Victoria and Royal College of Nursing allowing credentialing. Established GP Liaison Communication Program for the Tumour Stream MDM s in 2005. This has enhanced communication and referrals between the Geelong Hospital and primary care. The Supportive Care Team at the Andrew Love Cancer Centre (ALCC) aid in referrals back out to regional areas. Regional clinicians are invited to present any new patients coming into the ALCC. Cancer Link Nurse Project commenced in 2009. Aims to identify more extensive regional referral pathways. Further development and construction of the BSWRICS website and an online service directory will enhance regional awareness of the supportive care services and strategies. 2.4 Extending the capacity of the workforce through building supportive care skills: effective communication, counseling, knowledge of the needs of cancer patients and knowledge of services Education needs for clinicians across the Barwon region were scoped in 2005 via interviews and surveys. This is reviewed annually. Regional Multidisciplinary Cancer Education Forums (discussed previously) conducted monthly. Topics cover various issues in cancer care & supportive care. Link up to four regional sites. 13 Deakin University, Faculty of Health Medicine, Nursing and Behavioral Sciences, Modules in Cancer Care for Health Professionals, 2010. http://www.deakin.edu.au/hmnbs/pdu/modules/brochures/cancer%20care%20for%20health%20professionals.pdf 13
BSWRICS collaborated with Deakin University in 2009 to develop a learning module for nurses and allied health professionals covering topics like Psychosocial Issues for the Cancer Patient. 13 BSWRICS collaborated and participated in the 2009 Inter ICS Supportive Care Conference under the guidance of the VICS Supportive Care Interest Group. BSWRICS participates in quarterly meetings with the VICS Supportive Care Interest Group reviewing & discussing Victoria s Supportive Care Policy. Pilot workshop for multidisciplinary health clinicians conducted in South West region in 2008 on Responding to Distress. Feedback surveys evaluated. Future workshops for ongoing training of health clinicians working in supportive care to be conducted region wide. 14
Action Area 3 Implementing supportive care screening into routine practice 3.1 Identifying supportive care needs of those affected by cancer through the integration of supportive care screening into routine practice In 2008 Victorian Cancer Agency awarded BSWRICS a research grant to trial a Psychosocial Assessment Tool for Supportive Care Interventions (PATSI). This project has provided data that supports the Distress Thermometer as being a valid screening tool for cancer patients. This has also been supported by similar VICS research projects. At a statewide level the VICS SCCV has provided a framework and policy for implementation of the Distress Thermometer as the Victorian supportive care screening tool. The data from the PATSI project will be used to guide the next phase of implementation to achieve the VCAP & Strategic Plan Target of 50% of newly diagnosed patients screened for their supportive care needs. A regional model to support the implementation of the screening tool will be developed in June 2011. This will include engagement & training of clinical leaders in supportive care in private/public. 15
3.2 Training the cancer workforce in supportive care screening processes Previous education forums/workshops/training conducted by BSWRICS will guide future training of professionals in supportive care screening & survivorship. E.g. Workshop Responding to Distress. Baseline survey of clinician confidence in identifying supportive care needs & skill level will be conducted. This will provide a baseline of evidence to be able to adequately structure and plan the training program. Evaluation of the training program will provide evidence of the VCAP target evidence of the training of the workforce. It will be anticipated that health clinicians will show an improvement in communication skill level. 16
Action Area 4: Addressing Supportive Care Needs Referral & Linkage 4.1 Building supportive care partnerships to facilitate referral and linkage, service development and quality improvement. Supportive Care Team model established at the ALCC in 2009. Includes discussion of complex patients to enhance referral pathways back out to community. This model will be expanded and extended across the region during 2011. BSWRICS participated in the VICS Regional Quality Assurance Project. Work with Victorian and Tasmania Youth Cancer Network team to identify needs and collaborate with leading AYA organisations to implement supportive care initiatives for this age group. Strengthen existing partnerships between BSWRICS & supportive care service providers e.g. CCV, National Breast &Ovarian Cancer Centre. Cancer Link Nurse Project (previously discussed) to identify more extensive regional referral pathways. 17
Action Plan Expected Outcome Timeframe Supportive Care Needs Identified Analysis of South West Cancer Coordination Project data Analysis of Pilot Cancer Link Project data Cancer Patient Information Hubs established at each regional area Supportive Care Advisory Group Formed Supportive Care Plan Training & Screening written Supportive Care Teams established in each regional area Evidence of documented 60% cancer workforce trained in supportive care competencies Evidence of documentation of 50% of newly diagnosed patients screened Commenced December 2010 December 2010 December 2011 December 2010 June 2011 December 2011 December 2011 June 2012 18
References Australian Bureau of Statistics, 2006 census. www.abs.gov.au/websitebds/d3310114.nsf/home/census+data BSWRICS incident and mortality report 1982 2007, Cancer Epidemiology Centre, Cancer Council Victoria. Barwon South Western Regional Integrated Cancer Service, 2009-2012 Strategic Plan, March 2010. Cancer Council Victoria, Bowel Cancer Peer Support Project Report available on Cancer Australia Web Site. http://www.canceraustralia.gov.au/media/files/ca/about_us/final_report_model_for_bowel _cancer_peer_support.pdf Carey, M.,Ieropoli, S., & White, V., PROSPECT Program, An ongoing survey of people experiencing cancer treatment. Centre of Behavioural Research in Cancer, Cancer Council Victoria, 2009. (Preliminary Report) http://www.canceraustralia.gov.au/media/files/ca/about_us/final_report_model_for_bowel _cancer_peer_support.pdf Deakin University, Faculty of Health Medicine, Nursing and Behavioural Sciences, Modules in Cancer Care for Health Professionals, 2010. http://www.deakin.edu.au/hmnbs/pdu/modules/brochures/cancer%20care%20for%20he alth%20professionals.pdf Demographic profile Barwon South Western, Department of Human Services, www.dhs.vic.gov.au/operations/regional/bsw/regional-informaiton/demographicinformation Department of Human Services (DHS), 2007a, Achieving best practice cancer care: A guide for implementing multidisciplinary care, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. Department of Human Services (DHS), 2007b, Linking cancer care: A guide for implementing coordinated cancer care, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. Department of Human Services (DHS), 2007c, Clinical excellence in cancer care: A model for safety and quality in Victorian cancer services, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. Department of Human Services (DHS), 2007d, A guide to enhancing consumer and carer participation in Victoria s Integrated Cancer Services, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. Department of Human Services (DHS), 2007e, Patient management frameworks, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. Department of Human Services (DHS), 2008, Victoria s Cancer Action Plan 2008 2011, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. Department of Human Services (DHS), 2009, Providing optimal cancer care: Supportive care policy for Victoria, Metropolitan Health and Aged Care Services, Victorian Government, Melbourne. 19
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