• an agreed-upon care plan that outlines goals of care;
  • access to the full complement of resources necessary to implement the care plan;
  • access to high-quality clinical trials;
  • policies to ensure full disclosure of information about appropriate treatment options;
  • a mechanism to coordinate services; and
  • psychosocial support services and compassionate care.

Recommendation 5: Ensure quality of care at the end of life, in particular, the management of cancer-related pain and timely referral to palliative and hospice care.

How Can We Improve What We Know About the Quality of Cancer Care?

The following recommendations relate to information needs:

Recommendation 6: Federal and private research sponsors such as the National Cancer Institute, the Agency for Health Care Policy and Research, and various health plans should invest in clinical trials to address questions about cancer care management.

Recommendation 7: A cancer data system is needed that can provide quality benchmarks for use by systems of care (such as hospitals, provider groups, and managed care systems).

Toward that end, in 1999, the National Cancer Policy Board will hold workshops to:

  • identify how best to meet the data needs for cancer in light of quality monitoring goals;
  • identify financial and other resources needed to improve the cancer data system to achieve quality-related goals; and
  • develop strategies to improve data available on the quality of cancer care.

Recommendation 8: Public and private sponsors of cancer care research should support national studies of recently diagnosed individuals with cancer, using information sources with sufficient detail to assess patterns of cancer care and factors associated with the receipt of good care. Research sponsors should also support training for cancer care providers interested in health services research.

What Steps Can Be Taken to Overcome Barriers of Access to Quality Cancer Care?

The following recommendations are concerned with access to quality care:

Recommendation 9: Services for the un-and underinsured need to be enhanced to assure entry to, and equitable treatment within, the cancer care system.

Recommendation 10: Studies are needed to find out why specific segments of the population (e.g., members of certain racial or ethnic groups, older patients) do not receive appropriate cancer care. These studies should measure provider and individual knowledge, attitudes, and beliefs, as well as other potential barriers to access to care.

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