Since its pivotal report in 2001, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) has advocated for improving the quality of U.S. health care. To that effect, the IOM’s latest report, issued in September 2013, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, outlines a systematic plan to help the U.S. healthcare system meet that goal. The recommendations from the report will require interdisciplinary collaboration and commitment, but nurses will play a particularly critical role in its success.

In their article in the November 2013 issue of the Oncology Nursing Forum, Ferrell, McCabe, and Levit discussed how the 2013 IOM report addresses the quality of cancer care across the trajectory from diagnosis through treatment, long-term survivorship, and end of life. They also outlined oncology nurses’ role in each recommendation.

Engaged Patients

Goal: The cancer care team should provide patients and their families with understandable information on cancer prognosis, treatment benefits and harms, palliative care, psychosocial support, and estimates of the total and out-of-pocket costs of cancer care.

Patient-centered care is at the core of nursing practice, Ferrell et al. explained. Nurses are well-suited to empower patients to communicate their needs, values, and preferences. As such, oncology nurses should take a leadership role in assessing and communicating with patients about their needs and values during each decision point in their cancer journey. In addition, nurses must advocate for interventions to assist patients who have low literacy, language barriers, or other impediments to understanding their disease and treatment options.

Goal: In the setting of advanced cancer, the cancer care team should provide patients with end-of-life care consistent with their needs, values, and preferences.

Ferrell et al. explained that although physicians are often responsible for delivering bad news, nurses provide emotional support and education to patients and their families when dealing with a poor prognosis or making decisions about treatment or end of life. Because of this, oncology nurses should receive communication training and be reimbursed for having those difficult conversations.

An Adequately Staffed, Trained, and Coordinated Workforce

Goal: Members of the cancer care team should coordinate with each other and with primary, geriatric, and specialist care teams to implement patients’ care plans and deliver comprehensive, efficient, and patient-centered care.

Ferrell et al. pointed to the pending shortage of oncology physicians as an opportunity for nurses to assume a more prominent role in caring for patients with cancer and their families. This includes discussing treatment options, assisting in decision making, and providing direct care, including survivorship care. This is in line with the IOM’s 2010 Future of Nursing: Leading Change, Advancing Health report, which recommended eliminating barriers to nurses practicing to the full scope of their education and training. Collaboration between oncology and geriatric nursing is also a key component of this goal.

Goal: All individuals caring for patients with cancer should have appropriate core competencies.

According to Ferrell et al., ONS has been a leader in the nursing profession in establishing certification programs that formally recognize oncology nurses’ specialized knowledge, skills, and expertise. To meet this IOM goal, nursing should focus on increasing the number of oncology certified nurses and promoting the role of institutions in requiring certification. Outside of nursing care, family caregivers and unlicensed staff will provide the vast majority of care to patients with cancer, so oncology nurses should also lead training efforts for lay caregivers. 

Evidence-Based Cancer Care

Goal: Expand the breadth of data collected on cancer interventions for older adults and individuals with multiple comorbid conditions.

Nursing research that includes patient-reported outcomes should be a priority. In addition, nurses should encourage more older adult patients with cancer to participate in clinical trials. Historically, older adults are underrepresented in cancer clinical trials in comparison to the age distribution of the disease. Older patients are more vulnerable to treatment toxicity and complications, and much is currently unknown about how to effectively treat them, Ferrell et al. said.

Goal: Expand the depth of data available for assessing interventions.

Oncology nursing should continue its successful legacy of contribution to research, including

  • Calling attention to quality-of-life domains that reflect patients’ physical, psychological, social, and spiritual well-being
  • Highlighting the importance of quality-of-life outcome measures in patient decision making
  • Focusing on health promotion research, including smoking cessation, breast and ovarian cancer screening, and diet and exercise counseling for cancer survivors.

A Learning Healthcare Information Technology System in Cancer Care

Goal: Develop an ethically sound learning healthcare information technology system for cancer that enables real-time analysis of data from patients with cancer in a variety of care settings.

Ferrell et al. said that oncology nurses are key providers when it comes to monitoring safety and performance improvement initiatives. Nurses should contribute to the development and use of quality measure systems. In addition, many opportunities exist for oncology nurses to champion rapid learning systems that provide feedback on nursing practice and patient outcomes.

Quality Measurement

Goal: Develop a national quality reporting program for cancer care as part of a learning healthcare system.

Groups such as ONS should lead in this endeavor, Ferrell et al. said, joining with other health professional societies to share data that will build the evidence base needed to ensure the delivery of high-quality care. Oncology nurse researchers can define the key data points needed, and then clinical nurses should collect and report the data elements at the institutional and practice level.

Accessible, Affordable Cancer Care

Goal: Reduce disparities in access to cancer care for vulnerable and underserved populations.

Patients with cancer in the United States are facing more economic disparities when it comes to accessing high-quality, affordable cancer care. Oncology nurses should continue to help design interventions that address the financial needs of underserved populations.

Goal: Improve the affordability of cancer care by leveraging existing efforts to reform payment and eliminate waste. 

Ferrell et al. explained that oncology nurses have the most opportunity to make headway on this goal in the area of palliative care. Strong nursing leadership has focused palliative care on providing treatments that enhance quality of life and honor patients’ values and goals while eliminating treatments that have marginal or no benefits.

For more information about the IOM’s goals related to the provision of high-quality cancer care, as well as strategies and steps that national healthcare organizations and the entire cancer care team can take to help meet them, refer to the full article by Ferrell et al. 

Five-Minute In-Service is a monthly feature that offers readers a concise recap of full-length articles published in the Clinical Journal of Oncology Nursing or Oncology Nursing Forum (ONF). This edition summarizes “The Institute of Medicine Report on High-Quality Cancer Care: Implications for Oncology Nursing,” by Betty Ferrell, RN, PhD, MA, FAAN, Mary S. McCabe, RN, MA, and Laura Levit, JD, which was featured in the November 2013 issue of ONF. Questions regarding the information presented in this Five-Minute In-Service should be directed to the ONF editor at ONFEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted.