1. 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

2. 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

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

4. 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

5. 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. 5

6. 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 6

7. Provincial Survivorship Program 7

8. Provincial Survivorship Program 8

9. 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

10. 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

11. NPs in Primary Care are Effective 11

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

13. 13 What is a Survivorship Nurse Practitioner?

14. 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 (Surrey Centre)

15. 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%)

16. Referrals Patient Criteria –Unattached status Catchment Area Who can refer? BCCA staff/oncologists: 179 referrals Other HCPs Patients/Family Members 16

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

18. 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

19. Interviews: what we asked… 1.Awareness 2.Understanding of scope 3.Benefits 4.Opportunities for improvement 5.Other comments

20. Interviews: what we heard… 1.Awareness 2.Role clarity 3.Communication

21. Client Satisfaction Tool Bear & 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…..

22. Client Satisfaction Tool Bear & Bowers (1998) Cox: Elements of Client-Professional Interaction Affective Support Reassurance, comfort, understanding, encouraging Health Information Imparts 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

24. 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

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

26. 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 Questions?