The pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) project

 

1. Purpose

The overall aim was to improve the quality of symptom management by nurses providing remote (telephone) support to adults undergoing cancer treatment.

2. COSTaRS Practice Guides

Guided by CAN-IMPLEMENT© and the Knowledge to Action Framework, we originally developed 13 user-friendly symptom practice guides. Each practice guide was based on a systematic review to identify clinical practice guidelines that were quality appraised using the rigour sub-scale of the AGREE II instrument. They were validated by oncology nurses across Canada.

In March 2016, we updated the 13 symptom practice guides and added 2 new guides (pain, sleep problems) with evidence from a systematic review to identify clinical practice guidelines. We removed AGREE Rigour Scores for source guidelines given inconsistent reporting and medicine evidence ratings were changed to indicate how well the medications work (e.g. effective, likely effective, or expert opinion).

In the 2020 update, we updated the 15 symptom practice guides and added 2 new guides (Mouth Dryness/Xerostomia, Skin Rash). Key assessment items, triage, and medications for patients receiving immune checkpoint inhibitor therapy were added. NCI-CTCAE grading has been linked to applicable assessment questions in the practice guides. The 17 practice guides were reviewed by the current COSTaRS committee members and an Immune Checkpoint Inhibitor Therapy Working Group.

In October 2024, the 17 symptom practice guides were updated and a new practice guide for Difficulty Swallowing was added. The Self-Care Sections were re-formatted for clarity and usability. A family caregiver on our Steering Committee who had experience with nurses who used COSTaRS, reviewed each practice guide, and provided valuable feedback to ensure that the questions posed to patients and caregivers were written in plain language.

These practice guides are available for download in English or French here:

Current original versions English October 2024 (PDF) Français octobre 2024 (PDF)
Pocket guide versions Pocket Guide October 2024 (PDF) Guide de Poche octobre 2024 (PDF)
Canadian Association of Nurses in Oncology website https://www.cano-acio.ca/triage-remote-protocols
Summary of changes between 2020 version and 2024 version Changes 2024 (PDF) Sommaire des changements 2024 (PDF)
Archive of previous versions

These practice guides are protected by copyright but are freely available for you to use in part or as a whole as needed, provided you:

  • Do not charge for or profit from them;
  • Do not alter them except for customization for a specific setting and reformatting;
  • Cite the resource appropriately, as follows:

    Remote Symptom Practice Guides for Adults on Cancer Treatments © 2024. D Stacey for the Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Team. University of Ottawa School of Nursing and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

If you translate any of this material into languages other than English or French, we would appreciate that you notify Dawn Stacey, University of Ottawa.

3. Training materials

We first conducted an environmental scan to explore current telephone-based symptom support training programs for nurses in ambulatory oncology programs across Canada. Then, COSTaRS training materials were developed and evaluated in face to face training sessions and subsequently an English online tutorial. You can download our training materials in English or French here:

Training materials English January 2025 (PDF) Français janvier 2025 (PDF)
Online training module https://decisionaid.ohri.ca/costars/Tutorial
Canadian Association of Nurses in Oncology website https://www.cano-acio.ca/triage-remote-protocols

These training materials are protected by copyright but are freely available for you to use in part or as a whole as needed, provided you:

  • Do not charge for or profit from them;
  • Do not alter them except for customization for a specific setting and reformatting;
  • Cite the resource appropriately, as follows:

    Using COSTaRS practice guides for cancer symptom support: A Tutorial for Nurses © 2020. D Stacey, L Jolicoeur, B Ballantyne, A Davis, M Carley, for the Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Team. University of Ottawa School of Nursing and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

4. Videos

5. COSTaRS Publications

COSTaRS Protocol Development and Updates

Barriers assessments

Training

Studies Evaluating the Implementation of COSTaRS

Studies evaluating clinical practice without and with COSTaRS

6. Funding

The COSTaRS project has received funding from:

  • Canadian Partnership Against Cancer (2008-2011)
  • Canadian Institutes of Health Research (CIHR) (2012-2014)
  • Ontario Institute for Cancer Research (OICR) (2016-2017)
  • Canadian Institutes of Health Research (CIHR) Planning and Dissemination Grant (2017)
  • Cancer Care Ontario (CCO) - Clinical Programs and Quality Initiatives (CPQI) (2017-2018)
  • Canadian Cancer Society (2022-2024)
  • University Research Chair in Knowledge Translation to Patients, University of Ottawa (2012-2024)
  • In-kind methodological and organizational support was provided by the Queen's Group (2008-2011): Margaret B. Harrison (lead), Val Angus, Meg Carley, Kristen Dean, Victoria Donaldson, Janice McVeety, Amanda Ross-White, Joan van den Hoek

7. COSTaRS Team

The COSTaRS Team is a collaboration of researchers, information systems specialists, methodologists, library scientists, advance practice nurses and nurse leaders assembled in 2008. Led by Dawn Stacey, RN, PhD CON(C), the COSTaRS group includes stakeholders from 8 Canadian Provinces.

Current Team Members: Dawn Stacey (co-lead), Gail Macartney (co-lead), Joy Tarasuk, Craig Kuziemsky, Meg Carley, Kim Chapman, Carolyn Fifield, Lindsay Jibb, Claire Ludwig, Lorraine Martelli, Kristie Morydz, Jennifer Newton, Lorelei Newton, Komal Patel Saini, Amanda Ross-White, Maureen Smith.

Immune Checkpoint Inhibitor Therapy Working Group (2020): Jennifer Anderson, Chyanne Dey, Carolyn Fifield, Pam Ginex, Leah Jodoin, Karey McCann, Kristie Morydz, Jennifer Newton, Cindy Railton

Past Team Members: Julie Baisley, Debra Bakker, Barbara Ballantyne, Lorna Butler, Dauna Crooks, Greta Cummings, Andra Davis, Esther Green, Doris Howell, Barb Hues, Lynne Jolicoeur, Luisa Luciani Castiglia, Kathryn Nichol, Brenda Sabo, Myriam Skrutkowski, Ann Syme, Lucie Tardif, Carolyn Tayler, Tracy Truant, Linda Watson.

For more information regarding the COSTaRS Collaboration, please direct correspondence to:

Dawn Stacey RN, PhD, CON(C)
Lead, COSTaRS Project (Pan-Canadian Oncology Symptom Triage and Remote Support),
University Research Chair in Knowledge Translation to Patients,
Director, Patient Decision Aids Research Group,
Senior Scientist, Ottawa Hospital Research Institute www.ohri.ca/decisionaid
Professor, School of Nursing, University of Ottawa
613-737-8899 ext. 73817; dawn.stacey@uottawa.ca

Last modified: 2025-03-24.