Addressing survivorship challenges using a collective impact approach

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Background: The American Cancer Society (ACS) estimates 352,830 cancer survivors in WA State today. We had a group of avid stakeholders in the WA CARES About Cancer Partnership wanting to address survivorship issues. The challenge was how to work together to focus on improving the quality of life beyond treatment, recognizing that no single organization has the ability to solve the issues alone. Individual organizations were going their own way creating a duplication of effort. What would it look like if we aligned resources? We had influential champions, grant funds, and a true sense of urgency for change. Methods: We turned to FSG and their research on collective impact. Phase 1 of a collective impact approach was completed. We formed a cross-sector group, mapped the cancer survivorship landscape utilizing state cancer registry data, ACS Survivorship Report and local facility input. In Phase 2 a common agenda was agreed upon. Shared measurements of success for Survivorship Care Plans (SCP) were set. Mutually reinforcing activities were developed in an action plan. Methods and frequency of communication were decided. WA Dept. of Health (DOH) was designated as the hub organization. Results: DOH provides adaptive leadership skills and the ability to mobilize people without imposing an agenda or taking credit for success. We hosted a GW Cancer Institute Executive Training on Survivorship, June 2015. We held a 2 day planning retreat to develop a common agenda and action plan, Dec. 2015. Developed and deployed survey for CoC accredited hospitals to create a baseline for SCP utilization and challenges, Feb. 2016. In May 2016 we hosted 1 day retreat for the leadership team to finalize its action plan and added a second priority to launch a pilot in Yakima County to partner with 2-1-1 to provide resources to survivors. We have moved from having uncoordinated plans to embracing a centralized system. Conclusions: We recognize the need to identify and catalog previously unnoticed resources and make them available statewide; perform ongoing evaluations to elicit feedback for decision making; and, the need for further study to determine if tailored SCP and 211 resources improve patient/provider survivorship experience and attain financial sustainability.

Survivorship care plan utilization and challenges

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Background: Based on June and Dec. 2015 Survivorship Retreats hosted by WA Alliance for Cancer Survivorship (WACS), it was clear that staffing models, use of EMRs, cancer registry software programs or commercial products were program dependent with limited flexibility for facilities to adopt a single, state-wide, Survivorship Care Plan (SCP) model. Attendees at the retreats were concerned with financial sustainability of SCPs as the Commission on Cancer (CoC) requirement increased from 10-25-75% of all eligible patients by Dec. 31, 2018. The largest concern was the time spent on the preparation of the SCP. WACS wanted to validate resource needs across settings to identify needs/gaps being experienced. We asked the American Cancer Society (ACS) to conduct a survey of CoC accredited hospitals. Results would be limited to aggregate data and individual confidentiality would be maintained. Methods: ACS field staff made in-person appeals to each accredited program leveraging their existing relationship with CoC Liaisons. A 60% survey completion goal was set. A secure electronic survey was deployed in February. ACS staff promoted the project, followed up on non-responders, aggregated the data and prepared the results report. Results: We achieved a 70% participation rate for accredited programs. 75% of rural facilities, 71% urban but only 50% suburban facilities participated. Results showed they were spending 45 minutes to 2 hours to gather data to prepare the SCP and an equal amount of time being devoted to the patient SCP visit. There is a clear need and desire to have an efficient data gathering process for surveillance recommendations, latent side effect management and ready access for cancer site specific supportive care resources to reduce the time spent in preparation/delivery of the SCP and create a sustainable financial model. Conclusions: The transition from active treatment to survivorship care is a complex process, complicated by residual symptoms, educational needs and health risks. Our baseline information will inform our efforts to streamline the development of SCP as programs work to meet CoC goals. We plan to develop a survey to examine survivors recall and adoption of SCP recommendations to measure how SCPs are improving patient and facility outcomes.

Process evaluation of a regional public health model to reduce chronic disease through policy and systems changes, Washington State, 2010-2014

Introduction

Although the regionalization of public health systems has been well documented in the case of emergency preparedness, there is little literature on the application of regional approaches to other aspects of public health. From 2011 through 2014 the Washington State Department of Health implemented a Community Transformation Grant to support community-level policy and systems changes to decrease chronic disease risk factors and increase access to clinical preventive services. The Department of Health implemented the grant through a regional model, grouping 32 of the state’s 35 local health jurisdictions into 5 regions. Our process evaluation identifies the challenges and facilitators to Community Transformation Grant planning and implementation.

Methods

We conducted 34 key informant interviews with people directly involved in the implementation of the Community Transformation Grant. We interviewed state and local partners, including representatives from each region, the Department of Health, external consultants, and regional partners. We collected data from October 2013 through July 2014.

Results

Challenges for planning, building, and implementing a regional model for chronic disease prevention included stakeholder buy-in, regional geography, and communication; facilitators included shared regional history and infrastructure, strong leadership, collaborative relationships, shared vision and goals, sufficient funding, and direct technical assistance and training.

Conclusion

Lessons learned in Washington State provide a foundation for other states interested in using a regional approach to reduce chronic disease risk. Policy and systems changes require adequate time, funding, and staffing. States and funders should work closely with local leaders to address these challenges and facilitators.