Better Care, Better Health and Better Value. Authors: Linda Eagen, MBA, Founder, Cancer Coaching, President and CEO, Ottawa Regional Cancer Foundation.
Cancer Coaching: Better Care, Better Health and Better Value Authors: Linda Eagen, MBA, Founder, Cancer Coaching, President and CEO, Ottawa Regional Cancer Foundation Johanne Levesque, RN, BScN, MPA, Senior Vice-President, Survivorship Care, Professional Practice, People and Culture
Executive Summary The Ottawa Regional Cancer Foundation surveyed cancer survivors and found that while patients had a high level of satisfaction with their diagnosis and treatment, there were important gaps in their physical, emotional, informational and spiritual care. Survey participants reported that, despite their best efforts, navigating the healthcare system and accessing resources was a challenge, and they indicated a need for more personal time with their healthcare professionals.
Currently, cancer costs Canadians over $3.8 billion a year in direct healthcare costs,i and cancer patients are among the top 10% of high-cost healthcare users (over $100,000 per person during treatment). They visit emergency rooms, on average, nearly once a month and have regular contact with primary care providers.
The Cancer Coaching Model
The foundation undertook the development and establishment of a new health and social care program: Cancer Coaching. This comprehensive, person-centered service is delivered by regulated health professionals, who provide one-on-one problem-solving, decision-making and skills-development support to cancer patients, families and caregivers. Clients receive five hours of free coaching, and do not need to be referred by a healthcare professional. Coaching always starts with what matters most to the client. The objectives are to move clients along the path to self-management; to have a positive impact on health outcomes and healthcare utilization; and, to do this in a cost-efficient community setting. The program is funded philanthropically through community donations. Coaches receive training through the foundation’s Cancer Coaching Certification Program, which has been developed in partnership with York University and HealthChange® Australia. There is a growing body of evidence from the U.S. and the U.K. that indicates that health coaching leads to improved health outcomes and system-wide savings. A 2008 report found that this type of patient-centered coaching outperforms simple advice-givingbased approaches in 80% of clinical trials.ii
Results
Our evaluations reveal that Cancer Coaching is a promising new practice. It has shown the potential to significantly improve the quality of life of cancer patients at a cost much less than that of a single hospital visit, providing significant value to the provincial healthcare system. More than 2,900 individuals have been served in the five years since it was launched. Our most recent survey* showed that after Cancer Coaching, clients agreed:
• 97%: “I am better able to cope with life” • 93%: “I am more confident that I can do something about my cancer and/or my well-being” • 90%: “My quality of life has improved” • 93%: “I feel I am part of a connected cancer care team” • 93% rated Cancer Coaching as EXCELLENT or GOOD * Ottawa Regional Cancer Foundation, Cancer Coaching Client Experience Survey 2016. Percentages refer to survey respondents who agreed completely or somewhat to survey questions.
Cancer Coaching effectively addresses five critical gaps in cancer care today: patientcenteredness; survivorship care; behavioural change and self-management; navigation; and, caregiver support.
Discussion
The benefits of Cancer Coaching are so significant that we are compelled to pursue expansion opportunities. While many possible healthcare outcomes can be considered from the implementation of Cancer Coaching, we are focused on tangible outcomes that align with broader system priorities. The assumptions are that, with Cancer Coaches as partners in care, patients, families and caregivers will have a better experience, will be empowered and that better health outcomes will ensue. In addition, we believe Cancer Coaching will increase patients’ adherence to treatment plans. In assessing opportunities to lower the percapita costs of healthcare through improved outcomes, we believe Cancer Coaching will objectively: • Reduce the average number of emergency room visits for Cancer Coaching clients compared to other cancer patients. • Reduce the average number of physician visits, including both family physicians, oncologists, and other specialists, compared to other cancer patients. The Cancer Coaching program directly aligns to the Triple Aim framework of: • Better health for populations; • Improved experience of care for patients; and, • Lower costs of the system.
Conclusion
The Cancer Foundation has identified the need to look at more innovative approaches to expand Cancer Coaching. There is tremendous opportunity for improvement in the lives of those suffering from cancer, with equal potential to improve both clinical and healthcare cost outcomes. The foundation’s vision for Cancer Coaching is that it will one day be a standard of care for cancer patients and survivors. Notes i Public Health Agency of Canada. Economic Burden of Illness in Canada, 2005–2008. 2014. http://www.phacaspc.gc.ca/publicat/ebic-femc/2005-2008/index-eng.php ii Rollnick, S, Miller, WR, and Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, New York: The Guilford Press. 2008.
Further reading Canadian Cancer Society. “Cancer Statistics at a Glance.” http://www.cancer.ca/en/cancer-information/ cancer-101/cancer-statistics-at-a-glance/ Cancer Care Ontario. Ontario Cancer Statistics 2016. Toronto: Cancer Care Ontario; 2016. https://www. cancercare.on.ca/cms/one.aspx?objectId=360452&con textId=1377 Canadian Foundation for Healthcare Improvement. “What We Do—Triple AIM.” http://www.cfhi-fcass.ca/ WhatWeDo/triple-aim Canadian Partnership Against Cancer. The 2016 Cancer System Performance Report. Toronto: Canadian Partnership Against Cancer. 2016. http://www. systemperformance.ca/reports/ Evans, JM et al. “Integrating Cancer Care Beyond the Hospital and Across the Cancer Pathway: A PatientCentered Approach.” Healthcare Quarterly, 17(SP), p. 28-32, Jan. 2015. Smetanin, P and Kobak, P. “Interdisciplinary Cancer Risk Management: Canadian Life and Economic Impacts.” Presentation, 1st International Cancer Control Congress, Vancouver, Canada, Oct. 23-26, 2005. http:// www.riskanalytica.com/sites/riskanalytica.com/files/ Canadian%20Cancer%20Abstract%2010%20June%20 2005.pdf Wodchis, WP et al. “Cost trajectories for cancer patients.” Current Oncology, v. 23(SI), p. S64-S75, Jan. 2016. http://www.current-oncology.com/index.php/ oncology/article/view/2995/2061
