Principles of optimal cancer care during COVID-19
The Optimal Care Pathways for people with cancer are designed to guide the delivery of consistent, safe, high-quality and evidence-based care for people with cancer.
They align with key service improvement priorities including providing access to coordinated multidisciplinary care and supportive care, and reducing unwanted variation in practice. They are underpinned by the following principles, which have been augmented by Professor Christobel Saunders in the context of COVID-19.
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Principle 1: Patient-centred care
Patient-centred care is healthcare that is respectful of and receptive to patient preferences, needs and values. Patient-centred care can lead to improved healthcare quality and outcomes, and patient, family and staff satisfaction.
During the COVID-19 pandemic:
Patients being offered a treatment that is not in line with the Optimal Care Pathway should clearly understand this and provide their consent. This should include the patient understanding:
- whether COVID-19 has impacted the delivery of the Optimal Care Pathway
- how their treatment will be modified
- why this modification is necessary
- what the potential implications of these modifications are on their long-term outcomes.
- the agreement and documentation in the multidisciplinary team (MDT) meeting of the modified treatment plan, with clear communication to the general practitioner (GP).
Principle 2: Safe and quality care
This is provided by appropriately trained and credentialled clinicians, hospitals and clinics with the equipment and staffing capacity to support safe and high-quality care. It involves collecting and evaluating treatment and outcome data to improve patient care, and ensure practice remains current and informed by evidence.
During the COVID-19 pandemic:
Patients should be offered the safest options for care, and any changes in the cancer pathway to decrease the risk of contracting COVID-19 or suffering increased morbidity from the viral infection are fully explained to the patient.
Changes to care pathways may also be needed to protect the health system, and patients need to be fully informed of what these may be and how it may affect their care and outcomes
Ensuring safe care for cancer patients, which may include changing care pathways in potentially immunocompromised patients, or changing type and site of surgery to ensure minimal risk of complications, and minimising face-to-face consultations, using telehealth or video links, remains paramount during the COVID-19 crisis. Guidelines for safe cancer care in the COVID-19 environment have been developed and are evolving. Guidelines may need to be adapted to each patient and the care environment.
How the patient’s treatment and outcomes is altered should be tracked, reported and followed up.
Principle 3: Multidisciplinary care
Multidisciplinary care involves a collaborative and integrated approach to healthcare provided by medical and allied health professionals to develop an individualised treatment plan for each patient. This improves patient satisfaction and mental wellbeing; facilitates access to clinical trials and novel therapies, and supportive and palliative care; increases timeliness of and access to treatment; and streamlines pathways and reduces the duplication of services (Department of Health 2007).
During the COVID-19 pandemic:
Multidisciplinary care is even more important than ever. Guidelines suggest most or all of the multidisciplinary team should meet virtually. Good communication to GPs is vital with potentially more of the care of the cancer patient being undertaken by the GP, such as follow-up care and organising imaging and tests. Clinical trials that involve increased risk may be suspended during this time.
Principle 4: Supportive care
Supportive care, including palliative care, refers to a wide range of needs across the continuum of care and is increasingly seen as a core component of evidence-based clinical care. The five domains of supportive care include physical, psychological, social, information and spiritual needs.
Members of the multidisciplinary team, family, friends, support groups, volunteers and community-based organisations all have a role in providing supportive care.
Patient and family views on issues they require help with should occur throughout the care pathway, particularly at times of increased vulnerability, in order to identify a mutually agreed approach to supportive care.
During the COVID-19 pandemic:
Increased anxiety and psychological distress is inevitable for patients diagnosed with cancer and undergoing treatment during the COVID-19 pandemic, and their carers. Screening for distress and adequate access to telephone support from the healthcare team including counselling is important.
Principle 5: Care coordination
Care coordination involves a comprehensive approach to care to ensure it is delivered in a logical, connected and timely manner to meet the medical and personal needs of the patient. Improving care coordination is the responsibility of all health professionals involved in the care of patient and requires a whole-of-system response.
During the COVID-19 pandemic:
With many patients experiencing a change to their expected treatment pathway including a change in the facility in which their care is delivered, it is important that patient records and test results are available at all sites. With a move of much of follow-up care being delivered by telehealth, care coordination becomes more important, and secure systems to enable this need to be in place.
Principle 6: Communication
The healthcare system is responsible for ensuring the communication needs of patients, their families and carers are met. Communication with patients should be individualised, transparent, consistent, in plain language, culturally sensitive, active, interactive and proactive, ongoing, delivered in an appropriate setting and context, and inclusive of patients and their families. Healthcare providers should ensure communication is two-way by listening to patients, providing patients and their family and carers an opportunity to ask questions, encouraging patients to express individual concerns, and using professionally trained interpreters when communicating with people from culturally and linguistically diverse backgrounds.
During the COVID-19 pandemic:
Increased anxieties and changes in care plans mean patients are more likely to experience confusion about their care and this needs careful consideration.
An increase in telehealth means facilities and skills in telehealth communication need to be put in place. When using telehealth, the team need to consider what is best for the patient. When delivering bad news or a change in therapy or prescribing intensive treatment, if it is safe, a face-to-face meeting should be the first option. If this is not an option, a video link to the patient should be considered. The patient should be encouraged to be accompanied by a support person to assist. This is particularly important when the treatment plan is modified from standard care due to the pandemic.
Principle 7: Participation in research and clinical trials
Where practical, patients should be offered the opportunity to participate in research and/or clinical trials at any stage of the care pathway. Leading cancer agencies recommend participation in research and clinical trials as an important part of patient care. Even in the absence of measurable personal benefit, participation in research and clinical trials can contribute to the care of cancer patients in the future (Peppercorn et al. 2004).
During the COVID-19 pandemic:
Many cancer clinical trials have had to be suspended or not initiated due to the COVID-19 pandemic either because the trial is not feasible to do under constrained health circumstances when non-essential personnel are banned from clinics, or because the experimental treatment may expose the cancer patient to increased risk of viral infection (for example, more invasive investigations or trials of immunotherapy drugs). Patients should be reassured that the best conventional care will be offered to them.
