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Evaluating the effectiveness of cancer care coordination

Research updates

Issue 6, December 2010

For a person diagnosed with cancer, the treatment pathway through the health system is complex. The Cancer Institute NSW funds 58 cancer nurse coordinators across the state to improve the continuity and quality of care for cancer patients.

Purpose

An evaluation of the CNC positions has been undertaken to determine:

• the impact of the role on patients and carers
• the impact of the role on clinicians
• the role played by other clinicians in the provision of care coordination.

Method

Following an extensive literature review and consultation with key stakeholders the following evaluation methodology was developed:

• A survey of all CNCs funded by the CINSW.
• A survey of other cancer care clinicians.
• Focus groups with CNCs, cancer care clinicians and service managers.
• Patient level case studies at eight sites involving patient and carer surveys and interviews.

Results: Patients and carers perspective

The results of the patient/carer survey have been broken down into three sub-categories:

1. Those that had a CNC to coordinate their care.
2. Those that had a health professional (besides a CNC) to coordinate their care.
3. Those that said there was no one person responsible for coordinating their care.

For the majority of domains, those patients with a health professional (other than a CNC) coordinating their care rated the domains equal to or better than those with a CNC coordinating their care.

Whether patients felt having access to a cancer care coordinator
is an essential part of the treatment and care of patients with cancer

• Patients who have someone coordinating their care were more satisfied with the care they received compared to patients who had no one responsible for their care.
• Patients who have someone coordinating their care were more satisfied about the opportunities provided to them in being involved in the decision making process about their care and treatment compared to patients who had no one person responsible for their care.
• Patients believe that having access to a cancer care coordinator is an essential part of the treatment and care of patients with cancer.

How satisfied patients were about the care they received during their cancer experience

• Almost all patients with access to someone to coordinate their care were satisfied with the care they received.
• Eighty-four per cent of patients with no one person responsible for coordinating their care were satisfied with the care they received.

The proportion of patients satisfied they were provided information when they needed it

• Patients with access to a CNC were always provided with tailored education sessions about their diagnosis, treatment and possible side effects, and appropriate referrals.
• Patients without access to a CNC only sometimes received this information.

Patients' satisfaction levels with timely referral to support services

• Seventy-eight per cent of patients with access to a CNC were satisfied with referrals to support services. This reflects the priority placed on multidisciplinary care by care coordinators.
• This compares to a satisfaction of 36 per cent of patients without someone coordinating their care.

Results: Clinicians perspective

Impact of CNC on improving patient centred care

• CNCs have had a high impact on improving patient centred care.
• CNCs and their clinical colleagues described all the work CNCs do as patient centred.
• The CNC was described as the person in the middle of the health system, holding the patient's hand though his/her cancer journey, walking them to the relevant health professionals and support services.

Impact of CNC on improving care coordination

• CNCs have a high impact on coordinating patient care and providing access to appropriate services.
• CNCs have developed and maintained good communication and links with members of the cancer care team and allied health staff.
• The evaluation found that further work is needed for CNCs to effectively act as a conduit between clinicians based at the cancer service and the referring GP; and between clinicians based at the cancer care service and other members of the cancer care team based elsewhere.

Impact of CNC on improving multidisciplinary care

• In general all cancer professionals perceive the CNC role as having had a high positive impact on improving multidisciplinary care.

Conclusion

Care coordination is essential to the provision of well coordinated, multidisciplinary cancer care. However, from the patient's perspective it does not appear to matter whether the coordination is undertaken by a cancer nurse coordinator or another team member. The results of this evaluation will assist in the development of strategies to improve equity of access to care coordination throughout NSW, whether that be through a cancer nurse coordinator or another team member.