Full Public Health Program Proposal: Paper

CAMPSO: COMPLIMENTARY AND ALTERNATIVE MEDICAL PARTNERSHP SYSTEM OF
OREGON
Complementary and Alternative Medical PartnershipSystemof Oregon:
CAMPSO
Christina Spry
2043 College Way
Pacific University
Forest Grove, OR
Spry0707@pacificu.edu
April 11, 2016
3,280 Oregon women will be diagnosed with breast cancer this year. The treatment that follows
this diagnosis can lead to financial, physical, and mental problems. Complimentary and
Alternative Medicine (CAM) can ease these problems through helping patients feel physically
better and continue living productive lives during treatment. Patients rely on health care
providers for information about treatment courses, yet many allopathic clinicians are unfamiliar
with CAM. CAMPSO trains clinicians who treat breast cancer about CAM through expert
sessions led by CAM providers. Thereafter, CAM and allopathic clinicians meet monthly to
discuss new information in CAM and continue the partnership. CAMPSO also provides patients
a brochure about CAM treatments to encourage them to discuss CAMwith their allopathic
provider. The final component of CAMPSO is the ongoing discussion of CAM treatments
between the patient and provider through out the patients’ breast cancer treatment and post
treatment. CAMPSO will provide Breast Cancer patients with treatments to minimize their side-
effects which in the long run will lower the negative impacts cancer patients face post
treatment and it will help more women live a more fulfilling and productive life both during and
after treatment.

2
CAMPSO: COMPLIMENTARY AND ALTERNATIVE MEDICAL PARTNERSHP SYSTEM OF OREGON
PopulationDescription:
Oregon see’s 3,280 cases of breast cancer each year or 129 diagnosed cases of breast
cancer per 100,000 women, which is just higher than the national average. (Susan G.Komen,
2015). The population of women who will get breast cancer includes one third of women in
Oregon, which currently has over 1.9 million women (U.S. Census Bureau, 2015). Although
breast cancer is not common until women are in their 50’s, genetic factors cause women to
develop this disease at almost any age (Susan G. Komen, 2015). Although these women share
very diverse histories and come from very different areas around Oregon, they are all part of
the same group due to shared experience of breast cancer and treatment, which unites them as
a population.
“Cancer is a group of diseases characterized by uncontrolled growth and spread of
abnormal cells.. caused by external factors.. and internal factors, such as inherited genetic
mutations, hormones, and immune conditions,” as well as age and general break down of the
body over time,” (American Cancer Society, Quickfacts, 2015). The prognosis for survivors
depends on what stage the cancer is found and treated at. 61% of cases are diagnosed before
cancer has spread to the lymph nodes or nearby structures. For these women the 5-year
survival rate is 99%, however in absolute terms this statistic is 11 % lower for African-American
women (American Cancer Society, Quickfacts, 2015). For the other stages the 5-year survival
rates, among women of all races with regional disease is stage 2 (localized) has an average 5-
year survival of 98.6, stage 3 (regional) has a 83.8% survival rate (African American women have
a 72.1 % survival compared to white women’s 85.2 % survival rate) and stage 4 (distant) has an
average survival of only 23.4 % with African American women only having a 15% 5-year survival
rate and white women having a 24.9% survival rate (American Cancer Society, Cancer Facts and
Figures, 2015) .
Most breast cancer patients go to an oncologist once they are diagnosed and have a
fairly similar experiences within each diagnosed stage of cancer (Susan G. Komen, 2015). They
generally all also have a provider they can discuss treatments with and who suggests
treatments and prescribes medicines. The general treatments for breast cancer include,
“surgery, radiation, chemotherapy, hormone therapy, immune therapy and targeted therapy
drugs that interfere specifically with cancer cell growth),” (American Cancer Society, Quickfacts,
2015). The treatment plan that an individual patient has varies based on the type of cancer and
the stage with more aggressive treatments for later stage cancers (American Cancer Society,
Quickfacts, 2015). It is also important to understand that these treatments cause side effects
that this population has to deal with and that make them more vulnerable. Patients suffer from
a range of side effects during and after treatment including fatigue, headaches, muscloskeletol
issues, heart problems, new cancers and memory problems known as “chemo brain” are
common among patients and survivors (John Hopkins Medicine, Side effects from breast cancer
treatment, 2015). This population is also stressed due to 97% of the patients who die being 40
years old or older (American Cancer Society, How is breast cancer found?, 2015).
On average, breast cancer treatment costs between $100,000- $300,000 (Cost Helper,

3
2015). Even with insurance, this is a huge burden for most patients and is why breast cancer
patients actually have a higher incidence of patients below the poverty line. In Oregon 16.4% of
people live below the poverty line (U.S. Census Bureau, 2015), while women diagnosed with
breast cancer have a poverty rate closer to 25% and for single mothers that goes up to
30%(Susan G.Komen, 2015). This adds to the stresses put on women who have breast cancer
and is part of what makes them such a vulnerable population. Certain subgroups experience
higher incidence of breast cancer and poorer treatment outcomes. African American and
Hispanic women, as well as women with lower income and educational achievement are at an
elevated level of risk of death from breast cancer. Poverty and bad health go hand in hand, in
the case of breast cancer having low SES lowers access to healthcare and thus patients are
diagnosed at later stages (Reference).
ProblemAnalysis:
Through my practicum experience at Susan G. Komen and research I have found that
there is a lack breast cancer patients who know and are informed of Complimentary and
Alternative Medical treatment options (CAM), and thus a lack of people utilizing these
treatments . This is a problem because CAM treatments have been shown to improve the
overall health of cancer patients improve health outcomes but are still not being used in many
cases (Garland et. al., 2013). The reasons patients are not informed of CAM treatment options
vary.
The problems associated with patients’ knowledge of CAM treatments starts in the
history of CAM treatments. Historically insurance companies did not cover CAM treatments,
(Reference) which was generally due to the general negative societal view of these treatments
and a lack of research of these treatments. Today, we know a lot more about the benefits of
many different CAM treatments and research, although limited, has show the value of these
treatments (Institute of Medicine (US), 2005).
(The root cause of patients not knowing about CAM treatments is that their providers
do not tell them.)*ReWord! The reasons why providers do not tell patients varies, however the
main reasons are doctors do not know what insurance companies do and do not cover CAM
treatments, providers do not have adequate and current knowledge of CAM treatments and
providers and society in general, do not view cancer treatment in a holistic or whole body view
which is how most CAM providers see it (OHSU, Alternative treatments (CAM), 2015). There are
many other reasons and every provider is different, however, this problem can be solved
though addressing patients lack of knowledge and the effect of their providers lack of
knowledge.
Focusing on the idea that providers do not have adequate and current knowledge of
CAM treatments is a very important part of the problem. However, providers face several
problems with learning about CAM. The first problem is that there is little research on the
treatments, which makes it difficult for a doctor to prescribe something with only preliminary
results on its success, and information is new and not all providers are as up to date on
information (Institute of Medicine (US) (2005), Need for Innovative Designs in Research on CAM
and Conventional Medicine. Available from: http://www.ncbi.nlm.nih.gov/books/NBK83801/
Another problem is that larger organizations that practitioners and other medical
personnel rely on to give them new information, simply do not share new developments in

4
CAM treatments. I saw this first hand when I was at Susan G. Komen of Oregon and SW
Washington. Komen is one of the largest resources for breast cancer patients and many people
in the field consult their website when informing patients (Reference or how I know this…).
Their website however, does not have very much information on CAM treatments and does not
emphasize the important of these treatments. This is also one of the things that effects popular
view of cancer treatment and has led to a stigma against alternative options. Generally,
because such a large company that is trying to promote breast cancer health, does not show
the importance of CAM treatments many people have a negative view of CAM treatments or
have no idea what they are. *Summarize the main problems… so easier transition…
Evidence Base:
Breast Cancer patients are a vulnerable group which I have shown previously. For this
reason it is important for their doctors to ensure they have all of the tools they need to go
through treatment and recover with the highest success rate. This is why I believe it is
important to find a way to get information about CAM treatment to these patients. Based on
literature and the importance of patients working with their doctors I believe the best way to
fix this problem is through the practitioners since they are such an important part of a cancer
patients treatment.
CAMPS: Complimentary and Alternative Medicine Partnership System, aims to Increase
Knowledge and Use of Complementary and Alternative Medical (CAM) treatments by Breast
Cancer Patients in Oregon through Education of patients and Practitioners, combining
brochures, practitioner education and an open relationship about CAM between practitioners
and patients to foster the best possible health outcomes.
Brochures and Discussion with Practitioner:
Among Breast Cancer patients it has been shown by Pavic et. al. (2007), that giving
patients brochures or a brochure and then discussion with a practitioner raised knowledge of
information related to breast cancer screenings. The short comings of this intervention is it was
simply on if knowledge was raised on a fairly simple and straight forward topic. In my
intervention an actual cancer patient’s decision on CAM or treatment options in general, is
effected by many added factors. This is why the importance of a discussion with a practitioner
to clarify any difficult to understand material is also needed for this population.
An analysis of interventions by Coulter and Ellins (2007) found that brochures needed to
be specifically aimed at the target population and are most successful in patients in raising
knowledge of treatments when combined with discussions with a practitioner. This is important
and the idea of personalizing brochures and combining them with a discussion with the
practitioner are very important. However, this article also highlights that for talks with
practitioners to be successful health professionals need to be trained in good communication
skills and very knowledgeable of all treatment options, in my interventions case especially
concerning CAM treatments.
Patient-Provider Communication:
A study by Frankel, Arye and Cohen (2010) comparing cancer patients who had good
communication about CAM with their practitioner and those who did not found better over all
satisfaction by patients. This was due to patients felling their stress was better addressed, their

5
quality of care was higher and discussions with practitioners reduced exposure to misleading
information about treatments.
This study also highlights six themes that are important in patient centered
communication. These are fostering a healing relationship, exchanging information, responding
to emotions, managing uncertainty, making decisions and Enabling patient self-management.
My program will also incorporate these core ideas in how doctors are told to help cancer
patients with CAM decisions and treatment decisions in general.
A study of interventions involving patient-practitioner communication by Swenson et.
al. (2004) found that the best way for doctors to communicate with patients is through
personalized communication where the patient can ask questions and gain knowledge. It is also
important that the physician also be knowledgeable on the subject.
Adequate Knowledge for Practitioners
Anderson and Horthorn (1990) found that doctors who took short educational course
increased diagnostic knowledge and altered treatment recommendations. Although they
studied these changes in knowledge related to psyichiatric decisions it is very applicable to
doctor’s view of CAM treatments. They illustrate that a simple intervention where a specialist in
the field, for their study it was psychiatry, would inform, give a lecture and discuss the topic
with doctors would raise those doctor’s knowledge of the subject and would actually directly
effect their treatment recommendations. Chesney and Pearson (2007) add to this by illustrating
that doctors respond best to people they view as equals, and a CAM practitioner is the best
person to teach them about CAM and get the best results.
Hammock et. al. (2007) adds to this by illustrating there are important factors in
teaching doctors and it important to use Inter professional education. They showed that using
individuals with similar background helps practitioners learn and value information more. A
short coming of this study is way was shown to not be very good at changing people’s views, it
was only good at improving knowledge.
Program Description: 600-1200 works, currently 487… What is your novel
proposal based on what you saidin previous section? What community health
improvements will CAMPSO make?
CAMPSO aims to increase patient and practitioner knowledge and utilization of
Complimentary and Alternative Medicine (CAM) in Breast Cancer Patients through a multi-step
education program for providers and patients. There are several important aspects of my
program but for the program to even start a partnership between CAM providers and Breast
Cancer providers must be established. To accomplish this CAMPSO has a CAM provider come
and present to around 20 Breast Cancer providers about CAM treatments and then conducting
a Q&A session where the providers can ask any questions they have about CAM. Another part
of CAMPSO, aims at keeping this relationship, so it will establish a committee with Breast
Cancer providers and CAM providers that meets every month to discuss anything new in the
field and generally just keep a relationship and forward movement between the groups. *More
on purpose/goals of committee!
The other part of the program is directly giving brochures about CAM to recently
diagnosed breast cancer patients. These brochures will be aimed at how CAM treatments can

6
best relate to breast cancer treatment and will allow the patients to gain knowledge and think
of questions before meeting with a provider. The next step is where everything starts to come
together which is when the patient and practitioner meet for their first visit. This time allows
the patient to discuss anything they want to about CAM and to fully understand how it can
benefit them and any misunderstandings they may have (Clarify!). This is also when good
communication between the patient and practitioner can be established and the idea of
discussing CAMshould be reflected in the following visits.
It is also important that surveys be given to patients and providers before and after all
aspects of the program to evaluate progress and ensure the program is working properly. This
program will strive to lead to a better understanding of CAM by patients and practitioners,
better patients-practitioner relationship and discussion of CAM. Ultimately this program will
help relieve some of the stereotypes associated with CAM and increase general knowledge and
use of CAM. It could also lead to a lower amount of drugs being prescribed by practitioners
since problems will be taken care of with CAM treatments instead. In order to increase patient
and doctor knowledge and utilization of CAM the program will do the following…
1. Give 20+ Breast Cancer Practitioners a presentation on CAM by a CAM practitioner and
attend a Q&A session (measure change in knowledge with before and after surveys).
2. Establish committee with 5+ Breast Cancer Practitioners and 3+ CAM practitioners to
meet monthly and have an ongoing relationship and continue advancing the program.
3. Give every patient brochure and have practitioners discuss with every patient
maximizing their initial understanding.
4. Ongoing discussion of CAM between patient and practitioners, with the goal being that
CAM is discussed in some sense during each visit with the practitioner (measured
through survey).
Inputs/Resources Activities Outputs Short-term
Outcomes
Long-term Outcomes
Brochures on CAM Patients read brochures
whilewaitingfor doctor
# of patients who read
brochure
Higher amount of
knowledge of CAM
among Breast
Cancer patients
Higher use of CAM along
with regular treatment
OfficeStaff Give Patients Brochures # of brochures handed
out
Higher knowledge
of CAM by patients
“
Partnerships with CAM
Practitioners
Train BreastCancer
practitioners aboutCAM
# of Practitioners with
raised knowledge of
CAM
Higher Practitioner
knowledge of CAM
Higher amount of
Practitioner suggesting
CAM options to patients
Change in general
practitioners views of CAM
treatments and there
benefits and shortcomings
Committee with CAM
Practitioners and Breast
Cancer Practitioners
# of meetings they
attend/hold
Communication
between Breast
Cancer Practitioners
Established relationship
and communication
between Breast Cancer

7
and CAM
practitioners
Practitioners and CAM
Practitioners
Breast Cancer
Practitioners thatare
knowledgable in CAM
Practitioners discuss all
treatment options, including
CAM with patients
# of patients with
raised knowledge and
understandingof CAM
Higher patient
knowledge of CAM
treatment options
and their benefits or
potential negative
outcomes
Higher patient utilization
of CAM treatments with
their normal treatments
References:
American Cancer Society (2015). Cancer Facts and Figures. Retrieved from:
http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2016/
Anderson and Horthorn (1990). Changing the psychiatric knowledge of primary care physicians:
The effects of a brief intervention on clinical diagnosis and treatment. General Hospital
Psychiatry. 12. 177-190. doi:10.1016/0163-8343(90)90077-P
American Cancer Society (2015). Breast Cancer Overview. Retrieved from:
http://www.cancer.org/cancer/breastcancer/overviewguide/index
American Cancer Society (2015). Breast Cancer Survival Rates by Stage. Retrieved from:
http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-survival-by-stage
American Cancer Society (2015). How is breast cancer found?. Retrieved from:
http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-overview-
diagnosed
Chesney and Pearson (2007). The CAM Education Program of the National Center for
Complementary and Alternative Medicine: An Overview. Academic Medicine. 82. 921-926. doi:
10.1097/ACM.0b013e31814a5014
Cost Helper (2015). Cost of Breast Cancer Treatment. Retrieved from:
http://health.costhelper.com/breast-cancer.html
Coulter, A., & Ellins, J. (2007). Effectiveness of strategies for informing, educating, and involving
patients. BMJ : British Medical Journal, 335(7609), 24–27. BMJ 2007;335:24

8
Frenkel, M, Ben-Arye, E, and Cohen, L, (2010). Communication in Cancer Care: Discussing
Complementary and Alternative Medicine. Integrative Cancer Therapies. 9, 177-185. DOI:
10.1177/1534735410363706
Garland, S. N., Valentine, D., Desai, K., Li, S., Langer, C., Evans, T., & Mao, J. J.
(2013). Complementary and Alternative Medicine Use and Benefit Finding
Among Cancer Patients. Journal of Alternative and Complementary Medicine,
19(11), 876–881. doi: 10.1089/acm.2012.0964
Hammick, Freeth, Koppel, Reeves, and Barr (2007). A best evidence systematic review of
interprofessional education: BEME Guide no. 9. Medical Teacher. 29. 735-751.
DOI:10.1080/01421590701682576
Institute of Medicine (US) Committee on the Use of Complementary and Alternative Medicine
by the American Public. Complementary and Alternative Medicine in the United States.
Washington (DC): National Academies Press (US); 2005. 4, Need for Innovative Designs in
Research on CAM and Conventional Medicine. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK83801/
Institute of Medicine (US) Committee on the Use of Complementary and Alternative Medicine
by the American Public. Complementary and Alternative Medicine in the United States.
Washington (DC): National Academies Press (US); 2005. 2, Prevalence, Cost, and Patterns of
CAM Use. Available from: http://www.ncbi.nlm.nih.gov/books/NBK83794/
John Hopkins Medicine (2015). Side effects from breast cancer treatment. Retrieved from:
http://www.hopkinsmedicine.org/breast_center/treatments_services/survivor_care/side_effec
ts.html
Nahleh, Z., Tabbara, IA. (2003). Complementary and alternative medicine in breast cancer
patients. Palliat Support Care. 1 (3), pp267-273.
Oregon Health and Sciences University (OHSU) (2015). Alternative treatments (CAM). Retrieved
from: http://www.ohsu.edu/xd/health/services/brain/getting-treatment/clinical-
services/alternative-treatments/
Pavic D, Schell M, Dancel R, Sultana S, Lin L, Sejpal S, and Pisano D, (2007). Comparison of
Three Methods to Increase Knowledge About Breast Cancer and Breast Cancer Screening in
Screening Mammography Patients. Academic Radiology, 14, 553-560.
Susan G. Komen Oregon and SW Washington (2015). State of Breast Cancer. Retrieved from:

9
http://komenoregon.org/files/State_of_Breast_Cancer_Komen_Oregon.pdf
Swenson, s., Buell S., Zettler P., White M., Ruston D. and Lo B. (2004). Patient-Centered
Communication. Journal of General Internal Medicine. 19. 1069-1079. DOI: 10.1111/j.1525-
1497.2004.30384.x.
U.S. Census Bureau. (2015). State & county Quickfacts: Oregon. Retrieved October 5, 2015 from
http://www.census.gov/quickfacts/table/PST045215/41,00

Full Public Health Program Proposal: Paper

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Full Public Health Program Proposal: Paper

Similar to Full Public Health Program Proposal: Paper (12)

Full Public Health Program Proposal: Paper