UICC World Cancer Congress 2006

Sanchia Aranda & Annabel Pollard

Abstract Supportive care is a term increasingly used world wide to describe services provided for patients and families to help them manage the consequences of a cancer diagnosis and cancer treatment. This session will explore an organisational approach to the implementation of a supportive care strategy in a cancer centre. This implementation involves a shift from reactive services provided by various discipline working largely in isolation to one another to an increasing focus on an organisational perspective that seeks to build services according to the needs of patients and family members. This presentation will explore the critical success factors and potential pitfalls of such organisational approaches and offer some directions for other the development of supportive care in the cancer setting.

Session Objectives: 1. To explore the development of supportive care services in a cancer setting. 2. To consider the critical success factors in developing an organisational approach to support service delivery.

The National Institute for Clinica Effectiveness (NICE) in the United Kingdom describes supportive care as an umbrella term covering all services required by people with cancer and their carers to manage the consequences of cancer and cancer treatment. Such support can be generalist or specialist and extends from diagnosis, through treatment and into end-of-life care or survival. The assumption is that people will have needs for support from the first moment that cancer becomes a possibility in their lives.

Fitch (2000) outlined a potential model that has guided the development of the approach to supportive care taken at the Peter MacCallum Cancer Centre in Melbourne Australia. Central to Fitch's model is the identification of a public health approach to patient and carer support needs. The model forces service planners to consider the distribution and structure of services according to what all patients need, what many patients need, what some patients need and what a few patient need. Inherent within this is the assumption that needs in the all and many categories are common and less severe than needs in the some or few categories. Thus services designed to meet the needs of patients in the some and few categories are increasingly specialised and should match to the credentials of those designated to provide these services.

There are several logical outcomes of using such a conceptualisation in service planning. These include: • Examining each service to determine the target patient group and to assess if this is indeed the group accessing the service. • Considering the pathways that facilitate the referral of patients with more complex needs to those services with the appropriate expertise. • Making explicit the overlap in role functions and expertise between disciplines and establishing the ways in which these services will work together in service provision. • Establishing approaches to support provision that meet the needs of all patients without thinking this can only be done by increasing the availability of a specialist service which may not be feasible when this need is present for all or many patients.

The implementation of such a model into routine practice has been a challenging undertaking led in partnership by a nurse and a psychologist. The vision established was for a collaborative multidisciplinary approach to service provision that is patient and family centred and evidence based. The journey towards this is ongoing but the success factors to date include the following:

1. Gaining an organizational mandate for change – this step involved inclusion of supportive care into the strategic directions established for the hospital. This has helped us to make resource arguments and to keep the agenda for change a high priority at the executive table where key decisions were made. 2. Keeping patients and family members at the centre of developments – consumer representatives have been involved in the change since the beginning and as the change becomes embedded into the organization will require continued involvement as part of the monitoring of success. 3. Involving the key stakeholders – a steering committee to drive the change was established that included representatives from all key disciplines and tumour groups to ensure that all voices were heard. 4. Funding support – attracting money to the organization to support the changes both allowed energy to be devoted to the change and also raised the profile supportive care within the organization and the community. 5. Keeping focused – throughout the change process resistance has been a key feature of responses by many people. This has been both passive and active. Staying focused on a patient and family centred approach to care and using this as the key communication strategy has been instrumental in overcoming resistance. 6. Building a linked research program – as a research intensive organization the Cancer Centre understands the importance of evidence. At each step in the change process we have sought to review the evidence in order to promote change. Where evidence is lacking we are building primary research to drive the development of future services. 7. Planning for sustainability – what began as a project needed to live on beyond those driving the change. This step has required plans for an organizational restructure and insertion of supportive care into key reporting systems in the organization. This has also involved linking supportive care outcomes into the quality improvement and accreditation processes for the organization. The next step will be in lobbying Government for sustainable funding systems to allow service growth.

After almost four years the journey towards the vision is incomplete but moving forward. The effort has leveraged more than 3 million dollars in philanthropic and research funding to support new initiatives that result in improve supportive care for patients and families. We believe this is just the beginning.