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Best Practices: Needs Assessment Process, Data/Metric Tracking, and Survivorship Care Planning
 

Best Practices: Needs Assessment Process, Data/Metric Tracking, and Survivorship Care Planning

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Tricia Strusowski, MS, RN ...

Tricia Strusowski, MS, RN
Director, Cancer Care Management
Helen F. Graham Cancer Center
Christiana Care Health System

Sharon Gentry, RN, MSN, AOCN, CBCN
Breast Health Navigator
Derrick L. Davis Forsyth Regional Cancer Center

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    Best Practices: Needs Assessment Process, Data/Metric Tracking, and Survivorship Care Planning Best Practices: Needs Assessment Process, Data/Metric Tracking, and Survivorship Care Planning Presentation Transcript

    • Best Practices:Needs Assessment ProcessData/Metric Tracking
      Tricia Strusowski, MS, RN
      Director, Cancer Care Management
      Helen F. Graham Cancer Center
      Christiana Care Health System
    • Needs Assessment Process
      Objective
      To assess the needs of your navigation program
      To assess the needs of the patients and the families in your navigation program
      To assess and create navigator job responsibilities
    • Needs Assessment Process
      Anyone want to share their intake processes?
      Barriers?
      Challenges?
    • Data/Metric Reporting
      Objectives
      To review the documentation of support services provided by the navigator
      To review performance improvement outcomes for a navigator program
      To document patient and physician satisfaction with a navigation program
    • Helen F. Graham Cancer CenterNurse Navigation/Support Service Satisfaction Survey
      Example questions
      The nurse navigator was friendly and helpful to me
      The nurse navigator answered all my questions in a manner I could easily understand
      The nurse navigator helped me to understand my course of treatment
      The nurse navigator informed me of services available through the Cancer Care Management (CCM) program
    • Helen F. Graham Cancer CenterNurse Navigation/Support ServiceSatisfaction Survey
      Were you seen by any of the following support services?
      ___Social Worker
      ___Dietitian
      ___Financial/Transportation Coordinator
      ___Health Psychology
      ___Wellness Team
      ___Survivorship Team
      ___Pain/Palliative Care Team
      Was friendly and helpful to me?
      Answered all my questions in a manner I could easily understand?
    • Helen F. Graham Cancer CenterNurse Navigation/Support Service Satisfaction Survey
      CCM has the resources and tools to provide the best care/services to my patients
      CCM is committed to continuous quality improvement
      The staff from CCM whom I interact with are competent in their role
      CCM demonstrates a concern for patient safety
      Communication by CCM with me regarding my patients is timely and clear
    • Data/Metric Tracking
      Anyone want to share their tracking or reporting programs?
      Concerns with reporting?
      Questions regarding reporting?
    • Patient Testimonials
      “Having my nurse navigator was critical to keeping my brain focused on healing and not on all the little worries that kept popping up.”
      “Whenever I had a question or concern I’d call and she would always get me an answer.”
    • Always remember that you make
      the journey for the patients
      and their families so much easier.
      YOU DA BEST!!
    • Best Practices:Survivorship Care Planning
      Sharon Gentry, RN, MSN, AOCN, CBCN
      Breast Health Navigator
      Derrick L. Davis Forsyth Regional Cancer Center
    • Survivorship Care Planning
      Definition
      Where does definition fit in care continuum?
    • Who Is a Survivor?
      The National Cancer Institute considers a person to be a survivor from the time of diagnosis until the end of life
      Includes others who are affected
      Family
      Friends
      Caregivers
    • US Population of Survivors Is Medically Diverse
      15%
      22%
      4%
      7%
      7%
      19%
      8%
      9%
      8%
    • Patient Navigation Is Part of the Cancer Care Continuum
      Survivorship
      Transition
      Multiple Transitions
      Transition
      Patient Navigation
    • Sample Questions for Needs Assessment
      How do you define cancer survivorship?
      How do patients within your practice currently obtain survivorship services?
      What types of survivorship services do your patients currently utilize?
      What types of survivorship services would you like to provide within your clinical practice?
      If you need to refer a patient for survivorship services, what are some of the local resources you utilize?
    • Survivorship Care Planning
      Physical effects
      Psychosocial effects
    • Medical and Physical Effects of Cancer Treatment May Persist
      Neuropathy
      Osteoporosis
      Second primary tumors
      Lymphedema
      Chronic pain
      Menopausal symptoms
      Lung disease
      Cataracts
      Infertility
      Heart disease
      Kidney failure
      Endocrine issues (thyroid)
    • Significant Psychosocial Concerns May Persist
      Depression
      Heightened sense of vulnerability
      Fear of recurrence, death
      Adjustment to physical problems (eg, infertility)
      Sexual function/sexuality
      Parenting
      Alterations in social support
      Concerns about finances, employment, disability, insurance
    • Patient Navigation Supports Patients with Assessment, Education, and Coordination
    • Survivorship Care Planning
      American Society of Clinical Oncology
      National Comprehensive Cancer Network
    • Patient Navigation Can Help Survivors Receive the Care They Need
      Facilitate recommended surveillance for development of new cancers
      Risk 14% higher than in general population
      Risk highest in first 5 years after diagnosis
      Risk higher in females
      Survivors of childhood cancer at highest risk
    • Patient Navigation Can Help Survivors Receive the Care They Need
      Facilitate recommended surveillance for spread or recurrence of cancer
      Example – For all breast cancer survivors:
      Careful history and physical examination every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5, and yearly thereafter
      Example – For survivors who have undergone breast-conserving surgery:
      Posttreatment mammogram 1 year after the initial mammogram, at least 6 months after completion of radiation therapy, and yearly thereafter, unless otherwise indicated
    • Patient Navigation Can Help Survivors Receive the Care They Need
      Provide personalized support
      Help educate survivors about health needs and concerns
      Ensure adherence to treatment and follow-up activities
      Connect survivors with appropriate resources
      Track delivery of care and payment for services
    • Initiate the Program
      Take stepwise approach
      Begin with services/programs likely to demonstrate success
      Perform Outreach
      Utilize referral pathways and report back to those referring
      Collect data on all outcomes variables
      Patients served, referrals
      Services utilized
      Cost
      Involved providers
    • Community Outreach
      DC City-wide Patient Navigation Research Program
      University of Medicine and Dentistry of New Jersey