Models of Care Toolkit

Nurse practitioners with BC Cancer are licensed to run independent medical practices covered by the Medical Services Plan. With a master’s degree and advanced clinical training, nurse practitioners care for patients with a cancer diagnosis who do not have a family doctor. Referrals from an oncologist are not required.

With special training in cancer care delivery, nurse practitioners can order diagnostic tests, diagnose cancer, and prescribe most medications. They also monitor short- and long-term effects of cancer and its treatment, and screen for cancer recurrence. Nurse practitioners have access to oncologists for consultation on their patients’ health.

The primary care nurse practitioner model supports the delivery of connected care, reduces the need for regular oncologist appointments after treatment and addresses the shortage of family physicians.

Specialized oncology nurse practitioners have a similar scope of practice to general practitioners in oncology.

In response to clinical practitioner in oncology shortages, nurse practitioners are employed in some community cancer centres in Alberta. In the model, a nurse practitioner in a tertiary cancer centre connects via telehealth to the community site for a weekly clinic. The site’s registered nurse participates in the virtual clinical encounter with the nurse practitioner and the patient. The nurse practitioner also supports the community team virtually outside of clinic hours.

The nurse practitioners-led virtual care model helps:

• Increase resources at community sites can help address capacity issues at tertiary centres
• Control disease progression and increases palliative home care referrals for patients receiving treatment
• Enhance access to equitable care by virtually connecting patients who live at a distance from a cancer centre

Connect with Alberta’s model lead.

Patients undergoing cancer treatment need access to around-the-clock support for crisis and urgent support. Bayshore’s CAREchart@home is an after-hours support program for patients receiving systemic and radiation therapy. Patients can connect virtually to a live nurse to help manage their symptoms through a digital health app on a computer, tablet, or phone. Patients are also prompted to answer questions regarding their symptoms before a visit.

Patients enrolled with Bayshore have access to 24-hour care, 365 days a year. It is available for over 70 hospitals in Ontario. CAREchart@home services are administered using evidence-based guidelines by registered oncology nurses.

The Bayshore program provides a range of supports:

• Real-time and shared access to patient health records, allowing the treatment team to monitor and follow-up if needed and is critical for coordinated care.
• Real-time report submission to members of the patient’s health care team after each visit, ensuring all relevant case information is shared in a confidential manner.
• Help to patients with symptom management, reducing reliance on oncologists and supporting patients living at a distance from the hospital.
• Access to advice that reduces unnecessary emergency room visits, improving patient satisfaction.

Management of hematological malignancies such as leukemia, lymphoma and myeloma is complex and requires interdisciplinary involvement in planning. Because treatment can last years, finding ways to support the long-term needs of patients is important.

As part of a quality improvement initiative, Ontario Health’s Cancer Care Ontario reviewed the roles of multidisciplinary teams involved in the care of this patient population. They used this review to support changes to optimize the role of registered nurses, nurse practitioners and physician assistants. Oversight for planning, care and follow-up is provided by hematologists, oncologists and/or transplant physicians.

While specific to malignant hematology, this model could be extended to other patient populations with complex needs.

Despite the key role of clinical pharmacists in oncology, many cancer care teams have limited access to clinical pharmacy services. The James Comprehensive Cancer Center in Ohio developed the hematology/oncology allocation tool (HOPAT) to determine which inpatient services benefit most from having a clinical pharmacist on their team. The tool includes five criteria and allows health system planners to allocate limited clinical pharmacy resources efficiently and equitably.