Key findings
Cancer Care Ontario's Program in Evidence-Based Care continues to increase the number of electronically available evidence-based reports. However, gaps remain in some disease sites and at some stages along the patient journey.
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What are evidence-based reports?
Evidence-based reports are guidelines and standards that are used by healthcare providers, administrators and system leaders. Healthcare providers use them to improve the quality of clinical decisions they make with their patients. Managers and hospital leaders use them to set institutional policies and to guide organizational change. And system leaders use them to promote evidence-informed policy, access to care options and system redesign.
What's new this year?
This report presents new data for 2008. We also present the information in a matrix to better highlight the gaps in report development.
 Figure 1: Cumulative number of reports completed, by phase of care, 2002-2008
 Figure 2: Number of evidence-based reports for cancer care and control
What do the results show?
Number of evidence-based reports continues to grow.
The Program in Evidence-Based Care (PEBC) produced 20 new guidelines in 2008, 11% more than were produced in 2007 (not shown). These new guidelines are all available on the Cancer Care Ontario website.
Coverage across the care continuum
Most of Cancer Care Ontario’s evidence-based reports focus on cancer treatment, with 86% of reports (154 out of 181) related to anti-cancer drugs, radiation treatment, surgery or multi-modality care (Figure 1). However, 15% of the reports are related to topics other than treatment, and there have been significant advances in the breadth and diversity of guideline coverage. For example, the number of guidelines related to palliative care and end-of-life care has increased by 42% in the last year. Efforts to fill in the gaps and to ensure broad coverage will continue to be a priority.
Why is this important to patient care?
Easy access to clinical research helps ensure the best care decisions
The large volume of clinical research related to cancer care makes it difficult for healthcare providers and patients to find the information they need to make the right care decisions. Summarizing and organizing this wealth of information in a user-friendly format makes these evidence-based guidelines, standards and reports more readily available. They can then be used as a foundation for making decisions about the best possible prevention, screening, diagnosis, treatment and follow-up care 1, 2, 3, 4.
Diverse guidelines enhance care from prevention to end of life
Providing evidence-based information across the continuum of cancer care ensures that cancer is well managed from prevention to end of life. By applying the most appropriate and current knowledge, resources and skills, healthcare providers can improve patient safety and treatment outcomes.
How does Ontario compare?
A national and global leader
The PEBC is a national and international leader in clinical practice guideline development. The program has a rigorous process for assessing evidence and for stakeholder consultation and engagement 5. Its reports and guidelines are published in peer-reviewed medical journals and on the Canadian Medical Association Clinical Practice Guidelines Infobase website 6.
What is being done?
Supporting the cancer system
The PEBC continues to support the priorities of the cancer system. The program targets areas for guideline development based on Cancer Care Ontario’s goals and programs. For example, the provincial colorectal screening program, ColonCancerCheck, has used PEBC’s clinical and organizational guidelines from the outset to define program goals, operations and reporting standards.
Helping Regional Cancer Programs improve quality
In addition to clinical practice guidelines, the PEBC also develops organizational standards to help Regional Cancer Programs improve the quality of cancer treatment. An example is the standards for complex surgeries such as lung and liver. These standards detail the best system for delivering this type of cancer surgery in Ontario. The standards build on evidence that higher volumes of surgery improve outcomes, allowing the Regional Cancer Program to designate centres as either compliant or moving toward compliance with the standards. Look for reports about compliance with lung and liver surgery standards in the Evidence section of the 2009 CSQI.
Working with clinical leaders to support education and improve care
The PEBC provides advice that helps Ontario clinicians, system managers and patients make decisions based on scientific evidence. Cancer Care Ontario continues to work with clinical leaders to develop and implement, based on PEBC reports, tools that support education and clinical quality improvement.
Notes
1 National Cancer Institute. Definition of clinical practice guideline webpage. Available at: http://www.cancer.gov/Templates/db_alpha.aspx?CdrID=44790. Accessed February 27, 2009.
2 Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001; 39(8):II2-45.
3 Burgers JS, Grol RP, Zaat JO, Spies TH, Bij AK, Mokkink HG. Characteristics of effective clinical guidelines for general practice. Br J Gen Pract 2003; 53:15-19.
4 Browman GP, Brouwers M, Fervers B, Sawka C. Population-based cancer control and the role of guidelines-towards a “systems” approach. In: Elwood JM, Sutcliffe SB, editors. Cancer Control. Oxford, UK: Oxford University Press, 2009.
5 Browman GP, Makasrski J, Robinson P, Brouwers M. Practitioners As Experts: The Influence of Practicing Oncologists "in-the-Field" on Evidence-Based Guideline Development. Journal of Clinical Oncology 2005; 23(1):113-119.
6 Canadian Medical Society. CMA Infobase clinical practice guidelines website. Available at: http://mdm.ca/CPGSNEW/CPGS/index.asp. Accessed February 27, 2009.
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