Survivorship Nurse Practioner Primary Care and Oncology Implementation

Survivorship Nurse Practioner Primary Care and Oncology Implementation and Early Evaluation of a Survivorship Nurse Practitioner Role February 20 th , 2015 Quality 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 Oncology BCCA Provincial Survivorship and Primary Care Program BC Cancer Agency and Jim Pattison Outpatient Care and Surgery Center Surrey, BC jill. matheson@bccancer. bc. ca 2

Rapid Fire • Provincial Survivorship Program at the BC Cancer Agency • Survivorship Nurse Practitioner Role • Survivorship Nurse Practitioner Evaluation

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 approximately 2500 adult survivors of childhood cancer now. This number will double by 2025. 5

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. 6

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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 9

Survivorship Nurse Practitioner • NP 4 BC 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 Effective 11

What is a Family Nurse Practitioner? • New to BC • Acute and Primary Care • Patient Practices • Limitations 12

What is a Survivorship Nurse Practitioner? 13

Practice Description • • (Surrey Centre) 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.

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 16

Communication • • CAIS access (read only) Letter of acceptance Administration Emails/faxes/phone calls as needed • Oncology support 17

Role Evaluation • 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

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 Tool Bear & Bowers (1998) Patient Satisfaction: how we asked…. . • 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 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

Client Satisfaction Tool Bear & Bowers (1998) Cox: Elements of Client-Professional Interaction Affective Support Reassurance, comfort, understanding, encouraging Decisional Control Imparts knowledge about problem, treatment options, impact on lifestyle, self-management 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 Health Information Added: Accessibility Overall satisfaction with Care Open-ended comments boxes Factors involved in arranging to receive health care, time and effort to make appointments, waiting time, location accessibility Comments about NP, comments about care provided by the NP

Figure 1: Percent satisfied with NP by element 100 90 97 97 92 89 Accessibility Affective support Health information Decisional control 95 97 80 70 60 50 40 30 20 10 0 Technical competency Overall satisfaction

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 24

Resources British Columbia Cancer Agency www. bccancer. bc. ca After Cancer Web pages aftercancer. bc. ca Forward Magazine http: //www. bccancer. bc. ca/PPI/After. Cancer. htm Clinical practice guidelines and protocols in BC http: //www. bcguidelines. ca/submenu_oncology. html

Questions? Jill Matheson, Nurse Practitioner (F), Primary Care and Oncology BCCA 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 26