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Let's Discuss! Ensuring Delivery of Patient-Centered Cancer Care

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We started the 2012 year of cyber-seminars with a wonderful exploration of the new Commission on Cancer's guidelines for patient-centered cancer care and the implications for clinics and cancer control coalitions.  Connie Bura did an excellent job of laying out the rationale and evidence for new guidelines as well as implementation questions for clinics and coalitions to consider and Dr Teresa Ponn shared her experience of implementing the guidelines in a hospital in New Hampshire.

Now it is your turn to share your experience and knowledge...ask a question of the speakers or your fellow R2R members, share your stories of how you are addressing and implementing patient-centered care.  What lessons have you learned or tools have you used that others might benefit from.

Join us in the discussion!

If you missed the live seminar, the archive will be available next week.  Watch and then come share your thoughts.


Regarding Standard 2.3 - Risk

Regarding Standard 2.3 - Risk Assessment and Genetic Testing:  We have a RN who has completed training by ONS; however, she is not an Advanced Practice Nurse.  Does this person meet the qualifications?  There is only one geneticist in our community employed by another hospital.

We thoroughly enjoyed the

We thoroughly enjoyed the cyber-seminar today, although ran out of time to ask our question.  One of our providers has a question regarding Std. 3.2 Psychosocial Distress Screening.

We have looked on the Best Repository Practices to view the tools provided and have even had a conference call/demo with Polaris Health regarding their web-based tool (wonderful tool, yet very expensive).  Our question centers on the Tools section under the process requirements, which states it should be a "standardized, validated instrument with established clinical cutioffs" that is used to assess psychosocial distress.  Can you better define this type of validated tool for us and who would need to validate it?  Can we simply develop our own process, devise our own questions for our patients and input them into our EMR to satisfy the standard?  I guess we just need clarification on this aspect.  Any help or guidance would be extremely helpful.

Thank you!

Thank you for your questions,

Thank you for your questions, Melissa and Cheryl.  I hope that Teresa and Connie will join shortly and share their replies.  In the meantime, I also wanted to take the opportunity to share some of the other questions that we unfortunately did not get to answer on the seminar due to the overwhelming number of questions we received.

For both Connie or Teresa:

1. Do you anticipate separate insurance reimbursement to create and discuss cancer survivor plans?

2. Patients who only have surgery and maybe hormonal treatment only and does not go to a medical oncologist, does a treatment summary need to be offered to this patient also or just patients getting chemo and radiation?

For Connie/CoC:

1. Regarding genetic assessment, does this need to be done on ALL inpatients, not just cancer patients. 

2. Can you provide more information about the community needs assessment. How extensive? Do you have examples of a good needs assessment to conduct?  We have considered questioning cancer center patients to see what needs they identify and were or were not addressed.

3.  Will there be an 'patient opts-out' option for distress screening.  A number of patients prefer not to address it, particularly when their diagnosis is new.

We also received a number of questions about where the resources mentioned could be found.  I have listed below the websites for both the Commission on Cancer and the New Hampshire Comprehensive Cancer Collaboration and some of the specific resources mentioned:

--Treatment Summary Forms:

            --Best Practices Repository:

1. A consultation at end of

1. A consultation at end of treatment would be a good way to achieve treatment summary form fillout as well as insurance coverage for the patient. That would be  difficult for surgeons, since we have a global fee that lasts 3 months for Medicare patients.

2. According to the standards, all cancer patient should receive a treatment summary. We have not yet developed a simple form for those who undergo surgery alone, or in the case of breast patients, surgery and hormonal therapy ordered by the surgeon.

If anyone has developed such a form, please submit it for all of us to see and evaluate. We have found the  American Cancer Society  to be very helpful in this regard- they provide binders for all of our newly diagnosed breast cancer patients . These binders have pockets for Drs.' cards, appointments, and pathology and radiology reports. This would be a good place to keep sucha treatment summary.

I was not able to write down

I was not able to write down quickly enough who should be part of the palliative care team, what we should discuss and so -- I have a meeting with people tomorrow as we started a "palliative group." We discuss pts being seen in Oncology next week, who might need a social worker consult and why. But I get the feeling, that is not going to cover for Standard 2.4. Can you provide more in sight into this standard? I know a policy and procedure will need to be established to cover this standard. I spent hours on internet yesterday researching articles and topics you had mentioned on Tuesday.

Thanks, Carol

To Cheryl re: Standard 2.3 I

To Cheryl re: Standard 2.3

I would say no.  The applicable nursing professionals who are listed in the manual are a Genetics Clinical Nurse with genetics credentialing or an advanced practice oncology nurse with specialize education in genetics with ONS certification preferred.  This nurse should move forward to become and advanced practice nurse.  To meet the standard, this program will probably need to create a referral process, either to the geneticist employed by the other facility or perhaps through assessment and counseling by phone. 

To Melissa re: Standard 3.2

I would encourage you to Google for more information.  One online article I identified in the Journal of the NCI mentioned that 106 validation studies described a total of 33 screening tools.  Some of those mentioned in this article are the Combined Depression Questions, Center for Epidemiologic Studies-Depression Scale, Hospital Anxiety and Depression Scale and the commonly known Distress Thermometer.  I would say that this is the type of validation the standard is referring to.  With these validated resources, you should definitely NOT develop their own questions/tool. We will be adding these resources to the Best Practices Repository.

To Peyton in response to question #1 re: insurance reimbursement. 

I am not entirely sure how to respond to this.  I know that the CoC has formed a new advocay workgroup that would be tracking on and supporting any legislation related to survivor care plans adn patient navigation but there's nothing significant occurring at the present time that I know of.  In many case reimbursement is a local  issue. 

To Peyton in resopnse to question #2 re: treatment summary. 

The standard is written to apply to all patients who are completing treatment.  So if the treatment plan for the patient is surgery and hormone, then they should be included.  The only out is when the hormone treatment extends for a long period of time.  However, at some point, these patients do return the care of their local physician.  When this happens, then they should receive the treatment summary/survivor care plan. 

To Peyton in response to question #1 re: genetic assessment. 

The CoC standards only address patients with cancer so from that perspective, only patients with cancer are assessed.  That said, patients with other diseases may also require genetic testing and counseling about their risk for other diseases but including patients who do not have cancer is a decision best made by the facility.

To Peyton in response to question #2 re: about needs assessment. 

As with any new requirement, I would encourage facilities to start small with simple and/or limited questions and by assessing existing patients.  They should then build on their experience by expanding the questions asked and information gathered as well as moving outside the facility to the larger community.  I believe this is the reason that the standard is less specific than some would like.  It gives a lot of latitude to the cancer committee to customize this for their needs. We have not yet seen any specific examples of needs assessments from programs.  As we identify tools we'll post them to our Best Practices Repository.

To Peyton in response to question #3 re:  distress screening

Yes, I believe this is an important component to the standard. That is why the standard states, “referral for the provision of psychosocial care.”  Moving forward to receive this care should always be a patient choice. 

To Carol re: palliative care team

I’m not entirely sure what your question is.  However, you are correct in that referring to a social worker will not meet the standard.  I suggest that you provide a copy of the standard to the folks you are meeting with so that they can read through and discuss this. The members of the palliative care team are listed in the standard.  They are: A physician and at least 1 non physician which could include a nurse, pharmacist, social worker, mental health clinician, chaplain or spiritual care counselor, or a trained volunteer. 


We are in the process of

We are in the process of developing our Community Needs Assessment per requirement for community benefit.  I understood you to say that this assessment could be used to meet the CoC requirement as well.  Could you expand on that and what more our cancer program would need to do?  We have been given a very limited number of questions that we can ask specific to cancer needs in our community and are finding that task difficult since there are so many questions we could ask.

Thank you!

Response to Mary As with any

Response to Mary

As with any new requirement, I would encourage facilities to start small with simple and/or limited questions and by assessing existing patients which can be incorporated into your larger facility community assessment - which sounds like what you are doing.  It is really the role of the cancer committee to define those key questions.  We have not yet captured a specific set of examples of needs assessments from programs.  As we identify these resources we'll post them to our Best Practices Repository. 


I live in a state in which

I live in a state in which the cancer consortium does not seem to be involved in issues regarding the Commission on Cancer.  It seems they have been more involved in issues related to billing and private practitioners.  I wonder how I would go about bringing some of the issues related to the changes in the standards to the consortium.  Presently I do not even know how someone becomes a member.  I was very impressed with the work of the New Hampshire Cancer Consortium.

The CoC's State Chairs

The CoC's State Chairs represent the CoC at the state level and part of their role is to become involved in the state cancer plan coalition.  You might want to reach out to the state chair to see if he or she has made any attempt to become involved in the coalition and if they can assist in presenting or bringing information forward to the coalition about the work of the CoC and its standards.  The list of CoC State Chairs and their contact information is accessible from the following web page.