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