Clinicians looking after men with prostate cancers will, if the Australian and the State and Territory Governments can achieve their aim, become increasingly aware of, and be influenced by, an “Optimum Care Pathway” (OCP) in prostate cancer. The background and content of the OCP is important to members of ANZUP in the way it will affect the care provided for men with prostate cancer, and the extent this can be used as a tool to improve care. You can obtain all of the history, background, and metadata about the prostate cancer (and 14 other) OCPs from an Australian Government webpage: http://www. health.gov.au/internet/main/publishing.nsf/content/occp The short version is that these OCPs aim to “improve patient outcomes by facilitating consistent, safe, high quality and evidence-based care across Australia”. They are expected to “describe the key steps in a patient’s cancer journey and expected standards of care at each stage. They aim to improve patient outcomes by promoting quality cancer care and ensuring that all people diagnosed with cancer receive the best care; regardless of where they live or receive cancer treatment ... The pathways also ensure that those providing care understand how to coordinate the patient care between each stage”. The OCPs arose out of a 2010 Australian Government initiative to improve cancer care across Australia led by a National Cancer Expert Reference Group (NCERG) under the auspices of the Australian Health Ministers’ Advisory Council (AHMAC) and COAG Health Council. In turn, a steering committee working in the Victorian Department of Health was charged with overseeing the work, while the actual work was contracted out to the Cancer Council Victoria in consultation with a wide range of multidisciplinary experts, peak health organisations, consumers and carers. These OCPs have now been nationally endorsed by NCERG, Cancer Australia, Cancer Council Australia, COSA, AHMAC, and the COAG Health Council. A work program will push these out and promote them around Australia progressively in 2017 under plans determined by each State and Territory jurisdiction. For example, the prostate cancer OCP is not currently prioritised in Victoria but is being considered for emphasis in 2017. This OCP provides an opportunity for researchers and clinicians to advocate for system resources and change to improve care for men with prostate cancer. The OCP makes recommendations regarding referral pathways, times, key interventions, and the settings in which these should occur. The OCP explicitly recognises the import of research: “participation in research and/or clinical trials should be encouraged where available and appropriate”. This OCP has the imprimatur of all levels of Australian government, as well as the endorsement of high level cancer control and advisory organisations. One critical implication of this is that the OCP establishes standards and benchmarks for jurisdictional prostate cancer health care systems endorsed by the very providers and funders of those systems. Gaps and deficiencies between what should be provided and what is actually provided in the parts of the care system provisioned by—and under the control of—these jurisdictions become more obviously the responsibility of the jurisdictions to fix. This will help clinicians and researchers who might also be struggling to cope with and within these “system gaps”. In order to advocate for the men we see with prostate cancer, these gaps need to be unambiguously identified and quantified wherever they exist. One example of how this might be done is in Victoria. Here, the Prostate Cancer Outcomes Registry (PCOR) is working with a Victorian integrated cancer service network working group to define indicators derived from the (often) qualitative recommendations in the OCP and line them up with data on the care and outcomes of Victorian men with prostate cancer accrued on to the PCOR. This then allows an on- going “score-card” to measure and track any deficiencies and allow identification of geography or settings where standards are not being achieved. This powerful evidence can then be used by researchers and clinicians in discussion with funders and policy-makers to make cases for change and resource allocation to close these gaps for our patients.. Because the PCOR has now been opened – or will open – right across Australia, this is a mechanism that might be easily taken up as the OCP is promoted by governments across the nation.
1 Dec 2016
A Little Below the Belt. ANZUP Consumer Newsletter December 2016