Disease Pathway Maps (pathways) are quality improvement tools that show a high-level overview of the care patients should receive with a focus on one specific disease at a time. Outcome measures include improved quality, access, appropriateness, and coordination of care across the patient journey.1
In 2008, the Canadian Association for Enterostomal Therapy (CAET) was invited by Cancer Care Ontario (CCO) to participate in the development of a disease pathway map for colorectal cancer patients. This invitation was extended to an enterostomal therapy nurse (ETN) who was an active member of CAET, an advance practice nurse with clinical expertise in oncology nursing and living in the Toronto area. The purpose of having an ETN on the expert panel was to ensure that the unique needs of patients who required an ostomy due to colorectal cancer were represented.
Debbie Miller was CAET's representative and was one of a 28-member expert panel of clinicians, stakeholders, and patients from across the province of Ontario. During the first year of work, the panel identified 5 key themes for the patient diagnosed with colorectal cancer: optimizing the screening process; enhancing communication of clinical data; standardizing the staging process; incorporating "navigation" of the colorectal cancer journey; and improving the quality of life of patients. Seventeen initiatives under these themes emerged. The work of the expert panel was later shared at a CCO-sponsored symposium where additional stakeholders were given the opportunity to respond to and share their knowledge, expertise, and stories aimed at a better understanding of the colorectal cancer journey from the patient's perspective.
The development of the pathways for colon and rectal cancer took more than 4 years to complete. Each pathway reflected the patient's journey through screening, diagnosis, treatment, and follow-up care. A patient-friendly version of the pathway was also developed.2 As evidence-based documents, research and best practice were drawn from local, national, and international guidelines and in some situations by expert consensus. For example, CCO endorsed the Registered Nurses' Association of Ontario, Best Practice Guideline for Ostomy Care and Management.3 The ETN's presence was influential in having this Best Practice Guideline embedded within the pathway documents as an evidence-based resource that supports the care of the patient with an ostomy.
The ETN's role was extremely crucial on the outcome of these disease pathways. Initially, the first draft of the treatment pathway did not highlight the unique needs of the patient requiring an ostomy. After several persuasive communications by the ETN changes to the treatment, documents included 2 important features. The first was that the colon and rectal treatment pathways include: "All patients under consideration for an ostomy should be referred to an Enterostomal Therapy Nurse preoperatively. Patients should have access to an Enterostomal Therapy Nurse before and after ostomy surgery."4 The second feature was that the ETN was identified on the rectal cancer treatment pathway as a clinician who may need to be referred to for patients requiring a temporary or permanent ostomy.5 The importance of the ETN referral noted in only the rectal cancer pathway gives recognition to the fact that a diversion is more common for patients with rectal cancer than colon cancer.
The overall impact of the ETN's role in the development of these colorectal disease pathways had multiple benefits:
* Advocating for the necessary care requirements of patients who will have either a temporary or permanent ostomy as a result of colon or rectal cancer;
* Demonstrating the value of the specialist ETN role along the patient's journey from the preoperative phase to postsurgical follow-up care;
* Collaborating as an interprofessional member of the cancer care team as an ETN specialist;
* Contributing to a provincial standard of colorectal care excellence that will serve to guide national and international disease managed care; and
* Developing personal and professional opportunities in education and leadership.
This article not only addresses the unique needs of patients requiring an ostomy due to colon or rectal cancer, but recognizes and advocates for involvement of an ETN at different points along the care trajectory. It highlights the value and expertise of an ETN as an essential member of the interprofessional team both clinically and in the development of evidence-based documents.
1. Cancer Care Ontario Web site. Disease pathway management. https://www.cancercare.on.ca/ocs/qpi/dispathmgmt/. Accessed March 16, 2014. [Context Link]
2. Registered Nurses Association of Ontario. Best practice guidelines for ostomy care and management. http://rnao.ca/bpg/guidelines/ostomy-care-management. Published 2009. Accessed March 16, 2014. [Context Link]
3. Cancer Care Ontario Web site. Patient-friendly versions. https://www.cancercare.on.ca/cms/one.aspx?portalId=1377&pageId=256020#colorectal. Accessed March 21, 2014. [Context Link]
4. Cancer Care Ontario Web site. Colon Cancer Treatment Pathway Disease Pathway Management Secretariat Version 2014.03. https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=298459. Accessed March 16, 2014. [Context Link]
5. Cancer Care Ontario Web site. Rectal Cancer Treatment Pathway Disease Pathway Management Secretariat Version 2014.03. https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=298463. Accessed March 16, 2014. [Context Link]
Canadian Association of Wound Care/Canadian Association for Enterostomal Therapy
JOINT Conference
Westin Harbour Castle Hotel
Toronto, Ontario
October 30-November 2, 2014
Action 2014: Skin Health for Canada is the theme for the first joint conference between the Canadian Association of Wound Care and the Canadian Association for Enterostomal Therapy. This inaugural collaboration between these 2 associations, in conjunction with the International Lymphedema Association, supports the mutual vision to improve skin health in Canada by focusing on political advocacy, leading edge research, evidence-based education, and best clinical practice. Skin Health is a standard that all skin and wound clinicians strive for in the Canadian Health Care System where about 35% of persons receiving community care have a chronic wound (Health Outcomes Worldwide Research Data 2013) and 26% of persons in an acute setting have a pressure ulcer.1 Ultimately, there needs to be leadership and advocacy to create recognition that prevention is the key for to maintaining skin health.
Some of the highlights of the educational program include the following:
* An important panel discussion on who is a wound care specialist? This panel will discuss and debate on the necessary qualifications required for a health care professional to call themselves a wound care specialist in Canada. The panel will include an interprofessional perspective that will include a physician/dermatologist, nurse educator, physiotherapy, chiropodist, and enterostomal therapist.
* Improving Wound Care Standards in Canada: Accreditation Canada will present its Required Organizational Practices (ROP) for wound care and the Canadian Institute for Health Information (CIHI) will present a research project on wound reporting in Canada.
* A educational stream devoted to diabetes and complications.
* Can Social media impact wound care policy?
* Action! Advocating for People living with an ostomy-a Canadian perspective
* Skin care in vulnerable populations
* When wounds and stomas connect
* Lower limb edema and lymphedema management and many clinically relevant topics.
Wound care industry will be providing satellite symposia as well as a trade show featuring the latest in wound and skin technology.
This conference is a must attend for any health care professionals caring for people with skin and wound issues. This includes but not limited to RN, ET, chiropodist, podiatrists, rehabilitation specialists, pharmacists, diabetes educators, physicians, and specialists. This program will be accredited through the college of physicians and surgeon and applying for CME. For further information or to register, please go to http://www.cawc.net or http://www.caet.ca.
1. Woodbury MG, Houghton PE. Prevalence of pressure ulcers in Canadian healthcare settings. Ostomy Wound Manage. 2004;50(10):22-24. [Context Link]