Cancerpedia: A Framework for Implementing Comprehensive Cancer Centres

Background and context: Comprehensive cancer centers or programs form a nucleus of cancer care delivery. Although there are frameworks for population cancer control, no similar published framework exists for cancer centers. Aim: We sought to develop a framework for designing and implementing a comprehensive cancer center or program within the context of a population-based model of cancer control that spans diagnosis, treatment, supportive care, and palliative care as well as integration with primary care and the community. Strategy/Tactics: The framework was constructed with the patient at the center and provides a system-level perspective as well as a granular view of the fundamental resources and structures needed to build and maintain individual cancer centers and programs. Due to its breadth, we focused the framework on essential information while linking to a wide range of vetted publications that detail additional standards, guidelines and best practices. Program/Policy process: “Cancerpedia” emerged as a cohesive framework for the delivery of high-quality cancer care within and beyond the cancer center. It provides an overview of the cancer control and care delivery framework, describes cancer care services (e.g., radiotherapy, chemotherapy, palliative care) and details infrastructure and core services (e.g., physical facilities, human resources). In addition to these services, the framework presents guidelines for governance that ensure oversight and quality, describes the critical need for integrating education and research and presents the best practices for engaging in philanthropy. Cancerpedia also outlines the role of the comprehensive cancer center in integration with the community and influencing policy and regulation. Over 30 chapters provide a detailed description of each element and include a description of the service or function, resources requirements such as people, equipment and facilities, management structures, quality performance guidelines and future trends in innovation. Outcomes: To our knowledge, no comparable published framework exists as a reference for developing comprehensive cancer centers. Cancerpedia was designed to serve as a global public good and is adaptable and applicable to diverse contexts and healthcare environments. It is relevant to high-, middle- and low-income countries alike and provides a reference point from which to structure a plan for growth. What was learned: While it is important to describe the various elements required for cancer care delivery, it is critical to consider and address the integration and interdependencies of these various elements. Future opportunities for learning include seeking input from a global audience to gauge the utility and applicability of Cancerperdia to local contexts.

Communication system facilitates integrated patient-centred care

At the Wellesley Hospital in Toronto, a unit designed to house patients awaiting placement developed a communication system to facilitate integrated patient-centred care. The system included a patient and family orientation brochure, an interdisciplinary kardex and an interdisciplinary patient goal sheet. Patient care improved under the new system, as staff was easily able to access current assessment data and establish and document integrated patient goals. Other outcomes included improved communication among team members, enhanced team member accountability, cohesiveness and satisfaction, and increased patient and family satisfaction.

Consolidation of patients awaiting placement: a two-year review

Toronto's Wellesley Hospital retrospectively reviewed the effectiveness of consolidating long-stay patients within one environment where they were cared for by an integrated interdisciplinary team. The study found that this approach resulted in cost-effective care, improved patient outcome, improved bed utilization and prevention of unnecessary institutionalization. The model is universal and easily reproducible.

How can new technology be introduced, evaluated, and financed in critical care?

We briefly review issues impacting the introduction, evaluation, and cost of technology in critical care, providing a clinician's perspective. Where appropriate, we note important distinctions between health-care systems in Canada and the United States--primarily the result of significant differences in the methods for funding health care in the two countries. Finally, we discuss what processes might be reasonably considered for evaluating technology in critical care and discuss the probability of various consequences that will significantly affect the care we provide our patients if critical-care practitioners, industry, and health planners fail to jointly undertake this responsibility.

How can new technology be introduced, evaluated, and financed in critical care?

We briefly review issues impacting the introduction, evaluation, and cost of technology in critical care, providing a clinician's perspective. Where appropriate, we note important distinctions between health-care systems in Canada and the United States--primarily the result of significant differences in the methods for funding health care in the two countries. Finally, we discuss what processes might be reasonably considered for evaluating technology in critical care and discuss the probability of various consequences that will significantly affect the care we provide our patients if critical-care practitioners, industry, and health planners fail to jointly undertake this responsibility.