Report on CCCP Implementation Efforts with Health Care Professionals

1. Report on CCCP Implementation Efforts with Health Care Professionals

2. Overview of Presentations

3. “The Kansas State Cancer Plan: Practical Ways to Provide Extraordinary Care in your Office” Speakers: James Early, MD and Judy Johnston, MS, RD/LD Preventive Medicine & Public Health, KU School of Medicine, Wichita

4. Introductory Information • The Cancer Problem in Kansas • Development of the Kansas Comprehensive Cancer control and Prevention Plan • Implementation of the Plan

5. Prevention: Goals, Strategies, Rationale, Action Steps

6. What can YOU do as a partner in this effort? • Preventive Vital Signs • Provide a “big bang for the buck” • Provide a portal of entry for discussion of cancer prevention • Address at least 3 of the 4 strategies set forward by the Cancer Plan • Support the recommendations in the Guide to Clinical Preventive Services • Can become part of an overall strategy for office-based prevention • Can stand alone as a powerful message to your patients.

7. Preventive Vital Signs BP___ P___ R___ BMI (or wt.)___ Min PA___ F/V___ Tobacco Y/N Minutes of weekly Physical Activity = (Min PA)___ Fruits and Vegetables per day = (F/V)___ Smoking or tobacco exposure = (Tobacco) Y/N

8. Resources • Major resources in improving our preventive efforts are: • Guide to Clinical Preventive Services from the US Preventive Services Task Force. • www.cancerkansas.org • Links to American Cancer Society (ACS), Cancer Information Service (CIS), and other reliable resources • Aids and materials to help you provide consistent information and instruction on cancer prevention (i.e. tobacco use and exposure, nutrition, physical activity, environmental exposure).

9. Preventive Vital Signs Minutes of weekly Physical Activity = (Min PA) ___ Fruits and Vegetables per day = (F/V) ___ Smoking or tobacco exposure = (Tobacco) Y/N BP___ P___ R___ BMI (or wt.)___ Min PA___ F/V___ Tobacco Y/N

11. Screening/Early Detection: Goals, Strategies, Rationale, Action Steps

13. What can YOU do as a partner in this effort? • Continuously update your knowledge of accepted screening guidelines • Create better office systems to operationalize your screening efforts • Participate in and support research and data collection • Help in overcoming the financial and social barriers that restrict Kansans ability to access early screening and detection

14. Obtaining the Latest in Cancer Screening Guidelines • The United States Preventive Services Task Force (USPSTF) http://www.ahrq.gov/clinic/pocketgd.htm • MD Anderson Cancer Center--The OncoLog Report to Physicians—www2.mdanderson.org/depts/oncolog and refer to the April 06 newsletter • Memorial Sloan Kettering Cancer Center (includes skin cancer) www.mskcc.org/mskcc/print/65279.cfm • American Cancer Society Guidelines for the Early Detection of Cancer (www.cancer.org) • No specific guidelines are outlined for screening for lung cancer • The lack of specific guidelines in no way restricts providers from recommending screening on other grounds.

15. Operationalizing your Cancer screening and follow up • The key to optimal screening lies in the application of updated guidelines • Determine what updated guidelines you will primarily follow • Remember to include screening systems when developing Electronic Health Record (EHR) systems.

16. Ask yourself “What system is in place” to: • Be sure patients receive appropriate screening • When they visit your office routinely? • For those who may not be seen frequently? • For those at high risk? • For those with economic barriers to care? • For follow up of those with positive or borderline cancer screenings?

17. Frame, P. S. (1992). Health Maintenance in Clinical Practice: Strategies and Barriers. American Family Physician, 45, 1192-1200.

18. Web Resources: • ~ Kansas Comprehensive Cancer Control Plan • http://www.kdheks.gov/edw/download/kansas_cancer_control_plan_final_report.pdf • ~ www.cancerkansas.org- •  Links to American Cancer Society (ACS), Cancer Information Service (CIS), and other reliable resources •  Aids and materials to help you provide consistent information and instruction on cancer prevention (i.e. tobacco use and exposure, nutrition, physical activity, environmental exposure). • ~ The United States Preventive Services Task Force (USPSTF) • http://www.ahrq.gov/clinic/pocketgd.htm • ~ MD Anderson Cancer Center--The OncoLog Report to Physicians • www2.mdanderson.org/depts/oncolog and refer to the April 06 newsletter • ~ Memorial Sloan Kettering Cancer Center (includes skin cancer) • www.mskcc.org/mskcc/print/65279.cfm • ~ American Cancer Society Guidelines for the Early Detection of Cancer • www.cancer.org

19. Diagnosis/Treatment: Goals, Strategies, Rationale, Action Steps

20. What can YOU do to improve Diagnosis and Treatment? • Utilize the map of Cancer Treatment Locations in the State of Kansas for the best and closest referral • Post the MAP in your office • Enroll patients in clinical trials whenever possible • Be sure you are able to access timely information through www.cancerkansas.org • Be sure your patients have the support they need • Patient advocate • Case manager

21. Wichita CCOP • Main location: Wichita, KS • Satellite locations: - Chanute - Dodge City - El Dorado - Kingman - Liberal - Pratt - Newton - Salina - Wellington - Winfield

22. Kansas Cancer Treatment Locations

23. Survivorship/End of Life: Goals, Strategies, Rationale, Action Steps

24. What can YOU do as a partner in this effort? • Be sure that every cancer survivor has a plan • Use a cancer survivor checklist • Be sure that provision for adequate follow-up is in place • Be familiar with your local hospice and palliative services • Investigate your local hospice resources • Become more educated on palliation and know where resources are located • Make advanced directives available to your patients—especially your cancer patients facing an uncertain future • Living wills • Healthcare durable power of attorney documents

25. List of diagnostic tests performed and results Dates of treatment initiation and completion Full contact information on treating institutions and key providers A description of recommended cancer screening and other periodic testing and examinations and the schedule on which they should be performed Information on any possible late and long term effects of treatment and symptoms of such effects. Information on possible signs of recurrence and second tumors. Information on the potential insurance, employment, and financial consequences of cancer and referral to resources when necessary. Information on possible social/emotional effects of cancer, including marital/partner relationships, work, parenting, and the need for psychosocial support. Specific recommendations for healthy behaviors, such as diet, exercise, healthy weight, sunscreen use, smoking cessation, etc. to help prevent any cancer recurrence. As appropriate, information on known effective chemo preventive strategies for secondary prevention (Tamoxifen in women at high risk for breast cancer; aspirin for colorectal cancer prevention). Referrals to specific follow-up care providers, support groups, and/or the patient’s primary care provider. A listing of cancer-related resources and information (Internet based sources and telephone listings for major cancer support organizations. Cancer Survivor Checklist ~ Source: Institute of Medicine Fact Sheet, November 2005: Cancer Survivorship Care Planning

26. Hospice Resources • LIFE Project has resources on Hospice, including finding a hospice program, information on paying for hospice, palliative care, and advanced directives. • LIFE Project, www.lifeproject.org • Caring Connections, www.caringinfo.org

27. Advanced Directives • A living will allows the patient to document their wishes concerning medical treatments at the end of life. • A medical power of attorney (or health care proxy) allows the patient to appoint a person they trust as their health care agent (or surrogate decision maker), who is authorized to make medical decisions on their behalf. Kansas Life Project, Caring Connections, www.lifeproject.org/home

28. Advanced Directives and Hospice Resources • Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), is a national consumer engagement initiative to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation. They offer resources on hospice and palliative care, state specific advanced directives forms, care giving, etc. • www.caringinfo.org • The Life Project is a collaborative effort whose mission is to help all Kansans with advanced chronic and terminal illnesses live with dignity comfort and peace. The project is a coalition of many organizations working together to improve end-of-life care. • www.lifeproject.org • Kansas Health Ethics (KHE) is a nonprofit educational organization formed in 1992. KHE wants to help all Kansans understand the importance of ethics in healthcare planning and decision making, and equip them to make good healthcare and quality of life decisions. KHE provides Living Wills, Health Care Powers of Attorney, "Do Not Resuscitate" and other advance directives documents and information about their use to individuals as well as to facilities and institutions across Kansas. • www.kansashealthethics.org

29. Summary

30. The Kansas Comprehensive Cancer Control and Prevention Plan is a blueprint for the development of the future of cancer care in Kansas • It represents a major effort in trying to create a “system” that can increase availability, fairness, quality and optimal outcomes in the field of cancer care.

31. What we want YOU to take home • First we want you to appreciate the scope and importance of this major focus on all areas of cancer care and the time and money that have been and will be dedicated to the effort • Secondly, and possibly more importantly, we want you to take home and USE any of the suggestions and/or materials presented here.

32. Summary of tools • Concept of “Preventive Vital Signs” • Ideas and resources for selecting and implementing screening in your office • The Map of Cancer Resources throughout Kansas • The www.cancerkanses.org website • Listing of hospice and palliation resources • Advance directive materials

33. Additional Opportunity: Point of Care (POC) CME • New system to address clinical questions and/or care that arise in your practice • Web based resource designed to provide practice based learning • Self directed, on-line learning at the "point of care" i.e., your office

34. POC Steps • Identify practice-based knowledge needs • Complete extensive background research on a clinical questions • Reinforce clinical decisions through review of published evidence • Learn new information related to clinical practice • Improve patient care by utilizing current published evidence

35. University of Kansas AHECs • Will provide: • Provide individual orientation on the process • Tracking • Document activity • Identify appropriate evidence-based medical databases • Meet with professionals participating in the pilot project periodically to obtain your feedback. • Grant CME and Nursing CE • Physicians may claim up to 20 AMA PRA Category 1 credits per year • Nurses (through American Nurses Credentialing Center or ANCC) • Pilot in a maximum of 20 locations throughout Kansas funded by UKSM-W through a contract with KDHE

36. University of Kansas AHECs AHECs are finalizing the POC steps to encourage physicians to design or update cancer screening guidelines in their practice. Hopefully, the ability to claim CME and the recognition of the importance of screening guidelines based on their own patients will increase the number of physicians with routine screening protocols in their office practices.

37. Department of Preventive Medicine & Public Health, KUSM-W PVS Pilot Study • One busy primary care office will be trained on the protocol for implementation of Preventive Vital Signs and implement protocol for one month • Interviews with physicians and staff will provide feedback to revise protocol • Additional practices will implement the revised protocol for one month • Interviews will be used to evaluate process

38. In a world where we too often see human life undervalued, we have a chance to fight back. It is our job as health care providers to prove through the quality and comprehensiveness of our effort that every human life is extraordinary. That is what the Kansas Cancer Plan is all about. James Early, M.D. KUSM-W

39. 6 presentations statewide: Chanute, KS Colby, KS Dodge City, KS Hutchinson, KS McPherson, KS Pittsburg, KS Presentations for AHEC, KAFP Meeting, and KU Continuing Education 46 physicians, nurse clinicians and physicians assistants visited in 11 clinics 147 CME packets mailed out 186 people attended presentations CME packets available at AHEC offices statewide Dissemination Statistics

40. Kansas Dissemination by County