Comprehensive Cancer Control Plan Implementation
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Transcript Comprehensive Cancer Control Plan Implementation
Report on CCCP
Implementation Efforts with
Health Care Professionals
Overview of Presentations
“The Kansas State Cancer
Plan: Practical Ways to
Provide Extraordinary Care
in your Office”
Speakers: James Early, MD and Judy Johnston, MS, RD/LD
Preventive Medicine & Public Health, KU School of Medicine, Wichita
Introductory Information
The
Cancer Problem in Kansas
Development of the Kansas
Comprehensive Cancer control and
Prevention Plan
Implementation of the Plan
Prevention: Goals, Strategies,
Rationale, Action Steps
What can YOU do as a partner in
this effort?
Preventive Vital Signs
Provide a “big bang for the buck”
Provide a portal of entry for discussion of
cancer prevention
Address at least 3 of the 4 strategies set
forward by the Cancer Plan
Support the recommendations in the Guide to
Clinical Preventive Services
Can become part of an overall strategy for
office-based prevention
Can stand alone as a powerful message to
your patients.
Preventive Vital Signs
BP___ P___ R___ BMI (or wt.)___
Min PA___ F/V___ Tobacco Y/N
Minutes of weekly Physical Activity = (Min PA)___
Fruits and Vegetables per day = (F/V)___
Smoking or tobacco exposure = (Tobacco) Y/N
Resources
Major
resources in improving our
preventive efforts are:
Guide to Clinical Preventive Services from the US
Preventive Services Task Force.
www.cancerkansas.org
• Links to American Cancer Society (ACS), Cancer
Information Service (CIS), and other reliable
resources
• Aids and materials to help you provide
consistent information and instruction on cancer
prevention (i.e. tobacco use and exposure,
nutrition, physical activity, environmental
exposure).
Preventive Vital Signs
Minutes of weekly Physical Activity = (Min PA) ___
Fruits and Vegetables per day = (F/V) ___
Smoking or tobacco exposure = (Tobacco) Y/N
BP___ P___ R___ BMI (or wt.)___
Min PA___ F/V___ Tobacco Y/N
Screening/Early Detection:
Goals, Strategies, Rationale,
Action Steps
What can YOU do as a partner in
this effort?
Continuously update your knowledge of
accepted screening guidelines
Create better office systems to operationalize
your screening efforts
Participate in and support research and data
collection
Help in overcoming the financial and social
barriers that restrict Kansans ability to
access early screening and detection
Obtaining the Latest in Cancer
Screening Guidelines
The United States Preventive Services Task Force
(USPSTF) http://www.ahrq.gov/clinic/pocketgd.htm
MD Anderson Cancer Center--The OncoLog Report to
Physicians—www2.mdanderson.org/depts/oncolog
and refer to the April 06 newsletter
Memorial Sloan Kettering Cancer Center (includes
skin cancer) www.mskcc.org/mskcc/print/65279.cfm
American Cancer Society Guidelines for the Early
Detection of Cancer (www.cancer.org)
No specific guidelines are outlined for screening for
lung cancer
The lack of specific guidelines in no way restricts
providers from recommending screening on other
grounds.
Operationalizing your Cancer
screening and follow up
The
key to optimal screening lies in the
application of updated guidelines
Determine what updated guidelines you
will primarily follow
Remember to include screening
systems when developing Electronic
Health Record (EHR) systems.
Ask yourself “What system is in
place” to:
Be sure patients receive appropriate
screening
•
•
•
•
•
When they visit your office routinely?
For those who may not be seen frequently?
For those at high risk?
For those with economic barriers to care?
For follow up of those with positive or
borderline cancer screenings?
Ages 18 to 49 Years
DATE
AGE
Blood
Pressure
Serum
Cholesterol
Tobacco
Weight
Td Booster
Fecal Occult
Blood
Pap Smear
Breast Exam
Mammogram
Osteoporosis
EDUCATION
Use of Seat
Belts
Self Exams
Oral, Testes
Breast SelfExam
Post Menop.
Bleeding
18
19
20
21
22
23
24
25
26 27
28
29
30
31
32
33
34
35
36 37
38
39
40
41
42
43
44
45
46 47
48
49
QUIT
5-85
Blood
Pressure
Serum
Cholesterol
Weight
Td Booster
Fecal Occult
Pap Smear
Breast Exam
Mammogram
Osteoporosis
EDUCATION
Use of Seat
Belts
Self Exams
Oral, Testes
Breast SelfExam
Post Menop.
Bleeding
52
53
54
55
56
57
58 59
60
61
62
63
64
65
66
67
68 69
70
71
72
73
74
75
76
77
78 79
80
81
3 - 87
50
51
2 –86
3 - 90
AGE
2 – 88
Ages 50 to 81 Years
DATE
HYSTERECTOMY
1987
N
Frame, P. S. (1992). Health Maintenance in Clinical Practice: Strategies and Barriers. American Family Physician, 45, 1192-1200.
Web Resources:
~ Kansas Comprehensive Cancer Control Plan
http://www.kdheks.gov/edw/download/kansas_cancer_control_plan_final_report.pdf
~ www.cancerkansas.org Links to American Cancer Society (ACS), Cancer Information Service
(CIS), and
other reliable resources
Aids and materials to help you provide consistent
information and instruction on cancer prevention (i.e. tobacco use and
exposure, nutrition, physical activity,
environmental exposure).
~ The United States Preventive Services Task Force (USPSTF)
http://www.ahrq.gov/clinic/pocketgd.htm
~ MD Anderson Cancer Center--The OncoLog Report to Physicians
www2.mdanderson.org/depts/oncolog and refer to the April 06
newsletter
~ Memorial Sloan Kettering Cancer Center (includes skin cancer)
www.mskcc.org/mskcc/print/65279.cfm
~ American Cancer Society Guidelines for the Early Detection of Cancer
www.cancer.org
Diagnosis/Treatment: Goals,
Strategies, Rationale, Action
Steps
What can YOU do to improve
Diagnosis and Treatment?
Utilize the map of Cancer Treatment
Locations in the State of Kansas for the
best and closest referral
Enroll patients in clinical trials whenever
possible
Post the MAP in your office
Be sure you are able to access timely
information through www.cancerkansas.org
Be sure your patients have the support
they need
Patient advocate
Case manager
Wichita CCOP
Main
location: Wichita, KS
Satellite locations:
- Chanute
- El Dorado
- Liberal
- Newton
- Wellington
- Dodge City
- Kingman
- Pratt
- Salina
- Winfield
Kansas Cancer Treatment Locations
Survivorship/End of Life:
Goals, Strategies, Rationale,
Action Steps
What can YOU do as a partner in
this effort?
Be sure that every cancer survivor has a plan
Be familiar with your local hospice and palliative
services
Use a cancer survivor checklist
Be sure that provision for adequate follow-up is in place
Investigate your local hospice resources
Become more educated on palliation and know where
resources are located
Make advanced directives available to your
patients—especially your cancer patients facing an
uncertain future
Living wills
Healthcare durable power of attorney documents
Cancer Survivor Checklist
List of diagnostic tests performed
and results
Dates of treatment initiation and
completion
Full contact information on treating
institutions and key providers
A description of recommended
cancer screening and other periodic
testing and examinations and the
schedule on which they should be
performed
Information on any possible late
and long term effects of treatment
and symptoms of such effects.
Information on possible signs of
recurrence and second tumors.
Information on the potential
insurance, employment, and
financial consequences of cancer
and referral to resources when
necessary.
~ Source: Institute of Medicine Fact Sheet,
November 2005: Cancer Survivorship Care Planning
Information on possible
social/emotional effects of cancer,
including marital/partner
relationships, work, parenting, and the
need for psychosocial support.
Specific recommendations for healthy
behaviors, such as diet, exercise,
healthy weight, sunscreen use,
smoking cessation, etc. to help
prevent any cancer recurrence.
As appropriate, information on known
effective chemo preventive strategies
for secondary prevention (Tamoxifen
in women at high risk for breast
cancer; aspirin for colorectal cancer
prevention).
Referrals to specific follow-up care
providers, support groups, and/or the
patient’s primary care provider.
A listing of cancer-related resources
and information (Internet based
sources and telephone listings for
major cancer support organizations.
Hospice Resources
LIFE
Project has resources on Hospice,
including finding a hospice program,
information on paying for hospice,
palliative care, and advanced directives.
LIFE
Project, www.lifeproject.org
Caring
Connections, www.caringinfo.org
Advanced Directives
A
living will allows the patient to
document their wishes concerning
medical treatments at the end of life.
A
medical power of attorney (or health
care proxy) allows the patient to appoint
a person they trust as their health care
agent (or surrogate decision maker),
who is authorized to make medical
decisions on their behalf.
Kansas Life Project, Caring Connections, www.lifeproject.org/home
Advanced Directives and Hospice Resources
•Caring Connections, a program of the National Hospice and Palliative Care Organization
(NHPCO), is a national consumer engagement initiative to improve care at the end of life,
supported by a grant from The Robert Wood Johnson Foundation. They offer resources on
hospice and palliative care, state specific advanced directives forms, care giving, etc.
www.caringinfo.org
•The Life Project is a collaborative effort whose mission is to help all Kansans with
advanced chronic and terminal illnesses live with dignity comfort and peace. The project is
a coalition of many organizations working together to improve end-of-life care.
www.lifeproject.org
•Kansas Health Ethics (KHE) is a nonprofit educational organization formed in 1992. KHE
wants to help all Kansans understand the importance of ethics in healthcare planning and
decision making, and equip them to make good healthcare and quality of life decisions. KHE
provides Living Wills, Health Care Powers of Attorney, "Do Not Resuscitate" and other
advance directives documents and information about their use to individuals as well as to
facilities and institutions across Kansas.
www.kansashealthethics.org
Summary
The
Kansas Comprehensive Cancer
Control and Prevention Plan is a
blueprint for the development of the
future of cancer care in Kansas
It
represents a major effort in trying to
create a “system” that can increase
availability, fairness, quality and
optimal outcomes in the field of cancer
care.
What we want YOU to take home
First we want you to appreciate the scope
and importance of this major focus on all
areas of cancer care and the time and
money that have been and will be
dedicated to the effort
Secondly, and possibly more importantly,
we want you to take home and USE any of
the suggestions and/or materials
presented here.
Summary of tools
Concept
of “Preventive Vital Signs”
Ideas and resources for selecting and
implementing screening in your
office
The Map of Cancer Resources
throughout Kansas
The www.cancerkanses.org website
Listing of hospice and palliation
resources
Advance directive materials
Additional Opportunity: Point of
Care (POC) CME
New
system to address clinical
questions and/or care that arise in your
practice
Web
based resource designed to
provide practice based learning
Self
directed, on-line learning at the
"point of care" i.e., your office
POC Steps
Identify practice-based knowledge needs
Complete extensive background research on
a clinical questions
Reinforce clinical decisions through review
of published evidence
Learn new information related to clinical
practice
Improve patient care by utilizing current
published evidence
University of Kansas AHECs
Will provide:
Provide individual orientation on the process
Tracking
Document activity
Identify appropriate evidence-based medical databases
Meet with professionals participating in the pilot project
periodically to obtain your feedback.
Grant CME and Nursing CE
Physicians may claim up to 20 AMA PRA Category 1
credits per year
Nurses (through American Nurses Credentialing Center
or ANCC)
Pilot in a maximum of 20 locations throughout Kansas
funded by UKSM-W through a contract with KDHE
University of Kansas AHECs
AHECs are finalizing the POC steps to
encourage physicians to design or
update cancer screening guidelines in
their practice. Hopefully, the ability to
claim CME and the recognition of the
importance of screening guidelines
based on their own patients will
increase the number of physicians
with routine screening protocols in
their office practices.
Department of Preventive
Medicine & Public Health,
KUSM-W PVS Pilot Study
One busy primary care office will be trained
on the protocol for implementation of
Preventive Vital Signs and implement
protocol for one month
Interviews with physicians and staff will
provide feedback to revise protocol
Additional practices will implement the
revised protocol for one month
Interviews will be used to evaluate process
In a world where we too often see
human life undervalued, we have a
chance to fight back. It is our job as
health care providers to prove through
the quality and comprehensiveness of
our effort that every human life is
extraordinary. That is what the Kansas
Cancer Plan is all about.
James Early, M.D.
KUSM-W
Dissemination Statistics
6 presentations statewide:
Chanute, KS
Colby, KS
Dodge City, KS
Hutchinson, KS
McPherson, KS
Pittsburg, KS
Presentations for AHEC,
KAFP Meeting, and KU
Continuing Education
46 physicians, nurse
clinicians and physicians
assistants visited in 11
clinics
147 CME packets mailed out
186 people attended
presentations
CME packets available at
AHEC offices statewide
Kansas Dissemination by County