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Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
Prostate Cancer Navigation
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Prostate Cancer Navigation

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Frank delaRama, RN, MSN, AOCNS

Frank delaRama, RN, MSN, AOCNS

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  • reducing decisional conflict (the confusion and anxiety many patients experience during and following PrCA Tx decisions) decreasing the time between Dx and a Tx decision (whether for an active Tx or watchful waiting) improving adjustment to Tx outcomes (i.e., reducing the degree to which the patient is bothered by urinary, bowel, sexual, and hormonal function problems that may exist) increasing satisfaction with overall care and with the Tx decision process reducing health care resource utilization during the decision period improving quality of life.
  • Trad 60-60; MDC “30-30-30” Our MSC = Urol, Rad Onc & PCNN, so ideal candidates are low-med risk / localized PC / have mult options MSC with a Med Onc – may include higher risk / one modality pts OR Med Onc as non-vested 3 rd party.
  • Becoming a Linchpin -“the linchpin is an individual who can walk into chaos and create order, someone who can invent, connect, create, and make things happen. Every worthwhile institution has indispensable people who make differences like these”
  • There is no map “Indispensible linchpins are not waiting for instructions, but instead, figuring out what to do next. If you have a job where someone tells you what to do next, you’ve just given up the chance to create value”
  • There is no map “Indispensible linchpins are not waiting for instructions, but instead, figuring out what to do next. If you have a job where someone tells you what to do next, you’ve just given up the chance to create value”
  • There is no map “Indispensible linchpins are not waiting for instructions, but instead, figuring out what to do next. If you have a job where someone tells you what to do next, you’ve just given up the chance to create value”
  • Transcript

    • 1. Prostate Cancer Nurse Navigator: Tools for Your Practice & Program Frank delaRama, RN, MSN, AOCNS Palo Alto Medical Foundation
    • 2. Palo Alto Medical Foundation (PAMF) Prostate Cancer Care
    • 3. Today’s Topics
      • Program Development and Maintenance
      • Prostate Cancer Navigation
        • Shared Decision Making
      • What issues/questions do you want to tackle today?
    • 4. AGENDA
    • 5. Program Development and Maintenance
      • Learning from the PAMF Experience…
    • 6. Program Development and the Navigator Role
      • 1990s: Urology-Oncology Rounds
        • Mainly physician representation
        • Urology, radiation oncology, pathology
        • Retrospective cases
      • Early 2000s: Developing a Navigator
        • RN Radiation Oncology
          • Coordinating rounds
          • Arranging consults and tests
    • 7. Program Development and the Navigator Role (cont.)
      • 2004: Prostate Cancer Nurse Navigator (PCNN)
        • Hired additional radiation oncology RNs, so PCNN could dedicate majority of time to prostate cancer patients
        • Involvement in clinic-wide quality improvement (QI) committees: Patient-Focused Cancer Care Committee
          • Site visits
          • Focus groups
          • Staff education
            • Prostate Cancer Survivor Panels
            • Similar Community Education event
    • 8. Program Development and the Navigator Role (cont.)
      • 2004: Shared Decision Making in Prostate Cancer
        • Multi-site study
        • Prostate Cancer Resource Notebook
        • Grant writing
        • Study aim to explore the value of the PCNN/SDM Intervention and patient satisfaction with treatment decision vs usual care
    • 9. Program Development and the Navigator Role (cont.)
      • 2006: Cancer Care Clinic
        • Physical space at PAMF
        • Plan to host multispecialty clinics
        • Navigator offices there (breast and prostate)
    • 10. Program Development and the Navigator Role (cont.)
      • 2006 to present: Prostate Cancer Care Program blossoms…
        • Prostate Cancer Survivor video
        • PCNN study funded
        • PAMF Outcomes Measures Project
          • Electronic medical record/information technology
          • Quality-of-life (QOL) surveys
          • Retrospective data collection
        • Buddy Program
        • ACCC article
        • Hosting multispecialty clinics for non-PAMF patients
        • Cancer Patient Advisory Council
    • 11. Fundamental Themes for PCNN Development and Maintenance
      • Helping physicians/healthcare professionals
      • Helping patients in treatment decisions
      • Helping population: prostate cancer
      • Outcome measurement
      • Patients giving back…
    • 12. Shared Decision-Making Case Studies Active Participation of the Prostate Cancer Nurse Navigator… Step by Step
    • 13. Shared Decision-Making Nurse Navigator Intervention Study
      • Prostate Cancer Resource Binder
      • Shared Decision-Making Worksheet
        • Both available online at: www.pamf.org/prostate/
    • 14. TOC
    • 15. SDM Worksheet: Prioritizing Goals for Treatment and Outcomes
    • 16. SDM: Step 1
      • Where do I start?
        • Level of risk
        • Recommended treatment options (National Comprehensive Cancer Network)
        • Memorial Sloan-Kettering Cancer Center nomogram
    • 17. SDM: Step 2
      • Identifying my goals
        • Avoiding side effects
        • Maintaining QOL
        • Getting the cancer out/gone
        • Making treatment as convenient as possible
    • 18. SDM: Step 3
      • Setting priorities
        • Avoiding immediate side effects
        • Avoiding long-term side effects
        • Control cancer/life expectancy
        • QOL
        • Convenience
        • Operative risk
        • Other…
    • 19. Case Study 1 (A.N.)
    • 20. Case Study 1
      • 77-year-old retired teacher and coach
      • “ Extremely healthy, active”
      • 2005 biopsy = benign; 2006 biopsy = PIN; 2010 biopsy = Gleason 3+4 (2/10 cores)
      • Prostate-specific antigen (PSA) 9.48
      • 81 cc prostate; on Proscar already to reduce volume
    • 21. Case Study 1
      • Consults: Uro, RadOnc, Brachy
      • Interested in brachy, but…
        • Prostate size
        • Potency his main priority
        • Extensive travel schedule
    • 22. SDM 1
      • Priorities
        • Avoiding erectile dysfunction (ED)
        • Maintaining QOL
      • Decision
    • 23. Case Study 2 (R.D.)
    • 24. Case Study 2
      • 57-year-old male
      • PSA 5.4, T1cNxM0
      • Gleason 3+3, 2% submitted tissue, aggregate linear dimension 0.6
      • Minimal urinary and ED symptoms
      • Computer engineer
    • 25. SDM 2
      • Two scenarios
        • 1) Priorities for a man selecting active surveillance
          • Maintaining QOL
          • Avoiding long-term side effects
        • 2) Priorities for a man selecting radiation or surgery vs active surveillance
          • Getting the cancer out/gone
          • Avoiding long-term side effects
      • Decision -
    • 26. Case Study 3
    • 27. Case Study 3
      • 57-year-old male
      • T1c, Gleason 3+4 (5/12 cores)
      • PSA 1.1, 1.4, 3.0 (over about 2 years)
      • Occupation: sales/requires >50% travel
    • 28. SDM 3
      • Debating b/w surgery and radiation
      • Priorities:
        • Getting the cancer out/gone
        • Avoiding urinary side effects
        • Convenience of treatment (how fits into life)
      • Decision -
    • 29. Case Study 4 (R.D.)
    • 30. Case Study 4
      • 52-year-old computer engineer
      • Very active, golfs with wife (favorite activity)
      • PSA 4.5
      • T1c, Gleason 3+4 in 15% tissue
      • 34 cc prostate
    • 31. SDM 4
      • Debating b/w surgery and radiation
      • Priorities:
        • Getting the cancer out/gone
        • Avoiding urinary side effects
        • Convenience of treatment (how fits into life)
      • Decision -
    • 32. Case Study 5
    • 33. Case Study 5
      • 60-year-old male
      • Midlevel manager – biotech
      • T1c, Gleason 3+3, 6/12 cores
      • Good surgical candidate
      • Brother also had prostate cancer
    • 34. SDM 5
      • Strongly leaning toward radiation
      • Priorities:
        • Getting the cancer out/gone
        • Avoiding ED
      • Decision -
    • 35. Prostate Cancer Navigator
      • Mission The mission of AONN is to advance the role of patient navigation in cancer care and survivorship planning by providing a network for collaboration and development of best practices for the improvement of patient access to care and quality of life. Vision The vision of AONN is to increase the role of and access to oncology nurse and patient navigators, so that all cancer patients may benefit from their guidance, insight, and personal advocacy.
    • 36. Prostate Cancer Navigator
      • In prostate cancer, the nurse navigator plays an important role throughout the cancer care continuum, from screening/diagnosis, through treatment, and into survivorship
      • Serves as a valuable resource to patients, providers, and prostate cancer population in general
    • 37. Prostate Cancer Navigator
      • Advocate
      • Teacher
      • Counselor
      • Nurse
    • 38. Thank You!
      • Questions?
      • Comments?
    • 39. Selected Resources
      • www.nccn.org
      • www.mskcc.org
      • www.pcf.org
      • www.cancer.net
      • [email_address]
      • www.pamf.org/prostate
      • Twitter: fdelarama
      • Blog for Sutter Health My Life Stages:
      • http://bit.ly/pkPFDX
      • Facebook: Frank delaRama
    • 40. Selected Resources
      • PAMF Prostate Cancer Resource Notebook /SDM Worksheet http://www.pamf.org/prostate/resources/binder.html
      • ACCC Oncology Issues, Sept/Oct 2009 Developing a Multispecialty Prostate Cancer Clinic
      • ACCC Guide to Best Practices in a Comprehensive Prostate Cancer Program http://www.accc-cancer.org/publications/
    • 41. SUPPLEMENTAL SLIDES Useful notes/resources for the Prostate Cancer Nurse Navigator
    • 42. SDM Study Goals
      • Reducing decisional conflict
      • Decreasing the time between diagnosis and a treatment decision
      • Improving adjustment to treatment outcomes
      • Increasing satisfaction with overall care and with the treatment decision process
      • Reducing healthcare resource utilization during the decision period
      • Improving QOL
    • 43. PCNN SDM Study: Pearls
      • Qualitative differences, men vs women, in how they handle a new cancer diagnosis
        • Men: internalize, research, analyze
        • Women: externalize, search support, psychosocial
      • Value of the navigator, as expressed by survivors (more time with PCNN, the better)
    • 44. PCNN SDM Study: Pearls
      • Value of the shared experience, once the men opened up (surprised to find out who also had prostate cancer, and how willing to share stories)
      • Early feedback – satisfaction with treatment decision + PCNN intervention (vs ‘woulda/coulda/shoulda’!)
      • Consider potential downstream financial benefits of PCNN
        • Minimize outmigration
        • More encounters in the PAMF system (primary care, specialty care, lab/imaging)
    • 45. Multispecialty Clinic: Pearls
      • Initial consult time in MSC similar to traditional consults, but less MD visits prior to treatment decision making
      • 3 providers MAXIMUM, before information and time overload
      • Rapid succession of one-on-one visits vs panel-type visit
      • Traditional visits (over several days) work better for some
    • 46. Fundamental Themes for PCNN Development and Maintenance
      • Helping physicians/healthcare providers
      • Helping patients in treatment decisions
      • Helping population: prostate cancer
      • Outcome measurement
      • Patients giving back…
    • 47. Fundamental Themes for PCNN Development and Maintenance
      • What’s the problem?
      • How can the PCNN bring value?
    • 48. Physicians/Healthcare Providers
      • Problems:
        • MD tracking of positive biopsies
        • Arranging appointments, potentially over several departments or even facilities
    • 49. Navigator – Solutions/ Value-Added Services
      • One point of contact
      • Arrange appointments (consults/tests)
      • Focus during early program development
        • Opportunities to demonstrate simple value- added services/gain confidence
    • 50. Patients and Treatment Decisions
      • Problems:
        • Multiple “equal treatment options”
        • The “Male Patient”
          • Subthemes: engineers, stewers, couple dynamics
    • 51. Navigator – Solutions/ Value-Added Services
      • Identifying vetted resources (Internet, paper, nomograms)
      • Shared decision-making interventions
      • “ One person to call”
      • Unbiased third party
    • 52. Prostate Cancer Population
      • Problems:
        • Screening controversies
        • Many options/treatment technologies
        • Outcome measures, or lack thereof…
    • 53. Navigator – Solutions/ Value-Added Services
      • Outcome measures
      • Chart reviews/aggregated reports/ outmigration/$$$ reports
      • Community education events/speaking opportunities
      • PCNN perspective on technology, plus QOL
      • Research grants
      • Philanthropic opportunities
    • 54. Giving Back
      • Survivors helping the navigator!
        • Prostate Cancer Survivor video/panel presentations
        • Recruiting buddies/shared experience
        • Patient Advisory Boards/committee representation
        • Philanthropy
    • 55. Linchpin: Are You Indispensable?
      • www.sethgodin.com
    • 56. BONUS MATERIAL
      • Oncology Nurse Navigator as a “LINCHPIN”
    • 57. Becoming a Linchpin
      • “ The linchpin is an individual who can walk into chaos and create order, someone who can invent, connect, create, and make things happen. Every worthwhile institution has indispensable people who make differences like these.”
    • 58. There Is No Map
      • “ Indispensible linchpins are not waiting for instructions, but instead, figuring out what to do next. If you have a job where someone tells you what to do next, you’ve just given up the chance to create value.”
    • 59. The Culture of Connection
      • “ Linchpins don’t work in a vacuum. Your personality and attitude are more important than the actual work product you create, because indispensable work is work that is connected to others .”
    • 60. The Seven Abilities of the Linchpin
      • What does it take to be this person they can’t live without?
      • Providing a unique interface between members of the organization
      • Delivering unique creativity
      • Managing a situation or organization of great complexity
      • Leading customers
      • Inspiring staff
      • Providing deep domain knowledge
      • Processing a unique talent
    • 61. A Turning Point
      • “ Instead of focusing on complying with management as a long-term strategy for getting more stuff and being more secure, we have a chance to describe a powerful vision for our future and to actually make it happen. The new dream isn’t about obedience, it’s about vision and engagement.”

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