The CISCaT Odyssey

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The CI-SCaT Odyssey
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INTRODUCTION

• PART A CI-SCAT HISTORICAL VIEW
• PART B CI-SCaT PRESENT VIEW
• PART C CI-SCaT PROSPECTIVE VIEW

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HISTORICAL VIEW (1)

• A DECADE AGO
• Time-poor cancer clinicians
• Complex drug treatments
• Critical evaluation and application of evidence
• Non-standard treatment practices
• Work duplication
• Regional patients disadvantaged
• Limited access to technology

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HISTORICAL VIEW (2)

• THIS DECADE
• Increasingly complex cancer regimens
• Changes in models of care
• Scarcity of experienced clinicians
• High turnover staff leading to corporate
  knowledge loss
• Staff being stretched beyond skill level
• Lack of mentorship/leadership
• Silo mentality

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HISTORICAL VIEW (3)

• Professor Robyn Ward in collaboration with
  clinicians from 3 Sydney hospitals
• Website containing peer-maintained evidence-based
  medical oncology and haematology cancer treatment
  information for a range of users that is
  available all day, every day
• Activated 18 August 2005

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PRESENT VIEW (1)
INTENT

• A web-based information repository
• Available all day, every day
• At no cost to users
• Focuses on cancer treatments
• Peer-maintained and reviewed
• Evidence-based and evidence-adaptive information
• Addresses needs of a range of users
• Includes a dosing calculator

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PRESENT VIEW (2)
CONTENT

• gt 500 consensus-approved protocols
• Annual review of all information
• Standard Operating Procedure format
• External Drug Evaluators (Evidence, Toxicity,
  Efficacy)
• Expanded Content
• Dose Metabolism / Dose Modification (Hepatic) /
  Radiation Oncology / Nursing / Symptom Control
  (commencing July 2007)
• Prospective Content
• Bone Marrow Transplantation / Dose Modification
  (Renal) / Melanoma / Paediatrics / Palliative
  Care

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PRESENT VIEW (3)
CONTENT DEVELOPMENT

• Standard treatments currently in use
• Suggestions/requests from clinicians
• Maturation of trial data
• New indications/listings for drugs
• NSW health directives and safety alerts
• Evaluated by independent drug evaluators

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PRESENT VIEW (4)
REFERENCE GROUPS

• Ensure accuracy, currency and applicability
• Sharing of knowledge and benchmark personal
  practice
• Ensure the treatment can be carried out in all
  clinical environments

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PRESENT VIEW (5)
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PRESENT VIEW (6)
USAGE

• Over 350,000 Monthly Hits
• Nearly 11,000 Monthly Users
• Over 530 Calculator Users
• Access from all states and territories, and OS
• Approximately 20-25 of use is after hours

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PRESENT VIEW (7)
COLLABORATION

• Participation from NSW, VIC, SA, and QLD medical
  clinicians
• Nursing participation from all states and
  territories
• 10-20 daily feedback emails on protocol
  information
• Viewed as credible information source, with link
  requests
• 2006 QUM Award Winner (Health Professional
  Category)

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WHY CI-SCaT WORKS

• Change champions on board from outset
• Strong clinically-focused governance model
• Not associated with any one clinical institution
• Reinforces QI without reduced autonomy
• Responds to clinician demand feedback
• Effectively blends evidence with the realities of
  practice
• Saves time

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BENEFITS OF CI-SCaT

• Promotes equity of access
• Empowers clinicians
• Confirms acceptable standards
• Reduces unnecessary duplication
• Ensures currency and validity of treatment
  recommendations
• Improves patient outcomes

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PROSPECTIVE VIEW (1)

• FUTURE DIRECTION
• Complete systems rebuild
• - Focus groups
• Increased flexibility
• - Dose and drug adjustments (within limits)
• - Clinician comments
• Primary care information
• Increased patient information
• - Non English languages

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PROSPECTIVE VIEW (2)

• REQUESTS
• Workflow integration
• Interfacing/integration with relevant information
  systems and registry systems
• Interactive learning packages and databases
• Opportunity for data collection for Phase IV
  trials
• Hosting of national guidelines
• Health economics module

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THE ROAD AHEAD
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CONCLUSION

• Robyn Ward, Program Director
• Jen Bichel-Findlay, Program Manager
• Shelley Rushton, Project Coordinator (Med Onc)
• Angela Booth, Project Coordinator (Haem)
• Julija Sipavicius Karen Eaton, Sec Project
  Coordinators (Nurs)
• Kim Faulkner, Project Coordinator (Rad Onc)
• Aisling Kelly, Seconded Pharmacist
• Tash Knowles, Information Support Project
  Officer
• To be recruited, Administrative Support Project
  Officer
• Phone 1800 CISCAT
• Email ci-scat_at_cancerinstitute.org.au
• Feedback and Suggestions Always Welcomed
• www.treatment.cancerinstitute.org.au