Improving Pain and Palliative Care Competency among Non-Oncology Health Professionals

1. Improving Pain and Palliative Care Competency among Non-Oncology Health Professionals Pamela Bennett, RN, BSN Purdue Pharma, L.P. Maureen Lichtveld, MD, MPH Tulane University School of Public Health and Tropical Medicine Alison Smith, BA, BSN, RN C-Change

2. Thank Yous, Disclosure, & Disclaimer Thank you to many leaders and experts who have contributed to this body of work. Thank you to Purdue Pharma, L. P. who generously provided an unrestricted educational grant to C-Change that helped to fund the 4 pain and palliative care grant sites and the CCCLI Pain Workshop. The materials presented reflect the views and opinions of the individual presenters

3. Workshop Objectives By the end of this presentation, attendees will be able to … • Describe the basic challenges and contemporary issues in pain and palliative care • Appreciate how other sites have applied the competency-based method to achieve measurable outcomes • Outline a competency-based approach for designing educational interventions – from planning thru implementation, and evaluation • Identify sources for program curriculum, national standards, funding, advocacy, etc. • Move forward with a prioritized list of next steps

4. Cancer Core Competency Initiative Goal: Strengthen the basiccancer competency (knowledge, skills, and attitudes) of the non-oncology health workforce

5. Pain and Palliative Care: Issues and Challenges Research Practice Policy

6. Coalition Perspectives • Your Challenges? • Your Priorities?

7. Cancer Core Competency Initiative Goal: Strengthen the basiccancer competency (knowledge, skills, and attitudes) of the non-oncology health workforce

8. Examples of Success Pain & Palliative Care Grant Site Results

9. Examples of Success Target audience: • RNs and MAs practicing in rural, long term care facilities Focus: • Describe palliative and end of life care, and explain the role of hospice Results: • 40 participants • 12% increase in knowledge from pre- to post-test scores • Possible addition to Iowa nursing school curriculum Unique Approach: • Order sets for palliative/hospice care • Scripts/ talking points for difficult conversations

10. Examples of Success Target Population: • MD, RN, MSWs, and office staff in rural health, primary care clinics (mostly FQHCs) Focus: • Describe cancer-related symptoms, methods to screen for needs, and referral pathways and palliative care resources for patients. Results: • 90 participants • 90% reported gaining new knowledge and skills to provide better patient care Unique Approach: • Interdisciplinary program • Video with cancer patient perspectives • Video with a standardized patient scenario

11. Examples of Success South Puget Intertribal Planning Agency (SPIPA) Population: • Native health workers, cancer survivors, and caregivers Focus: • Address culture-specific cancer pain • Explain how cancer pain differs from other types of pain • Perform a cancer pain assessment • Differentiate pain and distress Results: • 102 participants • 120% improvement in confidence • 7% increase in knowledge Unique Approach: • Pre-Assessment with talking circles • Patient symptom journal • “Discomfort” Barometer

12. Examples of Success Population: • Medical students and pediatric residents Focus: • Recognize the barriers to effective pediatric pain management • Perform a pediatric pain assessment • Describe the pathophysiology of pain in children • Manage pediatric-related pain and analgesic side effects Preliminary Results: • 310 participants to date • 32% increase in knowledge Unique Approach: • Online, interactive course

13. Program Benefits • Professional • Professional development • Learner • Increased knowledge • Increased confidence • Received tangible reference materials • Enhanced academic experience • Enhanced professional self-reflection • Institution • Enhanced visibility/ credibility • Provided foundation for future trainings • Community • Enhanced relationship with institution • Addressed needs • Benefits of better prepared/ increased workforce

14. Pilot Site Findings UTILITY Pilot sites found the cancer core competencies to be highly useful FLEXIBILITY Implementation of the competencies was feasible across cancer core continuum, professional settings, and disciplines

15. Program Resources:C-Change Toolkit Order free copies or download: www.cancercorecompetency.org Examples Overview & “How to” Guidance Pilot Site Report Universtiy of Pittsburgh Medical Center Summary Publications Pilot Site Report Marshall University School of Medicine Pilot Site Report California University of Pennsylvania School of Social Work Pilot Site Report Audrain Medical Center Addressing the Cancer Workforce Crisis Using a Competency-Based Approach with Non-Oncology Professionals Pilot Project Evaluation Report July 2008 Templates

16. Program Resources:Purdue Pharma L.P. Resource Guide Information, resources, ideas and tools to help those suffering with pain: Pain scales, diaries, medication record and advocacy resources Tools to facilitate communication with providers Tips for living a healthier life Financial resources Caregiver tips Useful websites Toolkits may be ordered free of charge at www.IntheFaceofPain.comor by contacting Kimberley Tiller at 203-588-8538

17. Building a Competency-Based Pain and Palliative Care Educational Program

18. Why? The Challenge and Rationale for a Competency-Based Approach

19. Scope of the Workforce Supply • Demand for oncologists is expected to exceed supply by 25%-30% by 2020 (ASCO, 2007). • The social work labor force is older than most professions, with nearly 30% of licensed social workers over age 55 (NASW, 2006). • By 2020 the projected gap between supply and demand for RNs will be 340,000 (three times larger than ever experienced in the U.S.). • By 2020, more RNs will be in their 60s than in their 20s (Auerbach & Buerhaus & Staiger, 2007). • The average age of a public health worker is 47; many public health agencies currently face a 20% vacancy rate (APHA, 2008) • Cancer registrar vacancies remain difficult to fill in some regions of the country and demand for registrars is estimated to grow 10% in the next 15 years (NCRA, 2006) • The proportion of minorities in the population outstrips their representation among health professionals by several fold (IOM, 2004).

20. Scope of the Public Demand • Cancer is the second most common cause of death by disease claiming the lives of more than half a million people per year (ACS, 2007) • Cancer rates are expected to increase as baby boomers age (CDC, 2000) • The lifetime probability of developing cancer is 1 in every 2 men and 1 in every 3 women (NCI, 2005) • Five-year cancer survival rates have risen to 64% for adults (CDC, 2005)

21. Who? Defining learners / audience

22. Who? Physician Nurse Social Worker Pharmacist Public Health Worker Nursing Assistant Lay Health Worker Multi-disciplinary team Implications for Program Design Levels of education / training Areas of expertise Scope of practice Roles and responsibilities Interactions Interdependence Discipline, Scope of Practice

23. Exercise 1

24. What? Defining the targeted competency improvement

25. Bloom’s Taxonomy Verb describes level of independence EVALUATION SYNTHESIS ANALYSIS APPLICATION COMPREHENSION KNOWLEDGE

26. Anatomy of a Competency Statement Competency statements define what a professional should know or do: Define palliative and end-of-life care Targeted cancer content Level of complexity and/or independence Within context: Scope of Practice Level of Expertise Role and Responsibilities

27. Work Setting Competency Standards Discipline Breadth & Depth of the Competency Statement Administration Ambulatory Clinics Academics Acute Care Clinics Cancer Centers Home Health Agencies Professional Societies Advocacy Organizations Allied Health Medicine Nursing Pharmacy Public Health Research Social Work StudentsResidents/FellowsField FacultyPracticing Professionals Domain I Continuum of Care Prevention / Early Detection Treatment / Survivorship Palliative Care Domain II Basic Cancer Science Etiology / Epidemiology Clinical Trials Cancer Surveillance Domain III Communication & Collaboration Interdisciplinary Care Psychosocial Communication Cross-Cultural Communication Grieving

28. Palliative and End of Life CareCompetency Statements General • Define palliative and end of life care • Assess that resources for palliative and end of life care and insurance coverage are consistent with current recommendations • Refer patients to community palliative and end of life support resources • Explain the role of hospice care • Manage symptoms of the cancer patient • Incorporate end of life comfort strategies for the dying patient

29. Palliative and End of Life CareCompetency Statements Pain management • Explain how cancer pain differs from other types of pain • Describe the methods used to diagnose cancer pain throughout the progression of the disease • Differentiate between acute and chronic pain symptoms • Describe the characteristics used to assess cancer pain: frequency, intensity and site • Perform a cancer pain assessment • Explain the different treatment options for cancer pain • Perform a pain-related history taken during a physical exam • Manage cancer-related pain and analgesic side effects

30. Exercise 2

31. How? Developing the learning activity

32. Adult Learning Principles Adult learning environments are designed to minimize dependence and maximize independence. Adult instructional strategies adapt to the learners’ previous experiences including skills and content. Faculty in adult learning settings function as both instructors and facilitators.

33. Educational Activity Design Verb Competency to Curriculum Instructional Design Learner Assessment Describe Dialogue Short Answer Apply Case Study Role Play Essay Question Synthesize Table Top Standardized Patients Evaluate Peer Review

34. Curriculum Resources See resources list: • Best practice guidelines • Professional education • Clinical practice tools • Patient Education • Advocacy Materials • Grant Funding • e-News • National Conferences

35. Clinical Practice Tools

36. Exercise 3

37. So What? Evaluating Impact

38. Planning, Implementation & Evaluation Tools Logic Model OUTCOMES INPUTS OUTPUTS Program resources Activities Participation Short Medium Long-term Efforts on the part of the program or intervention staff Changes in the learner’s knowledge, skills, and attitudes Changes in practice, care delivery system, patient outcomes The logic model assures that all of the program resources directly support the achievement of the desired competency outcome.

39. Evaluation Measures

40. Exercise 4

41. Now What? Taking the next steps toward program implementation

42. Define Audience & Topic Area Evaluate and Interpret Data Refine Competency Focus Develop Logic Model & Validation Template Plan Implement Evaluate Build a Balanced Leadership Team Sustain Efforts Through Sharing PLAN EVALUATE Complete Needs Assessment & Interpret Findings PLAN IMPLEMENT Implement & Manage with Attention to Details

43. Key Aspects of Planning Leadership and faculty • Coalition members, cancer center experts Needs assessment • SPIPA talking circles Incentives and program promotion • CEs, gas card, food, free registration, job requirement Resources and partnerships • Iowa – long term care facilities, school of nursing • Florida – AHEC, cancer centers, university

44. Exercise 5

45. OUTCOMES INPUTS OUTPUTS Program resources Activities Participation Short Medium Long-term Map for Next Steps Validation Template Curriculum Validation Template Logic Model

46. Tools for Success Summary Effective method to address the cancer workforce shortage and achieving improved pain and palliative care competency Applicable in a variety of professional disciplines and settings Provides numerous resources for competency-based program development www.cancercorecompetency.org kcox@c-changetogether.org