Transcript Document

National Cancer
Survivorship Initiative
Supported SelfManagement Workstream
Lynn Batehup
Nicola Davies
Self-Management workstream
9th March, 2010
Self-Management and Cancer
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• Having an active role in managing a long-term condition can empower
people to act for themselves – increase their confidence in their ability
to manage problems associated with their condition (Coulter and Ellins,
2006)
• People generally manage problems associated with their cancer and its
treatment as part of their daily lives, and may want to have an active
role in tackling them.
Self-Management and Cancer
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• “People have different dispositions, supports and resources,
resulting in individual differences in recovery and restoration
of health and well-being, self-management activity, and the
need for self-management support.”
Foster et al. (2009)
Self-management of problems experienced following
primary cancer treatment: an exploratory study.
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Components of Cancer Survivor Self-Management
(Foster et al 2009)
Problems After
Cancer Treatment
Effects of treatment
Sources of Self
Management
Support
Abandonment
Healthcare workers
Lack of information
Families & friends
Lack of support
Accessing information
Emotional difficulties
Networking with other
cancer survivors
Social/relationship
difficulties
Work & finance
Physical/functional
changes
Organised support
External
Resources
Self Management
Strategies
Psychological problems:
Altered outlook/priorities
Managing emotions
Self resourcefulness
Social problems:
Proactive socialising
Sharing experience
Resisting contact
Managing work/finance
Physical problems:
Simple strategies
Complex strategies
Personal
Resources
Problem
Resolution
LIVE WELL
AFTER
CANCER
Support for Self Management:
• “what health services do to aid and encourage people
living with a long term condition, to make daily decisions
that improve health related behaviours, and clinical and
other outcomes’
• Adapted from ‘Co-Creating Health’
• The Health Foundation 2008
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NCSI Vision 2009: Three ‘Enablers’
• Skills development programmes for professionals
• Self management support options for patients/survivors
• Institutional support for service redesign
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Support for Self-Management – what is the
Evidence? – Fundamental Culture Change
• A relationship with health professionals which is based on partnership
is fundamental – both patient and professional are experts from their
different perspectives.(Powell et al 2009; Epstein & Street 2007)
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Evidence – Who Benefits?
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Personalised
assessment and
care plan (Yates
et al ongoing;
Ruland et al 2007)
Risk
stratification –
‘high risk’ groups
(e.g. Comorbidities;
ethnic minorities)
Tailored
information that
enhances
knowledge –
health
literacy(Jordan
&Osborne
2006)
A partnership
relationship with
their health
professionals
which enables
self management
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Evidence of Benefits
Self-management programmes
which target specific
problems/symptoms, and for
specific cancer types (CockleHearne and Faithful, 2009; May
et al., 2009)
Self-management programmes
supporting adjustment to survivorship:
Based on assessment of need and risk:
- Low support and low confidence
- Lack of preparedness(Stanton et al.,
2007)
- Health literacy
Evidence of
some benefit
Having to undertake
challenging lifestyle behaviour
change – obesity; physical
activity; smoking cessation; on
patient-triggered aftercare
Referral to organised cancer
support groups/peer survivors
– sharing and learning from the
experience of other cancer
survivors
Evidence - What Works?
What Works?
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Evidence
Clinician training for supporting self-management during the
consultation.
Coulter and Ellins,
2007; Powell et al
2009;
Epstein&Street
2007)
‘Intensive’ adjustment-focused self-management programmes
targeted at ‘high risk’ survivors.
Cockle-Hearn and
Faithful, 2010).
Design of programmes should have a theoretical basis to the design:
-information provision
-problem solving
-modelling
-personal goal setting
-practice
-social comparison
-reporting back
-goal review
- CBT techniques
- consider length
(Abraham and
Gardner, 2009)
Coulter & Ellins
2007
Lifestyle behaviour change requires ongoing support and coaching.
Coulter & Ellins,
2007;Korstjens 200
Self-help resources such as video/DVDs can be effective/costeffective if designed to incorporate self-efficacy(peer modelling)
(Mandelblatt et al.,
2008)
Self-management interventions can have cost advantages over
conventional care.
(Mandelblatt et al.,
2008)
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Health care as individual as you
East Surrey CareCall is a service
designed to help you manage your health.
Set up in response to local patient views, CareCall is a
free service offering you:• Your own personal Health Coach who is a specially
trained Registered Nurse.
• Information about health issues that are important to
you.
• Better control of your own healthcare.
• The opportunity to discuss treatment plans and options.
CareCall works along side your GP practice and other
community services – it does not replace your contact
with them.
CareCall is part of Surrey Primary Care Trust
How do I access the Service?
Participation in CareCall is your
choice. You can call a Health Coach
between the hours of 7am and 11pm
Monday to Friday and on Saturday
9am to 1pm through a freephone
number 0800 028 4207
.
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Outcomes: what are the important ones?
Patient
Clinician
Commissioners
Policy
Personalised care
Patient in
partnership
communication
skills.
Meeting national
targets.
Establishment of
patient-centred
care.
Health literacy
Confidence to selfmanage.
Self-management
skills development.
Reduced symptom
burden.
Improved quality of
life.
Satisfaction with
service.
Improved
healthcare
utilisation reduction in missed
appointments.
Service
improvement. quality
Cost-effectiveness.
Reduced costs of
treatment.
Secondary
prevention.
Innovation
Earlier diagnosis.
More clinic time.
Multidisciplinary
team work.
Improvements in
cancer care to
match those
established in the
best European
countries.
References 1 (not in alpha order)
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Foster C. et al(2009) Self management of problems experienced following primary
cancer treatment: an exploratory study, Unpublished report, University of
Southampton, Macmillan Survivorship Research Group.
•
Powell R et al (2009) Patient Partnership in Care: a new instrument for measuring
patient-professional partnership in the treatment of long term conditions; Journal of
Management and Marketing in Healthcare, 2, 4; 325-342
•
Epstein R.M. Street R. L.(2007) Patient-Centred Communication in Cancer Care,
National Cancer Institute
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Yates P et al(ongoing) Development of cancer survivor self management plans;
Queensland University of Technology,
http://www.hlth.qut.edu.au/nrs/research/researchprojects/cancersurvivorselfmanagementplans.jsp
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References 2
•
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Ruland C.M. et al(2007) Designing tailored internet support to assist cancer patients in
illness management; AMIA 2007 Symposium Proceedings, 635-639
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Jordan J.E. Osborne R.H.(2006) Chronic disease self management education
programmes: challenges ahead; eMJA Rapid Online Publication, 15th Nov 2006
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~Cockle-Hearne J. Faithfull S.(2010) Self management for men surviving prostate
cancer: a review of behavioural and psychosocial interventions to understand what
strategies can work, for whom, and in what circumstances; Psycho-Oncology in press
•
Stanton A.L. et al(2005) Out comes from the Moving Beyond Cancer psychoeducational randomised controlled trial with breast cancer patients; J Clin Oncol 23;
6009-6018
References 3
•
Coulter A. Ellins J.(2006) Patient centred interventions: a review of the evidence,
Picker Institute Europe and The Health Foundation.
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Abraham C. Gardner B.(2009) What psychological and behaviour changes are
initiated by ‘expert patient’ training and what training techniques are most helpful?
Psychology and Health; 24; 10; 1153-1165
•
Korstjens I et al(2008) Quality of life after self management cancer rehabilitation: a
randomised controlled trial comparing physical and cognitive behavioural training
versus physical training. Psychosomatic Medicine, 70; 422-429
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Mandelblatt J.S. et al(2008) Economic evaluation alongside a clinical trial of psychoeducational interventions to improve adjustment to survivorship among patients with
breast cancer. J Clin Oncol, 26; 10; 1684-1690
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