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Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
Cancer Thriving and Surviving
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Cancer Thriving and Surviving

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  • 1. Medicine 2.0 Conference Katy Plant, MPH Kate Lorig, RN, DrPH Stanford Patient Education Research Center
  • 2. Evidence Based Online Self-Management Programs
    • Cancer Thriving and Surviving **
    • Better Choices, Better Health
    • Better Choices, Better Health – Diabetes
    • Better Choices, Better Health – Arthritis
    • Building Better Caregivers
  • 3. What is Self-Management?
    • Self-management is defined as the tasks that individuals must undertake to live with one or more chronic conditions.
    • These tasks include having the confidence to deal with the medical management, role management, and emotional management of their conditions.
    • Institute of Medicine, 2004
  • 4. Foundation of All the Programs
    • Built on structured patient and professional needs assessments
    • Systematically use strategies to enhance self-efficacy:
      • Goal Setting
      • Modeling
      • Reinterpretation of Symptoms
      • Social Persuasion
  • 5. Characteristics of the Program
        • Six-week workshop (entirely on-line anywhere there is Internet access – even dial up)
        • 20-25 cancer survivors per workshop
        • New workshop session starts each week
        • No “real-time” commitment – any time/any day
        • Peer-led by two trained facilitators who are also cancer survivors– supervised by online mentor/safety monitor
        • Highly interactive
        • Participants asked to log on 2-3 times a week for a total of 1-2 hours
  • 6. Special Qualities of the Program
      • Peer led (2 peer facilitators) to reinforce modeling Standardized training for facilitators
      • Standardized participant materials
      • Several topics per session
      • Systematic use of strategies to enhance self-efficacy
      • Evaluated in randomized trials
      • We don’t manage participants – we engage them and provide them proven tools to better self-manage.
  • 7. Recruitment
    • Variety of sources including MacMillan Cancer Support Trust Facebook and Organization web site
    • 312 survivors left contact information 145 completed baselines
    • 135 participated in 1 or more workshop sessions
    • 110 filled out 6 month surveys
  • 8. Challenges to Thriving
  • 9. Workshop Topics
    • Topics Session
    • 1 2 3 4 5 6
    • Self-Management Overview X X
    • Stress/Symptom Management X X X
    • Problem Solving X X _
    • Finding Joy X _
    • Setting Goals X X X X X X
    • Making an Action Plan X X X X X X
    • Feedback X X X X X
    • Exercise X X _
    • Weight Management X _
    • Healthy Eating X X _
    • Body Changes X _
    • Difficult Emotions X X _
    • Communication X X X
    • Making Decisions X X _
    • Sleep X _
    • Fatigue X _
    • Future Plans X X
    • Effects of Treatment X _
    • Medications X _
    • Evaluating Treatments X _
    • Depression X _
    • Working with Health Care Team X X
  • 10.  
  • 11. Participation in Study Workshops
    • Percent completing session 6: 53%
    • Percent completing all 6 sessions: 47%
    • Percent logging in at least once to each session: 83%
    • Mean of 5.5 logins per participant per week
    • Over 1300 pages visited per participant
    • Over 1000 posts per workshop
  • 12. British Study Demographics (N=135)
    • Age 48.6 years (SD=9)
    • Male 18%
    • Education 48% professional or degree program
    • Married 56.2%
    • White 96%
    • Time since
    • cancer treatment 1.5 years (SD=1.3) Range 1 month to 5 years
  • 13. Types of Cancer Represented
    • Breast 42%
    • Uterine/Ovarian 11%
    • NHL 6%
    • Colon 10%
    • Other 9%
  • 14. Types of Treatment
    • Surgery Only 16%
    • Radiation Only 13%
    • Chemo Only 4%
    • Combination 66%
  • 15. British 6 mo Changes (N=110)
    • PHQ Depression p<.01
    • WHI Insomnia P<.01
    • Brief Fatigue Inventory p<.01
    • Role Function p<.05
    • Stress p<.01
    • Social Support NS
    • Aerobic Exercise p<.05
    • Communication with Physician NS
    • MD Visits NS
    • Oncology Visits p<.01
  • 16. Coming Soon
    • Data Analysis and Publication of Randomized US trial of US Cancer Survivors
    • Engagement Study Looking out Qualitative Data and Health Outcomes
    • National Dissemination of the Cancer: Thriving and Surviving Program through National Council on Aging

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