Models of care toolkit

Optimizing scope of practice

There are opportunities within models of care, to engage all members of the care team in care delivery, symptom management, patient education and decision-making. Models that limit routine cancer care to specialists can require patients to travel long distances to receive care and can increase pressure on cancer systems already under strain. In rural and remote communities, models of care that optimize scopes of practice for non-specialists are already used.

Cancer care is often supported by family physicians or other primary care teams with nurses, nurse practitioners and general practitioners in oncology (GPO). Empowering all health care providers to work to their full scope of practice may require a formal or informal change to professional scopes of practice as legislation, certification or health care centre allows.

Enhancing the role of pharmacists in cancer care

Pharmacists play a critical role on cancer care teams. This role continues to evolve with advances in dispensing technology, new pharmacist training and credentialling opportunities, and incremental expansion of prescribing authority.

There are significant benefits to models of care that include pharmacists:

• Supporting physicians to balance their workload
• Providing pain management
• Reducing adverse drug reactions and chemotherapy errors
• Advancing community-based cancer screening and referrals
• Reducing unplanned health care utilization

A rapid review identified two broad ways in which pharmacists are integrated into the cancer system:

• In outpatient and community settings, pharmacists provide medication dose optimization, adjustments for supportive medications, interventions for medication-related problems, and among other services.
• In multidisciplinary teams, pharmacists enhance patient knowledge about medication, support team members to develop and adjust medication regimens, ensure medication safety, and assist in financial review of patient medications.

Addressing demands on nurses and other health care providers

Nurses and nurse practitioners are critical to patient care in the cancer system. In addition to hands on care delivery, they provide patient navigation, care planning, primary care and support to patients between appointments.
With the expanding role of nurses and nurse practitioners across models of care, there is risk of overburdening the nursing health workforce, leading to work-related stress and exhaustion, and potentially causing mental health disorder symptoms.

Innovative approaches to address these challenges are needed that effectively use existing resources, while ensuring safe, supportive and ethical work environments, including mental health and wellness supports.

Support resources are available through leading Canadian organizations including: Health Care Excellence Canada and the Centre for Addiction and Mental Health