Integrated Analysis of Patient Engagement in the Cancer Care Journey
- Dec 3, 2018
- 5 min read
Updated: Dec 3, 2018
Introduction
Using the knowledge gained from MHST601- Critical Foundations in Health Disciplines, the following essay will be an integrated analysis of increasing patient engagement in the cancer care journey.
Cancer as a Chronic Disease
Cancer is defined as a disease with uncontrolled cell growth in a part of the body. Nearly 1 in 2 Canadians will develop cancer in their lifetime, with the most common forms of cancer being lung, colorectal, breast, and prostate. Cancer is the leading cause of death in Canada with 30% of all deaths being due to this disease (Canadian Cancer Society, 2018). However, with improvements in detection and treatment of cancers, there has been a steady decline in mortality rates due to cancer since 2003 (Figure 1).
Although the overall risk of dying from cancer is declining in Canada, the number of new cancer diagnoses continues to rise (Public Health Agency of Canada, 2018)(Figure 2). This means more Canadians are now living with cancer and living with the after-effects of treatment making cancer an ongoing chronic disease, similar to diabetes or heart disease. Management and prevention of cancer is important in reducing the prevalence of the disease among Canadians and this is why the Canadian and provincial governments have guidelines to help with early detection and prevention. For example, in Ontario there are the Ontario Breast Screening Program, the Ontario Cervical Screening Program, and the Colon Check Program.
Who does cancer affect?
The incidence rates of cancer is influenced by a number of determinants of health, which is defined as a “broad range of personal, social, economic, and environmental factors that determine individual and population health” (Government of Canada, 2018). Within these determinants, there is a specific group of social and economic factors called social determinants of health that relate to the conditions in which people are born, grow, work, live, and age.
One of the identified vulnerable populations to the incidence of cancer rates are seniors. The greatest number of new cancer cases are expected to be diagnosed in those ages 60-79 with an estimated 53.1% of all cases in 2018 in Ontario to occur in this age group (Cancer Care Ontario, 2018) (Figure 3). As well, the likelihood of dying from cancer grows with age. “In 2013, the cancer mortality rate among Canadians under 30 years of age was approximately 4 per 100,000 and it was over 2,200 per 100,000 in those 90 years of age and older” (Public Health Agency of Canada, 2018).
Even though Canada has free healthcare, there exists many health inequalities within the population. Health inequalities are the differences in the health status of individuals and groups. Within health inequalities, there are health inequity, which are health inequalities that are unfair or unjust (Government of Canada, 2018). An example of this is the lack of access to healthcare resources for Aboriginal people in Northern regions of Canada. This is one of the factors that also make the Aboriginal community a vulnerable population. In terms of cancer for example, cervical cancers is among one of the most preventable cancers with the use of the screening method, Pap test. However, the burden of cervical cancer in Indigenous populations world-wide is still very high due to under-screening. Marr and her colleagues (2016) state that cervical cancer is the most common cancer in First Nations women living in the Northwest Territories, and in an Albertan community, the incidence of cervical cancer was 20 times higher than in the province as a whole (p. 479).
With this knowledge of vulnerable populations and social determinants of health, health care providers, policy makers, and the government have the ability to find better ways to engage these populations and empower these patients to be involved in their own care. In turn, this will help populations, such as seniors and Aboriginal people, better address their cancer health risks at an earlier stage and better their survival and prognosis.
Patient-reported Outcomes
Looking to the future of healthcare, and more specifically cancer care, there has been a major shift from disease-centred care to person/patient-centred care. A part of this shift is empowering patients to be in charge of their own health and have input into the type of care that they receive. The use of patient-reported outcomes (PROs) for cancer care allow patients to describe the effects of cancer and its treatment from the patient perspective and allow patients to communicate to the health care providers their symptoms, both physical and psychosocial, that are of the most concern to the patient (Tran, et al., 2018). The aim of the patient reported outcome is to support the symptom management of patients as they go through their cancer journey as a patient may experience a variety of side effect throughout their cancer continuum (Cancer Care Ontario, 2016). With the patient reporting their symptoms in real-time this allows healthcare providers to prioritize the concerns that matter the most to patients. Research has shown that the use of PROs into routine “cancer care can improve patient-provider communication, satisfaction with care, symptom management, quality of life and survival” (Tran, et al., 2018). Cancer care Ontario states that 75% of patients report fatigue, 71% issues of wellbeing, and 50% of patients report feelings of depression (Cancer Care Ontario, 2016). However, the limitation of the patient-reported outcome measures is that it has not been implemented across all provinces and territories. Therefore, findings are limited to that of specific provinces and make it difficult to implement any national changes to cancer care.
Multilevel Approach to Increasing Patient Engagement
With the known benefits of patient-reported outcomes and how it can benefit the patient and the healthcare system, how do you standardize the collection of data across Canada and implement patient-reported outcomes across all cancer centres? Caissie and her colleagues suggested using a multipronged approach to building an adaptable, scalable system for PROs that aims to improve national alignment and uptake (Caissie, et al., 2018)(Figure 4).
Since this approach is still at the beginning stages, the study suggested to start with a Canadian Partnership for Quality Radiotherapy led pan-Canadian survey of the 44 radiation oncology programs in Canada to identify how each centre is using patient-reported outcomes. They then suggest that when making system-level changes to incorporate the frontline care providers by having local champions to ensure seamless adaptability of standardized pan-Canadian models into local systems and processes (Caissie, et al., 2018).
Conclusion
In summary, having increased patient engagement in healthcare allows for providers to give better and more efficient care, as well as improved population health. Using information of determinants of health, vulnerable populations, and chronic illnesses, a multilevel approach can be determined to improved patient involvement in healthcare decisions. In the particular example of cancer care identified in this essay, vulnerable populations of seniors and Aboriginal people need more empowering ways to decrease their cancer risk and one of the ways to do this is the use of patient-reported outcomes to let patients better inform their providers of how they are feeling and identifying their needs throughout their cancer journey.
References
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Strategies for increasing cervical cancer screening amongst First Nations communities in the Northwest Ontario, Canada. Health Care Women International, 37(4), 478-495. https://www.ncbi.nlm.nih.gov/pubmed/25375661
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