Equicare Health: Bridging Gaps and Enhancing Networks of Cancer Care

A comprehensive cancer care system encompasses the entire spectrum of care – from prevention and screening to diagnosis, treatment, and survivorship. At the secondary prevention stage, screening is utilized to detect potential cases. At diagnosis, the presence or absence of cancer is confirmed, and the patient is directed to the best course of treatment. Survivorship commences at diagnosis and continues onto long-term survival.

Early detection through cancer screening is paramount to the control and management of cancer cases. Each cancer type has a different screening procedure, making it imperative to understand the different modalities. The differences range in the administration of procedure to its specificity, sensitivity, and unintended consequences.

Once screening procedures are available and accepted, patient engagement initiatives play an important role in helping health professionals attract patients and better tailor treatment plans to specific tumor characteristics. As individuals move through the cancer care continuum – from screening to the stages of care – clear communication and access to education tools improve patient engagement.

Currently, digital technologies are utilized to enhance engagement with patients, physicians, and allied healthcare professionals by ensuring that accurate information is gathered and transferred throughout the health system in an efficient manner. For instance, patient reported outcomes (PROs) and questionnaires allow self-reporting of symptoms that provide invaluable information for timely risk management and assessing the overall effectiveness of cancer interventions. These tools have proven that enhanced communication and a well-coordinated system is not only advantageous for the patient, but also the medical team, and healthcare system.

Equicare Health – a leading provider of comprehensive care coordination solutions  – aims to assist patients and the medical team through the cancer care continuum. The key is a platform that bridges the gaps and seamlessly connects health professional team members to each other and their patients. For patients, through the patient portal, they can connect with their care team and engage in their healthcare journey. The portal facilitates patient activation and engagement. Once patients receive an invitation letter to sign up, they will be welcomed to Equicare Health’s portal. There, the dashboard guides patients to access resources such as health information, test results, educational material, and appointment schedule. Regular visits to the portal will help patients and their caregivers keep up-to-date on the progress of their treatment and maintain contact with their care team.

The healthcare team enhances patient activation by selecting the appropriate resources available within Equicare CS (ECS). For instance, a physician and/or allied healthcare professional can assign questionnaires to a patient based on the disease site and topic of concern (i.e. depression screening, sleep disorders screening, and/or distress screening). In addition, care teams can assign relevant education covering topics from pre-treatment to survivorship care to assist patients in their own care management. By doing so, patients become actively involved in their own health, and conversations between the care team and the patient are facilitated.

In addition to the care team guiding patients and processing referrals to specialists and health services, they can efficiently coordinate tasks within the care team through Equicare CS. The platform assists with navigation referrals and consults to medical services (i.e. imaging, surgery, radiation oncology), and support services (i.e. counseling, pain management, nutrition, and hospice care). This results in streamlined communication within and between departments and services, making it easier to support patients and enhance the care they need within the many facets of a healthcare team. Once ECS is adequately utilized, patient navigation reports and provider productivity reports can be generated to evaluate quality of care provided to support goals and compliance standards.

The key functionalities of navigation platforms and informatics tools described include the ability to:

 1) Do distress management for CoC accreditation

2) Track navigation activity to support the navigator role to administrator

 3) Standardize documentation throughout departments

 4) Provide timely information to patients

 5) Communicate to the entire cancer care team through the platform

Care becomes more difficult during survivorship, as patients are often lost to follow-up or unaware of the heightened health risks that arise post-treatment. This disconnect with the health system proves to be a challenge in managing patients’ medical and psychosocial concerns. Hence, electronic communication tools are imperative to maintaining contact both during and after active care: within the healthcare team and between the team and the patient.

Each step of cancer care is complex and multimodal. There is a need to create a chronic care model to improve clinical outcomes for patients as well as to maximize the operational efficiency for cancer centers. To date, Equicare Health has served over 250,000 oncology patients and 300 cancer centres who continue to utilize the diverse tools that ECS has to offer. With ECS, care coordination and center specific goals are supported through the Service Team and Workflow Specialist at Equicare, who connect with cancer centers and healthcare professionals to assist them in reaching their goals (i.e. number of PROs filled, meeting accreditation standards, and/or enhancing patient engagement). ECS supports patients and healthcare professionals through the care continuum. With its efficient communication tools, tailored educational content, and patient reported outcomes, ECS gathers information, data and education into a comprehensive platform that empowers healthcare providers, patients, and caregivers in the healthcare journey.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing

Patient engagement and empowerment tools enhance cancer care process

According to a recent survey, approximately 90% of patients with chronic illnesses need assistance with disease management, and 70% need healthcare providers to supply them with more educational resources [1]. However, the tools that have traditionally been in place do not provide the optimal level of assistance and communication to meet the needs of patients.

In essence, to improve health outcomes, patients and caregivers need to have access to tools that provide prognosis and procedural education, allowing for effective communication with the cancer care team. When patients are informed, they are able to express the urgency of their needs to better navigate through their care continuum.

In oncology, controlling and treating cancer ranges across a combination of surgery, radiation, and chemotherapy. Treatment measures can be effective in stopping tumor progression, managing pain, and extending life. These may be accompanied with unintentional side effects, ranging from short-term and transient to long-term and persistent that can arise years after the first treatment.

Patient portals containing electronic personal health records linked to health systems, patient reported outcomes, and patient-centered education are currently recognized as promising tools to enhance health outcomes. Studies show that patient engagement throughout diagnostic, workup, and treatment, improves patient-provider relationships, enhances patient safety, and empowers patients and their caregivers [2].

Portals allow health professionals the ability to efficiently “track preventive measures such as screening tests and immunizations [3]”, and enable shared-decision making between health professionals and the patient. Communication between patients and the care team is enhanced with careful documentation of each interaction. A study by Easley et al. highlights that better communication among health professionals and with patients is the most common factor contributing to a positive experience within cancer care coordination [4]. When health professionals are given suitable tools to further enhance health literacy and promote self-management – patient outcomes throughout cancer treatment and survivorship planning improve.

Patient safety is further enhanced through the usage of portals that allow the tracking of stages of care in a centralized manner [5]. When supplemented with other software tools (i.e. tailored evidence-based educational articles, and patient reported outcomes and questionnaires) patients are able to monitor their health and efficiently report their status to the care provider.

Equicare Health is amongst the leading patient navigation health IT companies, currently serving over 250,000 oncology patients at over 240 cancer centers across the globe. Equicare Health provides efficient communication tools, a platform of educational content, and patient reported outcomes and questionnaires. The aim is to empower oncology navigation teams, caregivers and their patients.

The educational content provided is personalized for the patient and their care team. Equicare’s partnership with Oncolink and the inclusion of comprehensive drug fact sheets provides patients access to an extensive set of cancer educational content. Equicare has integrated Oncolink’s Education Library into their system to allow for timely and appropriate education provision.

Patient reported outcomes and questionnaires are measurements of any aspect of a patient’s health status that are provided directly from the individual [6]. They can provide invaluable information for timely risk management and assessing the overall effectiveness of cancer interventions. Cancer care organizations have begun integrating patient reported outcomes into their routine clinical practice. The hope is to improve cancer symptom screening and management across their jurisdiction.

Informal patient reported outcome measures in cancer care have always been in play. However, it has only been recently that there is growing interest on collecting information in a systematic and efficient manner through electronic collection and e-patient reported outcomes. Electronic collection yields reliable data that are of higher quality than health professional reported data that, in turn, facilitate conversation and increase patient involvement in their care.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing. 

Cancer Care: From screening positive to diagnosis, and oncology team connection

Cancer screening procedures strive for effective early detection. In order to screen large numbers of at risk individuals, screening practices need to be simple, cheap and efficient. Diagnostic tests are used to determine the presence or absence of cancer. Symptomatic individuals, or individuals with positive cancer screening results, go through potentially invasive and expensive diagnostic procedures to establish the presence of a tumor.

As the cancer journey is complex and convoluted, the patient needs to meet with health professionals with different skill sets to facilitate the process. An oncologist oversees a patient’s care from diagnosis and throughout the course of treatment. Patients consult with their general practitioner and, at times in combination with, health insurance providers to be referred to the most appropriate oncologist. Databases, such as the American Society of Clinical Oncology (ASCO) [1], also provide open access lists.

Within the United States, approximately one third of patients aged 0 – 64 years (a population of approximately over 90 million) are referred to a specialist by their primary care physician [2]. A well-coordinated referral system needs to be established to accommodate this high frequency of referrals, in addition to connecting primary and specialty care.

All members of the oncology care team (oncologists, general practitioners, radiologists, nurse navigators, patient coordinators, registered dietitians, etc.) play an integral role in enhancing the quality of care received. The care provided encompasses diverse aspects of health services. In addition to appropriate care that is timely and appropriate, other elements of cancer care include psychosocial assessment, suitable and timely referral, and individualized treatment that considers each patient’s needs and preferences. A multidisciplinary team is needed to address these tasks, which may create complexities to care coordination in both hospital and community settings. Challenges include recognizing health professional roles and responsibilities, communication between the care team and with the patient, managing scarce resources, and transitioning patients through care.

Digital technologies have aimed to address these challenges [3]. These include:

  • Electronic portals

  • Electronic Health Records (EHRs)

  • Patient reported outcomes measures

  • Patient-centered education

They are utilized to enable collaborative care coordination systems. Patient experience and outcome is enhanced when implementation of optimal technologies are coupled with proper training and support for patients and the care team.

Recent evidence-based research has proven that improving quality of care through enhanced communication and a well-coordinated system is advantageous for the patient, the medical team, and healthcare system. Researchers have embarked on a series of studies aimed at identifying quality measures. Two examples of these cover:

1. The impact of EHRs and oncology EMR tools used by multidisciplinary teams in GP-oncologist communication and facilitation of cancer care. [4]

2. Use of IT-enabled measurements and patient reported outcomes by patients and the care team to enhance patient-centered care (allowing for a seamless incorporation of patient perspectives into cancer care practices). [5]

As a patient moves through from screening and diagnostics to workup, treatment plan, and the care planning stages – clear communication, education tools, and access improve patient engagement.

In our next article, we will take a closer look at different ways of engaging patients and their caregivers (e.g. patient portals, patient reported outcomes, and patient-centred education), and how they can ultimately improve the quality of health outcomes.

Main resources: https://www.ncbi.nlm.nih.gov/books/NBK223387/

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing. 

Impacts of Cancer Screening on Patients, Oncologists, and the Care Process

Cancer screening revolutionized the world of cancer care with its aim to detect cancer before symptoms appear. Early detection is paramount for the control of any disease. When symptoms are detected or apparent, diagnostic tests are used to find out the cause of the symptoms. A procedure, ranging in complexity and invasiveness, can have significant influences on detection, diagnosis, and trajectory of care. Once detected, engaging an oncologist early and connecting the screening results to the expertise needed enhances patient outcomes.

There are different cancer screening procedures in use across the range of cancer types. In the case of breast cancer and colorectal cancer, early detection is correlated with lowering mortality rates [1]. There are times that early detection does not lengthen the life of the patient, but may have other benefits with creating patient awareness. In general, screening tests are recommended and offered to all at-risk individuals, regardless of the outcome. This makes it imperative to be aware of the positive and negative impacts.

Two procedures that have been proven to be very effective at reducing cancer mortality rates are colorectal cancer and breast cancer screening. Colorectal cancer is the second leading cause [2] of cancer deaths in the United States. It mainly develops from abnormal growths in the colon or rectum. Screening tests can identify these abnormal growths. They can also detect tumors, and prevent the development of cancer before growths metastasize.

Interestingly, breast cancer mortality rates are lower than colorectal cancer rates. However, the rate of breast cancer diagnosis are higher within American women [3]. How is it that death rates are lower and diagnoses are higher for breast cancer, when compared to colorectal cancer? The answer is complex and depends on the screening tools used along with the nature of the cancer type and stage. Mammography is currently the most commonly supported screening procedure for breast cancer. Its greatest benefit is the decrease in breast cancer mortality: mammography screening has been associated with a 15% to 20% reduction in breast cancer mortality in women aged 40 to 74 years [4]. Despite the differences between colorectal and breast cancer, it is evident that timely and regular screening is key in lowering mortality rates.

An example of where early screening does not necessarily decrease mortality rates is the prostate-specific antigen (PSA) test for prostate cancer detection [5]. This blood test is able to detect prostate cancer at an early stage. However, routine PSA testing is debated. It is unclear whether early detection and treatment lead to significant changes in the cancer trajectory and the patient’s quality of life. The inadequate evidence of benefits for PSA testing hinders support for this screening test, and shines light on some unintentional consequences.

Recognizing the diversity of cancer screening modalities allows us to understand the scope of their influence across the cancer care spectrum. All tests are followed by results, and cancer screening is no exception. The test has either identified cancer in the individual, or it has not. However, there are truly four outcomes:

 

True Negative The screening test says the patient does not have cancer when they do not truly have cancer
False Positive The screening test says the patient has cancer when they do not truly have it
False Negative The screening test was not able to detect cancer when the patient truly has cancer
True Positive The screening test says the patient has cancer and the patient truly has cancer

 

In the True Negative scenario (an ideal case as a patient is cancer free), the potential implications from the screening test are procedural and financial. For example, when screening for colorectal cancer through colonoscopy, perforation and bleeding may occur.

For False Positive and Negative results, the screening test was not able to accurately identify the true state of the disease. When screening results appear abnormal even though there is no cancer (False Positive), anxiety may arise and each additional procedure may pose its own risks. For breast cancer, on average, 10% of women will be recalled from each screening examination for follow-up, only 5 of the 100 women recalled will have cancer [6]. In the case of False Negative, medical care is not sought in a timely manner. Treatment may even be delayed if cancerous symptoms are present. Understandably, the severity of the unintended consequences depend on the type and stage of the cancer.

It has been argued that screening may result in unnecessary earlier treatment or over-treatment. For breast cancer, the diagnosis and treatment of cancers that would otherwise never have caused symptoms or death in a woman’s lifetime can expose a woman to immediate risks. These include surgical deformity or toxicity from radiation therapy, hormone therapy, or chemotherapy, and late effects of therapeutic radiation – new cancers, scarring, cardiac toxicity.

Timely screening has proven to be an effective tool in curtailing cancer mortality rates. With early screening and engagement, health professionals are able to better tailor treatment plans to the individual tumor characteristics. Some screening tests and treatments are almost always recommended as the benefits outweigh the risks posed.

In our next article, we will explore the need for tools that facilitate the transition of care following a positive screening (False Positive and True Positive) through diagnostic, workup, and treatment plan. We will also elaborate further on directly engaging oncologists and the care team.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing. 

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