Editorial

D eb o rah K. M ayer, PhD, R N .A O C N ® , FAAN— E ditor

How Can We Deliver High-Quality Cancer Care in a Healthcare System in Crisis? his provocative question w as ad­ dressed in a rep o rt from the Insti­ tu te of M edicine ([IOM], 2013), D elivering H igh-Q uality Cancer Care: C harting a N ew Course f o r a System in Crisis. An interdisciplinary com m ittee synthesized m any of th e changes that are occurring in our society and health care th a t w ill challen g e o u r ex istin g cancer care system. These changes are familiar to many of us: an aging popula­ tion along w ith th e resulting increase in th e n um ber of cancer survivors, an in a d eq u a te n u m b e r of and in c re ase d dem and for trained healthcare provid­ ers, an d rising h e a lth c a re costs. T he IOM rep ort recom m ended a fram ew ork of six in te rco n n ec te d com ponents for improving the quality of cancer care (see Figures 1 and 2). Each of these com po­ nents is w orthy of an editorial and more. I w ould like to focus, however, on one of them : an adequately staffed, trained, and co o rd in ated w orkforce. And, for good reason, as I w ant to retire someday and know that others w ill be taking my place in caring for cancer survivors across the care continuum . So le t’s explore this one com ponent in m ore detail.

T

Adequately Staffed and Trained An estim ated 1.6 m illion people in the United States will be diagnosed w ith can­ cer this year, and 14.5 million Americans are cancer survivors (American Cancer Society, 2014; National Cancer Institute, 2014). T he O ncology N ursing Society ([ONS], 2014) has about 35,000 members, but w e know that other nurses also are caring for people w ith cancer; however, these figures give you a sense of the ratio of oncology nurses to people w ith can­ cer. And th e num ber w ho are diagnosed is ex p ected to grow to 2.3 million each year by 2030, w ith more than 19 million Clinical Journal o f Oncology Nursing

Evidence Base to Inform Clinical Care

FIGURE 1. High-Quality Cancer Care Delivery System Note, From Delivering High-Quality Cancer Care: Charting a N ew Course fo r a System in Crisis (p. 36), by In s titu te o f M edicine, 2014, W a s h in g to n DC: N a tio n a l A cadem ies Press. C o p y rig h t 2 0 1 4 by th e In s titu te o f M edicine. R eprinted w ith p erm ission.

survivors (Smith, Smith, Hurrian, Hortobagyi, & Bucholz, 2009). How many of us w ill be needed to care for them? W hat do w e need to do to make sure th ere w ill be enough nurses w ho w ill w ant to provide cancer care? O ne concern I have is that, because oncology is a specialty, others may not th in k th ey n eed to learn m uch about it. G erontology is sim ilar in th at some nurses specialize and develop g reater d ep th of know ledge in th is specialty; however, w e all need to learn how to care for older adults. Similarly, w e will need to educate healthcare professionals, in general, about cancer. If w e explored the

curriculum in nursing schools, I w onder how m uch cancer-related content w ould be included in general sessions? My guess is not enough. And if w e looked at how many cancer-specific program s w e have, my guess is that there aren’t enough of them either. T h erefo re, w e w ill n ee d to b e c re ­ ative in how w e educate b oth generalists and specialists ab o u t ca n ce r care and oncology nursing. O ne exam ple is th e online program developed by ONS for advanced practice providers new to on­ cology (http://w w w 2.ons.org/C ourseD e tail.aspx?course_id=115). This program w ill be helpful in providing foundational

Deborah K. Mayer, PhD, RN, A0CN®, FAAN, is an associate professor in the School o f Nursing at the University o f North Carolina-Chapel Hill. The author takes full responsibility for the content of the article. No financial relationships relevant to the content o f this article have been disclosed by the editorial staff. M ayer can be reached a t [email protected]. Key words: quality; cancer care; w orkforce Digital Object Identifier: 10.1188/14.CJON.381 -382

Volume 18, Number 4

Editorial

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E n g a g e d p a tie n ts

A system that supports all patients in making informed medical decisions consistent with their needs, values, and preferences in consultation with clinicians who have expertise in patient-centered com­ munication and shared decision making. A n a d e q u a te ly s ta ffe d , tra in e d , a n d c o o rd in a te d w o r k fo rc e

A system that provides competent, trusted, interprofessional cancer care teams that are aligned with patients' needs, values, and preferences, as well as coordinated with the patients' noncancer care teams and their caregivers. E v id e n c e -b a s e d ca n c e r care

A system that uses scientific research, such as clinical trials and comparative effectiveness research (CER), to inform medical decisions. A le a rn in g h e a lth care in fo rm a tio n te c h n o lo g y (IT) system fo r cancer

A system that uses advances in IT to enhance the quality and delivery of cancer care, patient out­ comes, innovative research, quality measurement, and performance improvement. T ra n s la tio n o f e v id e n c e in to c linical p ra c tic e , q u a lity m e a s u re m e n t, a n d p e rfo rm a n c e im p ro v e m e n t

A system that rapidly and efficiently incorporates new medical knowledge into clinical practice guide­ lines; measures and assesses progress in improving the delivery of cancer care and publicly reports performance information; and develops innovative strategies for further improvement. Accessible, a ffo r d a b le cancer care

transm ission of patient care sum m aries across multiple settings by 2014 and to be able to have access to com prehensive p atien t data th ro u g h p atien t-cen tered EHRs by 2016 (HealthIT.gov, 2014). That will help facilitate th e care w e w ant to deliver, but w e will still need to improve how w e com m unicate and collaborate in cancer care delivery. We need more research and dem onstration projects on how to do this well. The IOM (2013) rep o rt states that “the central goal of its conceptual fram ew ork is to deliver patient-centered, evidencebased, high-quality cancer care th a t is accessible and affordable to th e entire U.S. population regardless of th e setting w here cancer care is provided” (p. 34). This is a lofty goal and one that I hope w e can achieve w ith an adequately staffed, trained, and coordinated workforce.

A system that is accessible to all patients and uses new payment models to align reimbursement to reward care teams for providing patient-centered, high-quality care and eliminating wasteful interventions.

FIGURE 2. Institute of Medicine Recommendations for Delivering High-Quality Cancer Care Note. From Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis (p. 35), by Institute of Medicine, 2014, Washington DC: National Academies Press. Copyright 2014 by the Institute of Medicine. Reprinted with permission.

know ledge to those entering the special­ ty w ithout formal oncology education. I w ould like to see this provided during orientation for all of these advanced prac­ tice providers. ONS also offers an online OCN® review course and a n um ber of oth er offerings intended for the oncology nurse. But cancer survivors are cared for by others as well. How will they learn about cancer care? W hat is our role as a specialty organization in reaching out and educating others about the needs of this population? I hope that w e share our expertise w ith others, w h eth er they are hom ecare nurses or prim ary care nurse practitioners. We also may w ant to de­ velop program s for others providing care to people w ith cancer, such as caregivers and lay navigators. In this way, w e will ex ten d and enhance our ability to share our expertise to im prove cancer care.

Coordinated Workforce This is the oth er p art of th e IOM com ­ ponent. C oordinated is defined as “ef­ 382

fectively organized so that all the parts w ork well tog eth er” (Cambridge O nline Dictionary, 2014). Now, this is w here I think the IOM report was on target about a system in crisis. Cancer care is delivered by m em bers of interdisciplinary team s but may n o t be as co o rd in ated as w e w ould like. We need to be educated in effective com m unication and collabora­ tion and learn how to deliver cancer care w ith others. We need to begin learning this in o ur formative education as health­ care providers. We also n eed system s that help facilitate com m unication and care coord in atio n , su ch as elec tro n ic health records (EHRs). The cu rren t roll­ out (stage 2) for m eaningful use of EHRs calls for th e ability to have electro n ic

References American Cancer Society. (2014). Cancer fa c ts a n d fig u r e s 2014. Atlanta, GA: Author. Cambridge Online Dictionary. (2014). Co­ ordinated. Retrieved from http://diction ary.cam bridge.org/dictionary/british/ coordinated_l HeaIthIT.gov. (2014). EHR incentives and certificatio n . R etrieved from h ttp :// www.heaIthit.gov/providers-profession als/how-attain-meaningful-use Institute of Medicine. (2013). D elivering high-quality cancer care: Charting a new course fo r a system in crisis. Wash­ ington, DC: National Academies Press. National Cancer Institute. (2014). Office of Cancer Survivorship: Statistics. Retrieved from http://cancercontrol.cancer.gov/ ocs/statistics/statistics.html Oncology Nursing Society. (2014). About us. R etrieved from h ttp s://w w w .o n s .org/about-ons Smith, B.D., Smith, G.L., Hurrian, A., Hortobagyi, G., & Bucholz, T. (2009). Future of cancer incidence in the United States: Burdens upon an aging, changing nation. Journal o f Clinical Oncology, 27, 27582765. doi:10.1200/JC0.2008.20.8983

Correction In the June 2014 issue of the Clinical Journal o f Oncology Nursing (Vol. 18, No. 3), "EvidenceBased Management of Sepsis," by C. O'Leary, page 281 contained the sentence, "In patients with normal blood pressure, decreased lactate can be an indicator of hypoperfusion, impending sepsis, and organ dysfunction." The sentence should have read "increased" instead of "decreased."

A ugust 2014

V o lu m e 18, N u m b e r 4

C lin ic a l J o u rn a l o f O n c o lo g y N u rs in g

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How can we deliver high-quality cancer care in a healthcare system in crisis?

This provocative question was addressed in a report from the Institute of Medicine ([IOM], 2013), Delivering High-Quality Cancer Care: Charting a New ...
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