6.1 Goals and Objectives
The ongoing development, formalization and maintenance of satellite sites as part of the provincial, pediatric oncology network is seen as an important component of a coordinated and graduated service delivery system, which will optimize the use of appropriate resources and expertise developed at community, satellite, tertiary and quaternary levels.
The central goals and objectives of the Provincial Pediatric Oncology Satellite Program are to:
- Permit childhood cancer patients to receive components of their care and treatment in designated communities close to their homes, according to defined, acceptable standards of care.
- Ensure that satellite care is equivalent to tertiary care – i.e. that it is medically equivalent, pediatric, family-centered, humanistic and supportive, resulting in equivalent treatment and outcomes, including enabling the continued participation of children in clinical trials – thereby realizing the significant advantages of protocol-driven, outcome-evaluated treatment.
- Ensure that tertiary-satellite collaboration constitutes a designated part of the formal system of care, through the:
- Utilization of specified, formally prepared community hospital staff to deliver components of care. Formal preparation seeks to develop a level of knowledge and familiarity with the care of children with malignant disease and the support of their families.
- Assurance that care, documentation, treatment policies and practices reflect best practices in the network of pediatric oncology satellites conforming to defined, yet generic standards, while allowing for differences among satellite centres.
- Identification of components of therapy and patient management that may be delivered in the satellite context and the optimization of standards of practice through the introduction of guidelines for care, including management of infection, fever and neutropenia, anti-emetics, cytokines, transfusion, Insuflon use, immunization, etc.
- Designation of a program coordinator in each participating tertiary and satellite site, who will monitor and facilitate implementation of all aspects of formal, pediatric oncology activity, according to standards and guidelines.
- Assignment of a case coordinator in the participating tertiary site for each patient/family, who will monitor and integrate the care at all levels to ensure optimal access to tertiary, quaternary, community and home-based resources, for both medical and supportive care.
- Creation of a strategic alliance between specialized, tertiary pediatric oncology services and community pediatric programs, whereby a joint program for total cancer patient care is developed to meet the needs of the children. To this end, there should be:
- Defined governance, responsibility and accountability of the partners and their associated institutions.
- Close integration of satellite health care professionals into the staffing team and treatment plans developed for the child at the principal (tertiary, diagnosing) program, with resulting advantages for coherent, coordinated service delivery.
- Development of effective, optimally electronic, communication tools to ensure consistent and comprehensive data sharing and communication between satellite and tertiary partner centers.
- Address the significant disruption of families, through the:
- Reduction of out-of-pocket expenses and economic stress on families (including familial disruption, loss of income).
- Reduction of lengthy absences from home for care in tertiary centres over the chronic course of illness and treatment.
- Decreased school absences resulting from care in tertiary centres distant from home, over the chronic course of illness and treatment.
- Achieve cost containment within the health care system and optimal use of scarce, existing resources, through:
- Rational re-distribution of service delivery to loci of care that may be less costly. POGO will continue, through the monitoring and evaluation of new forms of program delivery, to seek this objective.
- Alleviation of under-staffing and the improvement of access of patients to their caregivers in quaternary, tertiary and community service delivery levels.
- Operation according to provincial practice guidelines.
- Ensure continued comprehensive data for policy development and service planning, including comprehensive service records on all patients, so that exact information about treatment and outcome, service demand and cost, and quality analyses of the highest order, will continue to be possible.
 Barr, RD, Furlong, W, Horsman, JR, Feeny, D, Torrance, GW, and Weitzman, S. The monetary costs of childhood cancer to the families of patients. International Journal of Oncology 1996; 8: 933 – 940.