Patients’ experiences, self-awareness, self-confidence, dignity, and personal integrity represent the fundamental obligations of psychosocial care, according to John Wynn, MD, DFAPA, Clinical Professor, Department of Psychiatry and Behavioral Sciences, University [ Read More ]
December 2015 Vol 6, NO 6
Implementing New Commission on Cancer Standards into Your Practice And other news from the AONN+ 2015 Conference
Aaron D. Bleznak, MD, MBA, FACS, Vice President and Senior Medical Director, Sentara Medical Group, Assistant Professor of Clinical Surgery, Eastern Virginia Medical School, Norfolk, discussed the intent of the new 2012 Commission on Cancer (CoC) standards, and what navigators need to do to comply. “You’re members of a team whose goal is to enhance the quality of cancer care that you’re providing to your patient population,” he said at the Sixth Annual Academy of Oncology Nurse & Patient Navigators (AONN+) Conference in Atlanta, GA. “Consequently, you have to work with the team to achieve accreditation, and retain accreditation.”
The Need for New Standards
Dr Bleznak provided his perspective as a practitioner, administrator, oncology care provider, and surveyor so that navigators could understand the scope of the new standards, and why they are necessary. The changes came partly as a result of when the Institute of Medicine declared that patient-centered care is not well-implemented, and that the healthcare system is complex and fragmented. In addition, between 25% and 40% of care does not positively impact patients’ outcomes. “Your organizations are all facing unprecedented changes in healthcare, and pressure is coming from all directions,” he explained. As a result of the changing landscape of healthcare, the 2012 CoC standards focus on outcomes and the continuum of cancer care.
Dr Bleznak provided some pointers for complying with Standard 3.1: Patient Navigation Process, Standard 3.2: Psychosocial Distress Screening, and Standard 3.3: Survivorship Care Plan. Standard 3.1 requires a navigation process that is driven by a community needs assessment, which must be completed once every 3-year survey cycle. “The Cancer Committee must define the scope of the community needs assessment as it applies to cancer,” according to Dr Bleznak. Data sources for the needs assessment are readily available, including client database reports, Cancer Quality Improvement Program data, and cancer registry data.
Standard 3.1 also focuses on addressing patients’ barriers to cancer care. “The intent of the standard is to identify and address a new barrier each year,” Dr Bleznak explained. “You can address the same barrier or disparity for up to, but not exceeding, 3 consecutive years.” The institution’s progress in addressing the barrier must be documented, and reported annually.
Dr Bleznak noted that one important requirement for Standard 3.2 is that the outcome of psychosocial distress screening must be discussed with the patient in person. “If the patient is at significant distress, you are required to have a downstreamed process to make sure they receive the care they require,” he stated.
Fewer than 40% of cancer programs felt prepared to implement a survivorship care plan as a result of a lack of clarity in Standard 3.3. Dr Bleznak recommended first using the American Society of Clinical Oncology’s core set of data elements for survivorship care, and to concentrate on implementing a pilot survivorship care program for the most common cancer types first. This will make it easier to reach 25% of non–stage-IV patients by 2016, which is required for CoC-accredited programs.
Mistakes to Avoid
Navigators should be aware that proper documentation is essential for compliance with the new CoC standards. Erroneous and brief documentation are common reasons for programs’ failure to comply. “We don’t get to come and watch what your Cancer Committee does; all we know is what you say you do. If it’s not written down, it did not occur,” he advised. The CoC provides a format for recording the minutes of Cancer Committee meetings to ensure all the necessary information is documented correctly.
In addition, fulfilling requirements for one standard cannot simultaneously fulfill another standard. For example, prevention screening standards have the potential to overlap with navigation standards regarding overcoming barriers to care. “If one of your barriers that you identify is poor screening for a population…in 2016, make sure you have a different screening goal…because 1 activity cannot be utilized to meet 2 standards,” Dr Bleznak said.
Finally, initiating compliance with the new standards late in the year is another error that should be avoided.
Carol Gunsch, RN, BScN, CONc, de Souza nurse, Gastrointestinal Diagnostic Assessment Program Nurse Navigator, Grand River Hospital, Waterloo Wellington Regional Cancer Program, Kitchener, Ontario, Canada, and Maureen Watt-Smit, RN, BScN, [ Read More ]