1

Supported self management for people living with cancer

Stephen Hindle

Cancer Survivorship Programme Lead

16th April 2010

2

Self management support:

“self management support is what health services do in order to aid and encourage people living with a long term condition to make daily decisions that improve health related behaviours and clinical, and other outcomes”

It can viewed in two ways: as a portfolio of techniques and tools: and as a fundamental transformation of the patient-caregiver relationship into a collaborative partnership”

(Co creating Health Programme 2008)

Shift 3

3Long term conditions and supported self management

• Evidence that self management can improve health status in chronic conditions:

can empower the person to act for themselves, increase confidence in their ability to manage

consequences of both condition and its treatment, and

enhance health quality of life.

• Aspects of cancer survivorship are emerging as having a ‘chronic component’.

Cancer survivors have similar health and well being profile to people with other long term conditions.

(Macmillan Health & Wellbeing Survey 2007):

• Four times more likely to have health problem• Higher percentages have ongoing physical problems• 30% of cancer survivors agreed their health prevented

them from working in their preferred occupation• Higher percentage had used various health services,

including GP, specialist doctor, A&E and surgery.

4

Need improved awareness of late effects and the importance of healthy lifestyle and support for lifestyle decisions

(Macmillan HWB Follow-Up Survey 2008)

• 40% unaware of late effects of cancer and treatment• 35% unaware of increased importance of healthy

lifestyle• 40% with a psychological condition did not seek help; • 19% with a physical condition did not seek help.

5

Evidence – Who Benefits? 6

Personalised assessment and

management plan.

Personalised assessment and

management plan.

A partnership relationship with their health professionals which enables self-

management.

A partnership relationship with their health professionals which enables self-

management.

Risk stratification – tailoring of support to

need.

Risk stratification – tailoring of support to

need.

Tailored information

that enhances

knowledge.

Tailored information

that enhances

knowledge.

Who to target for higher levels of support?

• Less prepared for survivorship or self management support

• Survivors experiencing depressive symptoms/ greater psychological difficulties

• Greater risk of sexual dysfunction related to treatment

• Ethnic minorities

• Low literacy groups

• Single, socially isolated, lacking social support

• Older people and others with co morbidities or mobility issues

• Individuals requiring behaviour change or lifestyle changes

7

Evidence of benefits EvidenceClinician training for supporting self-management during the consultation.

Coulter & Ellins, 2007; Powell et al., 2009; Epstein & Street, 2006.

‘Intensive’ adjustment-focused self-management programmes targeted at ‘high risk’ survivors.

Cockle-Hearn and Faithful, 2010.

Design of programmes should have a theoretical basis to the design:

-information provision -problem solving-modelling -personal goal setting-practice -social comparison -goal review- CBT techniques - consider length

Abraham and Gardner, 2009;Coulter & Ellins, 2007.

Lifestyle behaviour change requires ongoing support / coaching.

Coulter & Ellins, 2007; DoH 2008

Self-help resources eg videos/DVDs effective/cost-effective if incorporate self-efficacy (peer modelling).

Mandelblatt et al., 2008.

Self-management interventions can have cost advantages over conventional care.

Mandelblatt et al., 2008.

Supported self management ‘whole system change’

Supported Self Management framework

Birmingham East and North PCT – New pathway for breast cancer

11

12

Macmillan is funding 15 pilot HWB Clinics across the UK

HWB Clinics happen at the end of treatment, where patients hear from professionals about managing their cancer, signs and symptoms, and how to get help.

They will get help with lifestyle management, and information about self management and support groups.

Volunteers will be key to the clinics, meeting & greeting, organising and offering peer support.

Health and Well Being Clinics

13

Implementing self management shift depends on three enablers:

Self management education and training programmes

Skills development for professionals

Institutional support for service redesign