Integrated Care Planning – An Evidence-Informed Approach to Designing and Delivering Coordinated, Continuous & Person-Centred Care for Cancer Patients

Guideline Objective

This document synthesizes knowledge on integrated care planning and outlines an evidence-informed approach to planning integrated cancer care.

The Ontario Cancer Plan IV specifically identifies “integrated care plans” as a means to facilitate communication and coordination of care across multiple professionals and organizations. By 2019, it is expected that standardized integrated care plans will be available for selected disease sites, treatments and patient populations across care settings. To achieve this objective, a common understanding is needed of the content and functions of an integrated care plan as well as how these plans are developed, implemented and maintained over time and across professionals and settings.

In support of this objectives, CCO developed an evidence-informed approach to integrated care planning, including the development and use of integrated care plans, for patients with cancer on the basis of a scoping review of the academic literature and with stakeholder consultations. The results of this work are captured in a 70-page report.

CCO then further consulted the Program in Evidence-Based Care (PEBC) regarding the methodology and content of the report, and how to optimize its dissemination. PEBC validated the rigor of the work, and recommended to translate the report into a concise position statement supplemented by a video to facilitate uptake by managers and clinicians. As such, the the report’s key messages have been distilled into this position statement and a five-minute video aimed at CCO programs and regional stakeholders.

Intended Guideline Users

Clinicians, CCO staff, Health Care Administrators, managers