Transcript BCCA Provincial Survivorship and Primary Care Program

Survivorship Nurse Practioner
Primary Care and Oncology
Implementation and Early Evaluation of a Survivorship Nurse
Practitioner Role
February 20th , 2015
Quality Forum Rapid
Fire Sessions
Presenters
Karen Blain, Provincial Director Survivorship and Primary Care,
BC Cancer Agency
Vancouver, BC
[email protected]
Jill Matheson, Nurse Practitioner (F), Primary Care and Oncology
BCCA Provincial Survivorship and Primary Care Program
BC Cancer Agency and Jim Pattison Outpatient Care and Surgery Center
Surrey, BC
[email protected]
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Rapid Fire
• Provincial Survivorship Program at the BC
Cancer Agency
• Survivorship Nurse Practitioner Role
• Survivorship Nurse Practitioner Evaluation
Controversy: Who is a cancer survivor?
• “Time of diagnosis and to end of life”
–
–
–
–
–
Caregivers
Quality of life (physical, psychosocial, economic)
Surveillance and follow up
Late effects
Screening and prevention
~ (National Coalition for Cancer Survivorship NCCS)
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Cancer Facts
• BC population of 4 ½ million roughly and about 200
thousand have been diagnosed with cancer at some point
in their life
• By 2020 there will be nearly 250 thousand living with
cancer
• Each day 65 adults are diagnosed, one child or
adolescent every two days
• By 2030 annual incidence will increase by 68% Every
year about 25000 new diagnosis are expected
• There are approximately 2500 adult survivors of childhood
cancer now. This number will double by 2025.
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Who are we?
Vision
All survivors and those who care for them are supported
and empowered to live their best life with and beyond
cancer.
Mission
Together with our partners, we will provide leadership,
invest in research, and build system capacity to support
high quality, integrated care, and improve experience for all
cancer survivors in British Columbia and Yukon.
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Medical Lead and
Radiation Oncologist
ACCS Program
Dr. Karen Goddard
(0.5)
Medical Lead FPON
Dr. Phil White
(0.1)
FPON Medical
Advisor
(0.1)
FPON Medical
Advisor
(0.1)
Provincial Director
Survivorship & Primary Care
Karen Blain
FPON Medical
Advisor
(0.1)
Program Assistant
(ACCS)
TBD
Social Worker
ACCS Program
TBD
(1.0)
Social Worker
ACCS Program
TBD
(1.0)
Nurse Practitioner
ACCS Program
TBD
(1.0)
Survivorship
Research Chair
TBA
Education
Coordinator (FPON)
Jennifer Wolfe
Survivorship Nurse
Practitioner
TBD
(1.0)
Program Assistant
Survivorship
Anita Chow
(0.9)
Program Assistant
(FPON)
Shauna Remin
(0.5)
Survivorship Nurse
Practitioner
Jill Matheson
(1.0)
Survivorship Nurse
Practitioner
Kristina Morrison
(1.0)
CPAC Project
Manager
Jennifer Law
(0.8)
CPAC Research
Assistant
Ashley Turner
(0.4)
Project Funded
Program Leader
Primary Care
Lisa McCune
(0.9)
CS4 Project
Manager
Isabelle Linden
(1.0)
Program Leader
Survivorship
Devon Poznanski
(0.8)
Program Leader
Special Projects
Shaun Lorhan
(1.0)
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Opportunity
• Attachment rates
• ~ 700 unattached cancer survivors in the Vancouver area
• ~ 3000 unattached cancer survivors in the Fraser Health Region
• ~ 2500 unattached cancer survivors in the Interior Health
• Improve adherence to surveillance recommendations
• Help to address and manage survivorship concerns
• Help to relieve oncologists from managing primary care concerns
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Survivorship Nurse Practitioner
• NP4BC Campaign
• Proposal to Ministry
• Initiated February 2013
• 3 Locations:
• UBC Family Practice Centre- #400-750 West Broadway, Vancouver
• Jim Pattison Outpatient Care and Surgery Center- 9750 140 St, Surrey
• Third Interior Health location TBD
NPs in Primary Care are Effective
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What is a Family
Nurse Practitioner?
•
New to BC
•
Acute and
Primary Care
•
Patient
Practices
•
Limitations
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What is a
Survivorship
Nurse Practitioner?
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Practice Description
•
•
(Surrey Centre)
92 patients who have had a cancer diagnosis
17 tumor groups: 32% breast, 13% colorectal, 10% cervical, endometrial
and vaginal, 7% thyroid, 7% lymphoma, 6% lung
•
6% are survivors of childhood cancers
•
23 family members
•
Average age: 56 (7-92)
•
Gender: 70% female, 30% male
•
51 % have ongoing appointments with an oncologist.
Practice Description
(Vancouver Centre)
•
•
203 patients who have had a cancer diagnosis (92)
24 (17) tumor groups: 46(32)% breast, 11(7)% lymphoma, 6(13)%
colorectal, 6% prostate, 10% cervical, endometrial, and vaginal
•
44 (23) family members
•
Average age: 51(56) (9-88)
•
Gender: 74 (70) % female, 26 (30) % male
•
Ongoing appointments with oncologist: 80% (51%) yes, 20% no (49%)
Referrals
• Patient Criteria
– Unattached status
• Catchment Area
• Who can refer?
• BCCA staff/oncologists: 179 referrals
• Other HCPs
• Patients/Family Members
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Communication
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•
•
•
CAIS access (read only)
Letter of acceptance
Administration
Emails/faxes/phone calls as
needed
• Oncology support
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Role Evaluation
• Implementation Evaluation (interviews)
• Six months after start-date
• To identify and address concerns early
• Patient Satisfaction (survey)
• One year after start-date
• Bear & Bowers (1998) “Client Satisfaction Tool”
• 61/97 respondents
Interviews: what we asked…
1. Awareness
2. Understanding of scope
3. Benefits
4. Opportunities for improvement
5. Other comments
Interviews: what we heard…
1. Awareness
2. Role clarity
3. Communication
Client Satisfaction Tool
Bear & Bowers (1998)
Patient Satisfaction: how we asked…..
• Cox’s Interactional Model of Client Health Behavior
• Developed for NP model
• Confirmed validity and reliability
• Previously used at a PHSA NP Clinic
• Easy to understand and easy to administer by mail
*Thank you to Minna Miller, DNP(c), MSN, RN, NP(F), NP Child & Youth Primary Care Clinic, BCCH, Asthma Program, RICHER Initiative
Client Satisfaction Tool
Bear & Bowers (1998)
Cox: Elements of Client-Professional Interaction
Affective Support
Reassurance, comfort, understanding, encouraging
Decisional Control
Imparts knowledge about problem, treatment options, impact on lifestyle,
self-management
Pt given freedom of choice, opportunity to select goals
Technical
Competencies
Technical skills and abilities used to diagnose, treat and undertake technical
tasks in provision of health care
Health Information
Added:
Accessibility
Overall satisfaction
with Care
Open-ended
comments boxes
Factors involved in arranging to receive health care, time and effort to make
appointments, waiting time, location accessibility
Comments about NP, comments about care provided by the NP
Figure 1: Percent satisfied with NP by element
100
90
97
97
92
89
Accessibility
Affective support
Health information
Decisional control
95
97
80
70
60
50
40
30
20
10
0
Technical competency Overall satisfaction
Future directions/next steps
• Ongoing strategies to promote and raise awareness of the NP
role
• Expand network of Survivorship Nurse Practitioners across
British Columbia
• Continue to evaluate for continuous improvement for both
patients and providers
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Resources
British Columbia Cancer Agency
www.bccancer.bc.ca
After Cancer Web pages
aftercancer.bccancer.bc.ca
Forward Magazine
http://www.bccancer.bc.ca/PPI/AfterCancer.htm
Clinical practice guidelines and protocols in BC
http://www.bcguidelines.ca/submenu_oncology.html
Questions?
Jill Matheson, Nurse Practitioner (F), Primary Care and Oncology
BCCA Provincial Survivorship and Primary Care Program
BC Cancer Agency and Jim Pattison Outpatient Care and Surgery Center
Surrey, BC
[email protected]
Karen Blain, Provincial Director Survivorship and Primary Care,
BC Cancer Agency
Vancouver, BC
[email protected]
or
[email protected]
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