Models of care toolkit

Optimizing scope of practice

In cities and metropolitan centres cancer care is delivered by a multidisciplinary team that includes oncology specialists, physicians, nurses, pharmacists, therapists and other allied health professionals. Decisions about care ultimately rest with the primary oncologist, the patient and their family. There are opportunities within models of care, however, to engage other members of the care team in care delivery, symptom management, patient education and decision-making. 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.

By contrast, in rural and remote communities, cancer care is often supported by family physicians or other primary care teams with nurses, nurse practitioners and clinical practitioners in oncology (CPO). This reflects the availability of specialists within these communities and is considered a practical approach to care.

Models that limit routine cancer care to specialists can require patients to travel long distances to receive care. Ongoing staffing shortages, burnout, and attrition due to retirement, together with the challenge of recruiting and retaining people in certain professions increases pressure on cancer systems already under strain. These capacity issues are exacerbated by the COVID-19 pandemic.

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 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 providing care in the cancer system. Many of the models identified to improve cancer care rely on nurses and nurse practitioners to provide navigation, primary care, and services for patients needing care between appointments.

Excessive demands placed on all health care providers is causing attrition, work-related stress and exhaustion, and potentially causing mental health disorder symptoms. This situation was exacerbated by the COVID-19 pandemic.

Persistent burnout and staff leaving their practice necessitate innovative ways of using existing resources effectively, while ensuring safe and ethical work environments and providing mental health and wellness supports.

Support resources are available through leading Canadian organizations including: the Canadian Association of Mental Health, the Centre for Addiction and Mental Health, and the Canadian Centre on Substance Use and Addiction.