Innovation in Cancer Survivorship and Community-Based Primary Healthcare (March 2012)

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Title: Innovation in Cancer Survivorship and Community-Based Primary Healthcare
Principal ApplicantTitle(s)Institutional AffiliationFunding AmountAnticipated CIHR Submission Date
Dr. Denise Bryant- Lukosius

Associate Professor,

Director,

Clinical Scientist and Director

School of Nursing and Dept. of Oncology,

Canadian Centre for Advanced Practice Nursing Research at McMaster University,

Canadian Centre of Excellence in Oncology Advanced Practice Nursing (OAPN) at Juravinski Hospital and Cancer Centre

$15,000 March 2012
Co-Applicant(s)Titles(s)Institutional Affiliation(s)
Dr. Ruth Martin-Misener

Affiliate Faculty,

Associate Professor

Canadian Centre for Advanced Practice Nursing Research (CCAPNR) at McMaster University,

School of Nursing at Dalhousie University

Dr. David Price

Chair,

Primary Care Physician

Dept. of Family Medicine, Faculty of Health Sciences at McMaster University,

Stonechurch Family Health Centre in Hamilton

Dr. Laura Farrelly Chief of Nursing Practice Juravinski Cancer Program at Juravinski Cancer Centre, Hamilton Health Sciences
Dr. Cathy Faulds

Lead Physician,

Adjunct Professor,

London Family Health Team,

Dept. of Family Medicine at University of Western Ontario

Dr. Jane George Executive Director Wellwood Resource Centre
Dr. Esther Green

Provincial Head,

Assistant Clinical Professor

Nursing and Psychosocial Oncology Cancer Care Ontario,

School of Nursing, Faculty of Health Sciences at McMaster University

Dr. Ainsley Moore

Assistant Professor,

Primary Care Physician,

Staff Physician

Family Medicine at McMaster University,

Stonechurch Family Health Centre at McMaster University,

Women’s Health Clinic at Juravinski Hospital

Dr. Carol Rand Director Systemic, Supportive Care and Regional Cancer Program at Juravinski Cancer Centre
Dr. Anne Snider

Director,

Director,

Director,

Director,

Integrated Radiation Treatment Program Hamilton Health Sciences/Niagara Health Services,

Cancer Research and Cancer Informatics, Hamilton Health Sciences

Operations, Escarpment Cancer Research Institute at Hamilton Health Sciences and McMaster University

Dept. of Oncology at McMaster University

Dr. Jonathan Sussman

Associate Professor

Associate Director

Dept. of Medicine and Dept. of Oncology, Division of Radiation at McMaster University,

Supportive Cancer Care Research Unit and Radiation Oncologists at Juravinski Cancer Centre

Dr. Ruta Valaitis

Associate Professor,

Dorothy C. Hall Chair

School of Nursing, Faculty of Health Sciences at McMaster University,

Primary Care Nursing, McMaster University

Dr. Scott Wooder

Family Physician,

Assistant Clinical Professor,

Chairman of the Board of Directors

Hamilton Family Health Team,

Dept. of Family and Community Medicine at McMaster University,

Ontario Medical Association

 

Description of Proposed Project for Submission to CIHR

Introduction

A national research program is being established to improve cancer survivorship through innovation in interprofessional models of care within community-based primary healthcare (CBPHC) services. This research is relevant to CIHR's priority themes on CBPHC and Chronic Disease Management. Cancer is a chronic condition that often requires complex management and care coordination. Many Canadians do not "live well" following cancer treatment due to poor access to the physical, practical and psychosocial services necessary to address survivorship needs. This research aligns with Cancer Care Ontario priorities to improve access to post-treatment follow-up care and OHHRRN's research area on the impact of re-organization of work. Rising care incidence and prevalence rates will requires Ontario (and other provinces) to implement new models of post-treatment follow-up care such as the earlier transition of patients from cancer programs to CBPHC services. This shift in care will have significant human resources and service delivery implications for CBPHC in meeting the needs of a large and heterogeneous patient population. There is limited interface between cancer and CBPHC services, and structures to support transition from one service to the other are not in place. There is also variable expertise and receptivity among CBPHC providers to taking on responsibility for follow-up care.

Impact

This research program will inform: 1) whether new care models that integrate the expertise of traditional and non-traditional health providers and community/lay services access to and improve chronic disease management and cancer survivorship care; 2) which patient populations are best serve by CBPHC-based pot-treatment follow-up are and how and when the transition to CBPHC should occur; 3) what "package" of medical and non-medical services should be offered and the appropriate balance of specialist and primary healthcare provider involvement for different "at risk" populations; 4) the impact of new care models on health outcomes, patient/provider satisfaction and healthcare service use; 5) the effectiveness of implementation strategies for model uptake; and, 6) the accountability guidelines and performance-based indicators for achieving systems-wide change required to support CBPHC model of post-treatment follow-up care.

Research Objectives

Our goal is to improve patient, health provider and health system outcomes through a transformation in cancer survivorship care from a medical and disease-oriented approach to one that is comprehensive, person-centered and health oriented and that promotes self-care. Specific research objectives are to:1) design, evaluate and compare the structures, processes and outcomes of new care models in three provinces (Ontario, Alberta, Nova Scotia); 2) design and evaluate the effectiveness of implementation strategies to support the uptake of new models of care; 3) within an interprofessional framework, strengthen the contribution of various health professionals including oncology, family practice and advanced practice nurses; pharmacists; social workers' and dieticians; and 4) improve access to and quality of survivorship care through the integration of existing lay, community and social services (e.g., volunteers, support groups) within new models of care.

Research Approach and Design

A participatory, evidence-informed, patient-centered framework for designing innovative models of care guides the research program. The framework is effective for introducing new models of care and health provider roles and uses research-base3d strategies consistent with OHHRRN's theme of "better attending to the context of HHR" that are recommended for effective health human resource planning. Medical Research Council guidelines for developing and evaluating complex healthcare interventions will inform research methods used to design the new model of post-treatment follow-up care. Cancer and CBPHC services in Ontario , Alberta and Nova Scotia are the setting for this research. As the Ontario sites, the Hamilton and Stonechurch Family Health Teams (FHTs) permit the evaluation of CBPHC services unique to this province. A care study design will be used to examine how the new model of care is tailored to meet the healthcare contexts of each case or province and to evaluate and compare the structures and processes associated with expected outcomes across cases. Within the case study, qualitative and quantitative methods will be used to answer research questions specific to different stages of the model of care design and evaluation process. Focus groups, interviews, audits, administrative databases and questionnaires will be used to examine the impact of healthcare planning and implementation strategies on the uptake o the model of care. Integrated knowledge translation methods (i.e., Delphi, focus groups, expert panels, advisory committees, community forums, stakeholder meetings) will engage knowledge users (decision-makers, patients, clinicians) through the research process.