Background: Chronic Disease Self-Management Program (CDSMP)

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

2. 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.)

3. 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.

4. The Need: Self-Management & Survivorship • Chronic Care Model applied to survivorship in the landmark IOM report “Lost in Transition”, 2005. • 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): 271-82 (our wise friend Marci)

5. 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 2010. • 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).

6. 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) SESSION 1: Overview of Self-Management and Chronic Health Conditions *Using your Mind to Manage Symptoms and Distraction Making an Action Plan SESSION 2: Feedback/Problem Solving Dealing with Difficult Emotions Physical Activity and Exercise SESSION 3: Better Breathing Muscle Relaxation *Pain and Fatigue Management Endurance Activities: How Much is Enough? *Revised: CANCER SPECIFIC Fatigue Management: Prioritizing Activities & Asking for Help Getting a Good Night’s Sleep Living with Uncertainty Making Decisions

7. 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 Cancer Thriving and Surviving (CTS) Program Changes SESSION 4: Future Plans for Health Care *Healthy Eating Communication Skills Problem-Solving SESSION 5: Medication Usage *Making Informed Treatment Decisions Depression Management Positive Thinking Guided Imagery SESSION 6: Working with your Health Care Professional and the Health Care System Looking Back and Planning for the Future Chronic Disease Self-Management Program (CDSMP) *Revised: CANCER SPECIFIC Cancer and Changes to Your Body Making Decisions New Activity: Decision Making Exercise Cancer and Relationships

8. 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, 2011. • 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).

9. 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.”

10. Next Steps: • Abstract submitted for presentation to CDC Cancer Conference in August, 2012. • 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!