Survivorship Nurse Practioner Primary Care and Oncology

Implementation and Early Evaluation of a Survivorship Nurse Practitioner Role

February 20th , 2015Quality Forum Rapid

Fire Sessions

Presenters

Karen Blain, Provincial Director Survivorship and Primary Care,

BC Cancer Agency

Vancouver, BC

Karen.blain@bccancer.bc.ca

Jill Matheson, Nurse Practitioner (F), Primary Care and OncologyBCCA Provincial Survivorship and Primary Care Program

BC Cancer Agency and Jim Pattison Outpatient Care and Surgery Center

Surrey, BC

jill.matheson@bccancer.bc.ca

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• Provincial Survivorship Program at the BC Cancer Agency

• Survivorship Nurse Practitioner Role

• Survivorship Nurse Practitioner Evaluation

Rapid Fire

Controversy: Who is a cancer survivor?

• “Time of diagnosis and to end of life” – Caregivers – Quality of life (physical, psychosocial, economic) – Surveillance and follow up – Late effects– Screening and prevention

~ (National Coalition for Cancer Survivorship NCCS) 4

Cancer Facts • BC population of 4 ½ million roughly and about 200

thousand have been diagnosed with cancer at some point in their life

• By 2020 there will be nearly 250 thousand living with cancer

• Each day 65 adults are diagnosed, one child or adolescent every two days

• By 2030 annual incidence will increase by 68% Every year about 25000 new diagnosis are expected

• There are approximately 2500 adult survivors of childhood cancer now. This number will double by 2025.

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Who are we?Vision

All survivors and those who care for them are supported and empowered to live their best life with and beyond cancer.

Mission

Together with our partners, we will provide leadership, invest in research, and build system capacity to support high quality, integrated care, and improve experience for all cancer survivors in British Columbia and Yukon.

         

Provincial Survivorship Program

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Provincial Survivorship Program

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Provincial Survivorship Program

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Provincial DirectorSurvivorship & Primary Care

Karen Blain

Survivorship Nurse Practitioner

Jill Matheson(1.0)

Survivorship Nurse Practitioner

Kristina Morrison(1.0)

Survivorship Research Chair

TBA

CPAC Project Manager

Jennifer Law(0.8)

CPAC Research Assistant

Ashley Turner(0.4)

CS4 Project Manager

Isabelle Linden(1.0)

Project Funded

Survivorship Nurse Practitioner

TBD (1.0)

Program AssistantSurvivorship Anita Chow

(0.9)

Social Worker ACCS Program

TBD(1.0)

Social Worker ACCS Program

TBD(1.0)

Nurse PractitionerACCS Program

TBD(1.0)

Program LeaderPrimary Care Lisa McCune

(0.9)

Program LeaderSurvivorship

Devon Poznanski(0.8)

Program LeaderSpecial Projects Shaun Lorhan

(1.0)

Medical Lead FPON Dr. Phil White

(0.1)

Program Assistant (FPON)

Shauna Remin(0.5)

FPON Medical Advisor

(0.1)

FPON Medical Advisor

(0.1)

FPON Medical

Advisor(0.1)

Medical Lead and Radiation Oncologist

ACCS ProgramDr. Karen Goddard

(0.5)

Program Assistant (ACCS)

TBD

Education Coordinator (FPON)

Jennifer Wolfe

Opportunity

• Attachment rates

• ~ 700 unattached cancer survivors in the Vancouver area• ~ 3000 unattached cancer survivors in the Fraser Health Region• ~ 2500 unattached cancer survivors in the Interior Health

• Improve adherence to surveillance recommendations

• Help to address and manage survivorship concerns

• Help to relieve oncologists from managing primary care concerns

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Survivorship Nurse Practitioner

• NP4BC Campaign• Proposal to Ministry

• Initiated February 2013

• 3 Locations:• UBC Family Practice Centre- #400-750 West Broadway, Vancouver• Jim Pattison Outpatient Care and Surgery Center- 9750 140 St, Surrey• Third Interior Health location TBD

NPs in Primary Care are Effective

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What is a Family Nurse Practitioner?

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• New to BC

• Acute and Primary Care

• Patient Practices

• Limitations

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What is a Survivorship

Nurse Practitioner?

• 92 patients who have had a cancer diagnosis

• 17 tumor groups: 32% breast, 13% colorectal, 10% cervical, endometrial and vaginal, 7% thyroid, 7% lymphoma, 6% lung

• 6% are survivors of childhood cancers

• 23 family members

• Average age: 56 (7-92)

• Gender: 70% female, 30% male

• 51 % have ongoing appointments with an oncologist.

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Practice Description (Surrey Centre)

Practice Description(Vancouver Centre)

• 203 patients who have had a cancer diagnosis (92)

• 24 (17) tumor groups: 46(32)% breast, 11(7)% lymphoma, 6(13)% colorectal, 6% prostate, 10% cervical, endometrial, and vaginal

• 44 (23) family members

• Average age: 51(56) (9-88)

• Gender: 74 (70) % female, 26 (30) % male

• Ongoing appointments with oncologist: 80% (51%) yes, 20% no (49%)

Referrals

• Patient Criteria– Unattached status

• Catchment Area

• Who can refer?• BCCA staff/oncologists: 179 referrals• Other HCPs• Patients/Family Members

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Communication

• CAIS access (read only) • Letter of acceptance• Administration• Emails/faxes/phone calls as

needed• Oncology support

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• Implementation Evaluation (interviews)• Six months after start-date• To identify and address concerns early

• Patient Satisfaction (survey)• One year after start-date• Bear & Bowers (1998) “Client Satisfaction Tool”• 61/97 respondents

Role Evaluation

Interviews: what we asked…

1. Awareness

2. Understanding of scope

3. Benefits

4. Opportunities for improvement

5. Other comments

Interviews: what we heard…

1. Awareness

2. Role clarity

3. Communication

Client Satisfaction ToolBear & Bowers (1998)

•Cox’s Interactional Model of Client Health Behavior

•Developed for NP model

•Confirmed validity and reliability

•Previously used at a PHSA NP Clinic

•Easy to understand and easy to administer by mail

*Thank you to Minna Miller, DNP(c), MSN, RN, NP(F), NP Child & Youth Primary Care Clinic, BCCH, Asthma Program, RICHER Initiative

Patient Satisfaction: how we asked…..

Client Satisfaction Tool Bear & Bowers (1998)

Cox: Elements of Client-Professional Interaction

Affective Support Reassurance, comfort, understanding, encouraging

Health InformationImparts knowledge about problem, treatment options, impact on lifestyle, self-management

Decisional Control Pt given freedom of choice, opportunity to select goals

Technical Competencies

Technical skills and abilities used to diagnose, treat and undertake technical tasks in provision of health care

Added:

Accessibility Factors involved in arranging to receive health care, time and effort to make appointments, waiting time, location accessibility

Overall satisfaction with Care Open-ended comments boxes

Comments about NP, comments about care provided by the NP

Accessibility Affective support Health information Decisional control Technical competency Overall satisfaction0

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20

30

40

50

60

70

80

90

100

97 97 92 89 95 97

Figure 1: Percent satisfied with NP by element

Future directions/next steps

• Ongoing strategies to promote and raise awareness of the NP role

• Expand network of Survivorship Nurse Practitioners across British Columbia

• Continue to evaluate for continuous improvement for both patients and providers

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Resources

British Columbia Cancer Agencywww.bccancer.bc.ca

After Cancer Web pagesaftercancer.bccancer.bc.ca

Forward Magazine http://www.bccancer.bc.ca/PPI/AfterCancer.htm

Clinical practice guidelines and protocols in BChttp://www.bcguidelines.ca/submenu_oncology.html

Jill Matheson, Nurse Practitioner (F), Primary Care and OncologyBCCA Provincial Survivorship and Primary Care Program

BC Cancer Agency and Jim Pattison Outpatient Care and Surgery Center

Surrey, BC

jill.matheson@bccancer.bc.ca

Karen Blain, Provincial Director Survivorship and Primary Care, BC Cancer Agency

Vancouver, BC

Karen.blain@bccancer.bc.ca

or

survivorship@bccancer.bc.ca

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Questions?