A Decade in Review Cancer Care Ontario's Approach to Symptom Assessment and Management

Background: In 2007 Cancer Care Ontario (CCO) implemented standardized systematic symptom evaluation in all cancer patients in Ontario using the Edmonton Symptom Assessment System. The initial implementation did not include symptom management guidance and this limited the success of the implementation. Within a short time, the need for guidance on how to respond to symptoms became apparent. Objective: To describe how CCO has approached electronic symptom monitoring and related clinical response to symptom scores. Results: CCO's approach to symptom management includes acknowledgment, assessment, and intervention steps. In partnership with the Program in Evidence Based Care, CCO developed guidance documents for management of each of the symptoms assessed with Edmonton Symptom Assessment System. These materials included an in-depth document similar to the full guidelines created by Program in Evidence Based Care for cancer treatment topics, a shorter pocket guide, and a 1-page algorithm. The guidance was aligned with symptom score severity. The 1-page algorithm was the most popular format of these materials. When time for revisions came, only this document was revised. When additional PRO measures were implemented, the plan ensured that the launch included a bundle of clinician-facing and patient-facing guidance materials together with the measure. All resources are accessible from a mobile-friendly website. Conclusions: Providing clear guidance for symptom management is an important part of successful PRO measure implementation. Involving a wide range of stakeholders early in the creation of such resources facilitates implementation and team building.