Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Objectives
Define patient-centeredness as a function of quality care Describe several organizations that set care standards Discuss patient-centered standards that impact cancer care across the continuum
Quality Care
Safe Effective Patient-Centered Timely Efficient Equitable
Why Patient-Centeredness?
For diseases that are often chronic and sometimes incurable, with interventions that can have toxic and long-term consequences, it is especially important that decisions influencing patient outcomes reflect the patients own perspective. Cancer provides a compelling case in point.
Lipscomb J, Gotay CC, Snyder C. Patient-reported outcomes in cancer: a review of recent research and policy initiatives. CA, 2007;57: 278-300, p 278.
Why Patient-Centeredness?
Right thing to do Improved care Improved well-being Addresses disparities Better value
Epstein et al. Health Affairs. Why the nation needs a policy push on patient-centered health care. 2010.
Prevention
Diagnosis
Treatment
Posttreatment
End of Life
Care Standards
National Comprehensive Cancer Network (NCCN) American Society of Clinical Oncology (ASCO) Association for Community Cancer Centers (ACCC) Commission on Cancer (CoC)
GWCI Center for the Advancement of Cancer Survivorship, Navigation & Policy
National and local training center
In-person and online trainings for different audiences
Focus on
Widespread implementation of patientcentered standards Advancing the fields of navigation and survivorship through collaboration
Patient Navigation
Definition
Patient Navigation is an intervention that addresses barriers to quality standard care by providing individualized assistance to patients, survivors and families.
39%
70%
Freeman HP, Wasfie TJ (1989). Cancer of the breast in poor black women. Cancer, 63(12), 2562-2569. Oluwale/Freeman, Journal of American College of Surgeons, 2003.
What Navigators Do
Reduce barriers Educate Build partnerships in the community Coordinate appointments Maintain communication Arrange for/connect with support Teach self-advocacy Provide access to clinical trials
Other Standards
National Patient Navigation Collaborative ACCC guidelines Professional Societies
Academy of Oncology Nurse Navigators National Coalition of Oncology Nurse Navigators Oncology Nursing Society National Association of Social Workers
Psychosocial Distress
Areas of Need
Cancer Treatment Information Emotions Related to Cancer Managing the Illness
Changing Behaviors
Barriers to Screening
Knowledge Lack of clarity Beliefs Values Assumptions Level of skill Pressure to do more with less System barriers
Other Standards
NCCN Guidelines for Management of Psychosocial Distress ASCO/QOPI measure
Patient emotional well-being assessed by the second office visit
Survivorship
National Reports
Source: American Cancer Society, Cancer Treatment & Survivorship Facts & Figures, 2012; Data Modeling Branch, Division of Cancer Control and Population Sciences, NCI 28
Cancer
Arthritis Osteoporosis
Diabetes
Overweight / Obesity
Source: Smith, et al. (2008). Cancer, comorbidities, and health-related quality of life of older adults. Health Care Finance.
29
Source: City of Hope, Beckman Research Institute, 2004, reproduced with permission in the American Cancer Societys Cancer Treatment & Survivorship Facts & Figures, 2012 30
Survivorship Terms
Long-term effects
Side effects or complications of treatment Begin during treatment and continue beyond treatment
Late effects
Unrecognized toxicities that are absent or subclinical at the end of treatment Occur months and years after treatment
Radiation therapy
Surgery
Source: Mayo.com 32
1-YR
3-YRS
6-YRS
11-YRS
Nu er op at hy
Co nc en tra Se t io xu n al Fu nc t io ni ng
En er gy
Pa in
53
39
46 37 31 9
22
25
17
12
Sa dd n
Fe ar o
Poor communication
Lack of survivorship standards of care Capacity for delivering care
Institute of Medicine Lost in Transition report.
Lack of agreement on who should provide care Diverse survivorship populations Huge change in the culture of oncology
Great need for patient and provider education Still trying to understand the right economic model
Other Standards
NCCN disease-based guidelines ASCO Survivorship Guidelines ACCC guidelines National Cancer Survivorship Resource Center (The Survivorship Center)
Conclusion
Widespread recognition of the need for patient-centered care Cancer standard-setting organizations have the potential to rapidly influence cancer care Patients will benefit greatly from patientcentered cancer care across the continuum
GW Cancer Institute Center for the Advancement of Cancer Survivorship, Navigation and Policy
Thanks!
Anne Willis, MA annewillis@gwu.edu 202-994-0988