Cancer Thriving and Surviving


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Cancer Thriving and Surviving

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