Project: Tele-Oncology

2005
Canada health infostructure partnerships program (CHIPP)

Synopsis

The Tele-Oncology project was developed to establish a comprehensive model for cervical cancer screening and management in part of New Brunswick, specifically, the regions served by the Beauséjour, Miramichi, Chaleur and Restigouche regional health authorities. The central components of the project were: (a) promotion of cervical cancer screening and awareness raising among New Brunswick women concerning the importance of this examination; and (b) establishment of screening clinics and development of a technological infrastructure, including a central registry and a system for remote electronic consultation.

Outcomes

The following were the main outcomes of the survey of patients:

• Planning and installation of the central registry and an e-consultation tool. Implementation of the technology was, without a doubt, the most complex aspect of the Tele-Oncology project. The technological infrastructures developed in connection with this project showed that there is enormous potential for transfer in terms of their application in other provinces or for other health problems.
• Development of a promotion and awareness-raising program aimed at women. This objective was fully achieved and was an important part of the implementation of the project. The setting up of screening clinics had a major impact on promotion of cervical cancer screening and women's decision to have a Pap smear test. The women expressed satisfaction and optimism in relation to the role played by the nurses in cervical cancer screening. The patients appreciated having a woman do the Pap smear.
• Development of a quality control system. Standardization of the sample collection technique for the Pap smear tests and of the nomenclature for the laboratories and the recommendations for pathologists was developed through laboratory techniques and procedures for the purpose of doing quality control.
• Planning and implementation of a project evaluation plan. Four evaluators were involved in this project. By means of a participative method, the main evaluation indicators were identified and the tools needed for data collection were developed.
• Directing of a research project among Aboriginal persons. The Aboriginal women in the Big Cove community were invited to participate in a study designed to evaluate the effects of distance intervention with regard to cervical cancer and screening of Aboriginal women.

Policy Implications

• The Tele-Oncology project opted not to store identifiable information in the computerized central registry because collecting information from each patient proved impossible. This may limit certain analyses, so, in that sense, this directive could have a negative impact for health care providers and policy makers, who would not have as complete and precise a picture as they would if they had access to identifiable information.
• The Tele-Oncology project found a way to enable the nurses to perform a delegated medical procedure, namely, doing Pap smear tests, by providing them with a duly constituted training program, with theoretical and practical components. In conjunction with this, there was awareness raising aimed at the physicians with regard to the nurses' expanded role.

Research Implications

Potential transfer

• Considering that integrated solutions were used, it is recommended that this cervical cancer screening model be applied for the entire Canadian population. It is also recommended that a model similar to the computerized central registry be used in all cancer and disease control programs.

Screening clinics

• By establishing clinics in which nurses are responsible for doing cytologies, women's access to cervical cancer screening is increased. In New Brunswick, this service could be integrated into the community health centres that the province is preparing to set up. In this connection, it is recommended that health self-management projects be developed to make Canadian men and women accountable and to influence their behaviours in relation to their own health and well-being.

Nurses' expanded role

• The nurses are of the opinion that the educating of New Brunswick women ought to continue, since a significant proportion of the women are still unaware of the importance of the Pap test. It is recommended that established policies and a structured training program for training of nurses be available to Canadian provinces wishing to take this route.

Lessons Learned

The predominant problem in this project was the small amount of time allowed for implementation.

During the closing day for the Tele-Oncology project, the main subject raised concerning lessons learned was communication. The other subjects that were stressed were screening and technology.

Communication

A number of participants pointed out that communication at the start of the project implementation was not adequate and that this led to a number of concerns and to some confusion regarding the role of the various health authorities and professionals. In addition, the lack of involvement of the other participating health authorities in development of the project seems to have had a major impact on the evolution of the project. A number of people from the various authorities were very pleased that this kind of project had come about, since it forced the regions to communicate better with each other. In addition, they believed in the value of the project and in the possible improvements to health care delivery.

Screening

A number of comments regarding screening had to do with promotion or education. This was a lesson that the project leaders took seriously from the start of the project, as they unhesitatingly changed the content of the pamphlet to adopt a more general message, in which the emphasis was more on the need for screening than on cancer itself. The other lesson learned that a number of nurses raised had to do with educating women about cervical cancer and Pap smears. A number of nurses mentioned that the educating of New Brunswick women ought to continue.

Technology

With regard to the lessons learned concerning technology, a number of participants mentioned that the infrastructures developed in connection with this project were a very innovative aspect that surely could improve management of health care in New Brunswick and, possibly, in other provinces. The health professionals' information technology skills are not all at the same level. The information and communications technologies (ICT) must be easy to use, while respecting the current procedures in health care delivery.

The Future

The Beauséjour Regional Health Authority team is very interested in pursuing implementation of the model in the province, in collaboration with the telehealth co-ordinators in each regional health authority. They have already submitted a viability plan to the New Brunswick Department of Health and Wellness.

The main obstacle is funding to maintain the system already implemented in half the province's regional health authorities and to extend this model to the rest of the province. Each of the regional health authorities assumed the current costs of the program from December 31, 2002, the date the CHIPP funding ended, to March 31, 2003.

The research conducted with Aboriginal persons in connection with the Tele-Oncology project shows that they consider videoconferencing the best way to receive training, while remaining in their community.

Pilot projects using ICT should be implemented to give small communities reasonable access to health care.

Innovative and often inexpensive initiatives should be encouraged, in order that the French-speaking professionals may share their expertise, knowledge, work tools and so on. At the same time, pilot projects should be initiated to develop effective approaches reflecting French-speaking communities' needs.

Appendix A: Document or Products Generated

Users' manual:

• Description of the technology

Statements of qualification and/or recruitment documents:

• Recruitment documents

Systems:

• Description of the technology

Standards

• Description of the technology

Clinical training protocols:

• Clinical report

Clinical program protocol(s):

• Clinical report

Confidentiality and privacy:

• Protection of personal information

Consent forms:

• General evaluation report
• Research report
• Description of the technology

Sustainability plan:

• Viability of the comprehensive cervical cancer screening program

For more information, please contact:

Suzanne Robichaud at suzanner@health.nb.ca or at 506-862-4044.