Translation and Dissemination of the Evidence-based Chronic Disease Self- Management for Cancer Survivors Colorado CPCRN (with Texas A&M) Steering Committee Call, 2/15/2012

Background: Chronic Disease Self- Management Program (CDSMP) Self-management is a component of the Chronic Care Model. One of the few evidence-based strategies to meet this need is the Stanford CDSMP ( Lorig K, Bandura A, Sobel D, Byron B et al.)

What is the CDSMP? Six week, community-led social cognitive behavioral intervention which uses group problem-solving and education. High fidelity delivery through peer Master Trainers (Stanford). RCT (1996) found improvement in outcomes relevant to survivorship: physical activity, communication with physicians, self-reported general health, fatigue, self-efficacy, decreased system use. These data yielded a cost to savings ratio of approximately 1:4.; many of these results persisted for as long as three years.

The Need: Self-Management & Survivorship Chronic Care Model applied to survivorship in the landmark IOM report Lost in Transition, Recently published evaluation of the LAF Centers of Excellence in Survivorship found…:self-management support was largely limited to health promotion in clinics, with few COEs providing patients with self-management tools and interventions. Campbell MK, J Cancer Surv 2011; 5(3): (our wise friend Marci)

CDSMP, Survivorship, & Colorado CPCRN: In the right place, at the right time… A curriculum for cancer survivors was initially developed in the U.K. and piloted in Virginia in Marcia Ory is an investigator in the ongoing nationwide evaluation of the CDSMP. Community partner with over 300 trainers in Colorado (Consortium for Older Adult Wellness).

Cancer Thriving and Surviving: Adaptations to the Chronic Disease Self-Management Program (---Cancer Specific changes; Boxes = New Modules) Cancer Thriving and Surviving (CTS) Program Changes Chronic Disease Self-Management Program (CDSMP) Getting a Good Nights Sleep Living with Uncertainty Making Decisions *Revised: CANCER SPECIFIC Fatigue Management: Prioritizing Activities & Asking for Help

Cancer Thriving and Surviving: Adaptations to the Chronic Disease Self-Management Program (---Cancer Specific changes; Boxes = New Modules) Cancer and Changes to Your Body Making Decisions New Activity: Decision Making Exercise Cancer and Relationships *Revised: CANCER SPECIFIC Chronic Disease Self-Management Program (CDSMP)

Progress to Date: Training: 14 facilitators from Colorado and 4 from Texas were trained in the first ever CTS Leader Training, led by Drs. Lorig and Seidel in January, Facilitator de-briefing 3 months post-implementation indicated CTS delivery was feasible and acceptable. COAW trainers are exceptional. Implementation: 128 enrolled to date (goal = 300). Participants reported over 10 different cancer types. 10 classes completed since August, 2011 in Colorado. Evaluation: Wait-list control RCT design powered for medium effect size. Using Stanford tools for comparison (baseline, post-program and 6 month follow-up measures).

Lessons Learned: RCT design feasible (no dropouts at enrollment) Most recruiting providers required approval of their own IRB (allow extra time) Also allow extra time to meet with management one-on- one to answer site-specific questions Media outreach (TV interviews, periodicals) was a main source of recruitment during start-up Working with community partner in delivery presents initial challenges but works well once procedures set From participant…I received much needed insight on how to cope with being a cancer survivor. It was a growing experience.

Next Steps: Abstract submitted for presentation to CDC Cancer Conference in August, Manuscript to describe adaptations to EBI, first facilitator training, potential for dissemination, and evaluation plan in development (Risendal, Ory, Dwyer, Lorig and U.K. program developers). Future grant submissions: possibly a D&I R01, or CMS application - with other CPCRN partners? Thank you!