Models of Care Toolkit

Advanced practice and education

clipart of man at a computer desk next to booksAdvanced practice and continuing education opportunities are essential to implementing models that rely on an expanded scope of practice of nurses, clinical practitioners in oncology and other primary health care providers.

Consultation with partners highlighted the lack of capacity within current nurse and clinical practitioner resources as a key barrier to expanded scope of practice. Recent pressures on the health system resulting from the COVID-19 pandemic have further exacerbated this issue. It is critical that health system planners, care providers, professional associations and educational institutions work together to assess and plan for the current and future needs of local, regional and national populations.

A rapid review conducted by McMaster Health Forum and partner consultation identified a series of training and education programs that can complement the introduction of models of care that optimize the scopes of practice of non-specialists.

Part of a broader Family Practice Oncology Network in British Columbia, the General Practitioner in Oncology (GPO) education program is an eight-week learning opportunity to strengthen the oncology skills of new GPOs and enhance cancer care in their communities.

Through support and training with the program, GPOs have the capacity to deliver chemotherapy and support oncology wards in rural settings. GPOs have guidance and support to help diagnose cancers and, with support from oncology specialists, manage patients during active treatment and provide follow-up support.

In addition to the GPO education program, the network includes:

  • Cancer care guidelines customized to the needs of family physicians
  • Continuing medical education opportunities
  • A subscription to the Journal of Family Practice Oncology
  • Research and evaluation project opportunities and results to increase the Network’s effectiveness over time.

Learn more about British Columbia’s GPO education program.13 and the Family Practice Oncology Network14

Ontario’s Advanced Practice Nursing (APN) Toolkit provides a systematic approach to augmenting the role of APNs in cancer settings and within the community. It is based on the Participatory, Evidence-Based, Patient-Focused Process for Advanced Practice Nursing Role Development, Implementation and Evaluation (PEPPA) Framework for role development.

The toolkit can help health care teams:

  • Implement models of care that optimize providers’ full scope of practice
  • Determine if a new APN role would provide system or program benefit, and establish the APN scope of work
  • Support implementation and evaluation of the new APN role

It is expected that some of the materials in the toolkit can be used to support other advanced health provider roles such as physiotherapists and advanced radiotherapists.

Learn more about Ontario’s Advanced Practice Nursing Enhancement program.15

Ontario’s Oncology Nursing Program builds oncology nursing competency in cancer care by improving access to high-quality, person-centred oncology nursing expertise across the province.

The oncology nursing program supports:

  • Promotion of the best use of nursing roles in oncology care
  • Integration of nurses trained in the delivery of cancer services into community health systems
  • Increased nursing knowledge and skills by building oncology nursing competencies and standards in the delivery of safe, effective, and high-quality cancer care
  • Alignment of nursing competencies with regulatory and national standards to support their scale and spread

Learn more about Ontario’s Oncology Nursing Program16.

Manitoba offers advanced training for family physicians looking to develop skills in cancer management through the Cancer Care Enhanced Skills Program. The program focuses on patients with malignant disease and includes both didactic teaching and clinical rotations. It includes a comprehensive certification course and continuing education opportunities.

The enhanced skills program offers training in:

  • Out-patient medical and radiation oncology
  • Rural family practice oncology
  • Palliative care or at an in-patient palliative care unit with exposure to surgical and psychosocial oncology

Trainees also have access to personalized training options such as surgical oncology, in-patient hematology, and research.

Learn more about Manitoba’s Cancer Care Enhanced Skills Program.17

  1. Williamson S, Beaver K, Gardner A, Martin-Hirsch P. Telephone follow-up after treatment for endometrial cancer: A qualitative study of patients’ and clinical nurse specialists’ experiences in the ENDCAT trial. Eur J Oncol Nurs. 2018;34:61-67.
  2. Beaver K, Williamson S, Sutton CJ, Gardner A, Martin-Hirsch P. Endometrial cancer patients’ preferences for follow-up after treatment: A cross-sectional survey. Eur J Oncol Nurs. 2020;45(101722):101722..
  3. Beaver K, Williamson S, Sutton C, et al. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG. 2017;124(1):150-160.
  4. Cohen PA, Webb PM, King M, et al. Getting the MOST out of follow-up: a randomized controlled trial comparing 3 monthly nurse led follow-up via telehealth, including monitoring CA125 and patient reported outcomes using the MOST (Measure of Ovarian Symptoms and Treatment concerns) with routine clinic based or telehealth follow-up, after completion of first line chemotherapy in patients with epithelial ovarian cancer. Int J Gynecol Cancer. Published online 2021:ijgc-2021-002999.
  5. Schenker Y, Althouse AD, Rosenzweig M, et al. Effect of an oncology nurse-led primary palliative care intervention on patients with advanced cancer: The CONNECT cluster randomized clinical trial: The CONNECT cluster randomized clinical trial. JAMA Intern Med. 2021;181(11):1451-1460.
  6. Komatsu H, Yagasaki K, Yamaguchi T, et al. Effects of a nurse-led medication self-management programme in women with oral treatments for metastatic breast cancer: A mixed-method randomised controlled trial. Eur J Oncol Nurs. 2020;47(101780):101780.
  7. Nelson S, Turnbull J, Bainbridge L, et al. Optimizing Scopes of Practice: New Models for a New Health Care System.; 2014. Accessed November 22, 2021. https://www.cahs-acss.ca/wp-content/uploads/2014/08/Optimizing-Scopes-of-Practice_REPORT-English.pdf
  8. BC Cancer. Primary Care Nurse Practitioners. Accessed December 2, 2021. http://www.bccancer.bc.ca/our-services/services/primary-care
  9. Bayshore Health Care. CareChart. Accessed December 2, 2021. https://www.bayshore.ca/services/government/care/?gclid=CjwKCAjw7fuJBhBdEiwA2lLMYeRHHHTW01oLkWjEuxEeotQ1xyCr14JRceToJfkl_rnOhyYHhVqg4RoCIFEQAvD_BwE
  10. Ontario Health (Cancer Care Ontario). Complex Malignant Hematology Models of Care: Recommendations for Changes in the Roles and Composition of the Multidisciplinary Team and the Setting of Care to Improve Access for Patients in Ontario – March 2017. Accessed December 2, 2021. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/43051%5d
  11. BC Cancer. Community Oncology Network. Accessed December 2, 2021. http://www.bccancer.bc.ca/health-professionals/networks/community-oncology-network
  12. Health Sciences North. Cancer Care. Accessed December 2, 2021. https://hsnsudbury.ca/en/Services-and-Specialties/Cancer-Care
  13. BC Cancer. General Practitioner in Oncology Education Program. Accessed December 2, 2021. http://www.bccancer.bc.ca/health-professionals/networks/family-practice-oncology-network/general-practitioner-in-oncology-education-program
  14. BC Cancer. Family Practice Oncology Network. Accessed December 2, 2021. http://www.bccancer.bc.ca/health-professionals/networks/family-practice-oncology-network
  15. Ontario Health (Cancer Care Ontario). Advanced Practice Nursing Toolkit. Accessed December 2, 2021. https://www.cancercareontario.ca/en/guidelines-advice/treatment-modality/nursing-care/advanced-practice-nursing-toolkit
  16. Ontario Health (Cancer Care Network). Oncology Nursing Program. Accessed December 2, 2021. https://www.cancercareontario.ca/en/cancer-care-ontario/programs/clinical-services/oncology-nursing-program
  17. University of Manitoba. Cancer Care Enhanced Skills Residency. Accessed December 2, 2021. https://umanitoba.ca/medicine/department-family-medicine/cancer-care-enhanced-skills-residency
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