36 Oncology IssuesJanuary/February 201236 Oncology IssuesJanuary/February 2012

Gibbs Cancer Center is a designated NationalCancer Institute (NCI) Community CancerCenters Program (NCCCP) pilot site. AfterARRA(AmericanRecoveryandReinvestmentAct) funding was awarded to the NCCCP,

GibbsCancerCenterwasoneofeightsitesidentifiedtospe-cifically develop a community survivorship program. Thenewprogramincludedastand-alonesurvivorshipclinicandanarrayofsupportandeducationalprograms.Theoverallgoalofthecomprehensivecommunitysurvivorshipprogramwastomeettheneedsofcancerpatientsassurvivorsintheirowncommunity.

During implementation of the survivorship program,Gibbs Cancer Center faced numerous barriers, includinggainingacceptanceandbuy-infromitsmedicaloncologists.Tomeet these challenges,GibbsCancerCenterdevelopedmarketingandeducationalstrategiesandrecommendationsbasedonclinicaldata,casestudies,andresearch,aswellastheprofessionalopinionsofthesurvivorshipprogramcoor-dinator,nursenavigator,andkeystakeholders.

Program Objectives & Outcomes Developinganewprogramatacommunitycancercenterrequires considerable time, effort, and resources. It alsorequires a group effort; all parties involved are vital totheprogram’soverallsuccess.Whilelogisticsvarywidelydependingontheprogram’sscope, the targetpopulation,andthenumberof individualsororganizations involved,programimplementationshouldbewellplanned,withrolesandresponsibilitiesdelineatedcarefully.1

Beforeimplementingitssurvivorshipprogram,GibbsCancerCenterfocusedonthreemainmarketingandedu-cationalobjectives:

First, increase physician awareness of the need for additional survivorship care beyond that which patients were traditionally receiving. With increased physicianawareness, Gibbs Cancer Center hoped to gain buy-infrom oncologists who would then refer patients to thesurvivorshipclinic,aswellasothereducationalservices.

Second, enhance hospital staff awareness of the new survivorship clinic and educational offerings.Theeduca-tionofstaffwouldaidindisseminatinginformationaboutthese new survivorship resources to patients. Specificinterventionstoincreasestaffawarenessincludedupdat-ingthehospital’sInternetandintranetsurvivorshipwebpagesandschedulingtalksatstaffandcommitteemeet-ings. Through successful education, we hoped to see ameasurable increase in class enrollment and referrals tothenewsurvivorshipclinic.

Third, educate patients and the community about the survivorship clinic and its educational offerings.Thesuc-cessful education of patients and family members could

by Regina Franco, MSN, NP-C; Marietta P. Stanton, PhD, RN, CCM, NEA-BC, CMAC, CNL; and Stacey S. Kindall, MPH

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The effects of marketing and education on

program implementation

Cancer Survivorship Programs

In BriefInthepastdecade,cancerpatientswhohavecompletedtheirintensivetreatmentshaveexpressedaneedforclearlyoutlinedcareplansthathelpthemtransitiontomaintenanceorfollow-upcare.Today,manycommunitycancercentersareimplementingsurvivorshipprogramstomeetthesepatientneeds.Marketingandeducationhelptocreateinternalbuy-infortheseprograms—ultimatelycontributingtotheoverallsuccessofthenewprogram.Thisarticleexamineshowmarketingeffortsandeducationofkeystakeholdersimprovedphysician,staff,andpatientawarenessandencouragedbuy-inforthesurvivorshipprogramatGibbsCancerCenterinSpartanburg,S.C.

Oncology IssuesJanuary/February 2012 37Oncology IssuesJanuary/February 2012 37

alsobemanifestedbyincreasedawarenessforpatientsandthecommunity.Specificactivitiessupportingtheseobjec-tivesincluded:■■ Updating the hospital’s Internet and intranet sur-

vivorship web pages that describe the survivorshipclinicanditseducationalofferings

■■ Placing a calendar on the survivorship web page thathighlights the survivorship activities, including a livecontactnumberandemailforquestionsaboutthesur-vivorshipclinic

■■ Speakingatsupportgroupsandothercommunityactivi-ties.

Toseehowwedidmeetingtheseobjectives,goto“SuccessStories&LessonsLearned”onpage40.

Marketing StrategiesSurvivorship programs are a new innovation nationally.Anynewprogramrequires significantmarketing to thepublic and healthcare community to foster acceptance.Hospital subject matter experts often assume new andexistingstaffwillabsorbcertaininformation.Inourcase,wefeltthatafailuretoproperlyeducatestaffonthebasictenantsof the program and underlyingcomponentsofthesurvivorshipmovement would negativelyimpact implementation. Inten-siveeducationandcommunica-tion to staff is vital to improveunderstanding and buy-in. Inorder for our marketing staffto effectively promote our sur-vivorship program, we foundthat spending time with oursurvivorship team was impera-tive. An obvious first step wastoensurethateveryoneinvolvedintheprojecthadaclearunder-standing of what “marketing”involves.In“ANewMarketingPlaybook,”authorNancyPatonsuggeststwoactions:21. Change your marketing strat-egy to win over today’s patients from a value proposition stand-point.2. Move to a marketing message that’s about patients, the stabil-ity of your healthcare organiza-tion, and the reasons your pro-gram pursues quality.

Successfulmarketing involves anequal exchange inwhichbothpartiesexperienceabenefit.This,inturn,shouldleadtothedevelopmentofarelationship.3Effectivemarketingof a survivorship program can lead to both—benefits toproviders and patients and a relationship between cancersurvivors and the survivorship program. Before a lastingpatientandhospitalrelationshipcanbedeveloped,how-ever,theremustfirstbeahospitalandstaffrelationship.Sobeginbymarketingyoursurvivorshipprogramwithinyourorganization.

Whenstaffhasaclearunderstandingofthesurvivor-shipprogramanditsgoals,theycanthenactivelypromotetheprogram.ForGibbsCancerCenter,thismeantbrand-ing our program—first internally and then externally.Alcorn and colleagues suggest that: “An internal brandisthegluethatbindsthecultureandorganizationsothecompanycanmakegoodonitsexternalpromise.”4Ifhos-pitalstaffisalignedwiththebrandstrategy,theywillbeabletocommunicateaconsistentexpressionofthebrandtopatients.5

Withthisinmind,GibbsCancerCenterintroducedanewbrandplatformto“personalize”thecancercenter.

38 Oncology IssuesJanuary/February 201238 Oncology IssuesJanuary/February 2012

Weplacedasimplethreewordstatement—personal. experience. shared—onallofourbrandingfortheGibbsCancerCenter(seelogo on page 36). Our branding strategywas designed to highlight the three mainvalue components of our cancer center’sphilosophy.

Education is KeyHospitals often assume that certain infor-mationiscommonplacetonewstaff.Inourcase, we found that a marketing staff inex-perienced in oncology (and without a solidunderstanding of which internal brandingthemesneededpromotion)combinedwithafailure toproperlyeducate staffon internalbrandingcouldnegativelyimpacttheimple-mentationofoursurvivorshipprogram.Twotakeaways:1)forourmarketingdepartmenttoeffectivelypromoteandbrandoursurvi-

vorshipprogram,spendingtimewithoursurvi-vorshipteamwasimperative;and2)educatingourstaffaboutthenewcancersurvivorshipprogramwasessentialsothattheywouldbeable,inturn,toeducateanddeliverthismessagetoourcancersurvivors.

In2008ChangandChangwrote:“Themostimportant resources for an organization are nolongerrawmaterials,productiontechnique,ortheproduct itself,butratherwell-educated, service-orientedemployees.”6Withoutpropereducation,ourstaffwouldfailtomakereferralstothesurvi-vorshipprogram.Worse,ourpatientsandfami-lies would be unaware of the new survivorshipprogram.Educationforstaffonthenewprogramwouldequipthemtodiscusstheseserviceswithourpatients.Further,weunderstoodthateduca-tionoftenresultsinincreasedconfidence.Inotherwords,whenstaffmembersareconfidentabouttheirknowledge,theyaremorewillingtobecome

When staff

has a clear

understanding

of the

survivorship

program and

its goals,

they can

then actively

promote the

program.

Oncology IssuesJanuary/February 2012 39Oncology IssuesJanuary/February 2012 39

engaged in program efforts. At Gibbs Cancer Center, wefoundthatphysiciansandclinicalstaffwhowereeducatedandknowledgeableonoursurvivorshipprogramincreasedreferralstoournewsurvivorshipprogram.

Patienteducationisjustasimportant.Asthepivotal2005IOMreport,From Cancer Patient to Cancer Survivor: Lost in Transition, states: “Healthcare providers, patient advo-cates,andotherstakeholdersshouldworktoraiseawarenessoftheneedsofcancersurvivors,establishcancersurvivor-shipasadistinctphaseofcancercare,andacttoensurethedelivery of appropriate survivorship care.”7 Educating thecommunityaboutoursurvivorshipprogramwouldincreaseawarenessoftheseservices.Whilesurvivorshipprogramsareadirectresultoftheneedsofcancersurvivors,wefoundthatoftencancer survivors areunawareof availablepost-treat-mentresources.Educatingourcancerpatientscanhelpthemunderstandtheseservicesandseekoutsurvivorshipcareintheircommunities.

Physician Buy-In Marketingandeducationcollectivelycreatebuy-in.Withbuy-in comes support from individuals, groups, depart-ments,andhospitaladministration,whichisimperativeforasurvivorshipprogram.Physiciansupportiskeybecause:8■■ Physiciansenrollpatientsinprograms.■■ Mostdiseasemanagementinitiativesrequirephysician

approvalbeforepatientscanenrollinaprogram.■■ Patients frequently ask their physician whether they

shouldenrollinaprogramofferedbytheirhealthcareplan.

Programs that fail to gain widespread physician supporthavegreatdifficultyenrollingpatientsandusuallyexperi-enceenrollmentratesoflessthan50percent.8Conversely,programswithstrongphysicianbuy-incanachieveenroll-mentratesashighas80to90percent.8Physicianswhosup-

port survivorship care as a distinct entity can help otherphysiciansunderstandhowsurvivorshipcareintheirhos-pital can improve quality initiatives internally, as well asmeetexternalbenchmarks.

The Survivorship Clinic Visit and BeyondThemostopportunetimeforareferraltothesurvivorshipcliniciswhencancerpatientscompletetheirradiation,endo-crine,orchemotherapytreatment.Atourone-on-onesurvi-vorshipclinicvisit,survivorsmeetwithanursenavigatorandnursepractitioneranddevelopapersonalizedroadmapforthenextphaseofcare.Survivorsreceiveapersonalizedsurvi-vorshipcareplan—bothapaperhardcopyandanelectronicversiononasecurity-encryptedflashdrive.Thiscareplaniscomposedofastagingsummary,atreatmentsummary,andapathologyreport.Weforwardacopyofthecareplantothepatient’soncologistandprimarycarephysician.Wealso:■■ Provide follow-up care recommendations for cancer

surveillance,aswellasvisitswithprimarycarephysi-ciansandspecialists.

■■ Makeanynecessaryreferrals.■■ Assessthepatient’sphysical,social,psychosocial,and

spiritualneeds.■■ Provide an overview of how survivorship directly

relatestoeachpatient.■■ Promote overall wellness education, including infor-

mationondietandexercise.Referralstowellnesspro-gramsaremadeasneeded.

■■ Handouta“LifeafterTreatment”folderandamanualoflocalandnationalsurvivorshipresources.

Survivorsareencouragedtoattendtheeducationaloffer-ings held at our cancer center and, when appropriate, tobringtheircaregiversaswell.Theseclassesallowsurvivors

Additional Online Content

InJune2011GibbsCancerCenterreleasedthesecondeditionofitsbook,

Pathways to Wellness: A Survivor’s Guide to Local Resources.Writtenbythe

survivorshipprogramcoordinatorReginaFranco,MSN,NP-C,withhelpand

inputfromMariettaP.Stanton,PhD,ReggieScoggins,RN,PerryPatterson,and

volunteercancersurvivorsKayMcClure,HollieWalker,andLaurensFlanagan.

This54-pagebookisdistributedtoallcancerpatientswhovisitthesurvivorship

clinic.Contentsincludeinformationaboutnutrition,exercise,survivorship

careplans,asurvivorshipreadinglist,andmore.Itisavailableonlineat:

www.accc-cancer.org/oi/JF2012.Publicationoftheguidewasmadepossible

byagrantfromtheSouthCarolinaCancerAlliance.

(continued on page 41)

■■ To enhance physician awareness and encourage physician buy-in of the survivorship program,wecirculatedpeer-reviewedpubli-cationshighlightingsurvivors’needsandexamplesofdocu-mentsgeneratedinourSurvivor-shipClinictophysiciansandstaff.DuringthecourseoftheNCCCPpilotproject,wereal-izedthatnursesandnurseprac-titionersplayasignificantroleinremindingphysiciansofnewinitiatives.Thesuccessofoursurvivorshipprogramdependedgreatlyuponthereferralsfromtheseclinicians,sowesimplifiedthereferralprocessbycreatingprescriptionpadsdesignedtoencourageparticipationinsur-vivorshipinitiatives.Oursurvi-vorshipcliniccoordinatoralsoengagedoncologistsatweeklyandmonthlyclinicalmeetings.Soonourphysiciansbecamestakeholdersandencouragedeacheligiblepatienttotakepartinthesurvivorshipprogram,clinic,andeducationalofferings.Moreover,weintroducedanautomaticentrypromptinourelectroniccheck-out.

■■ To enhance internal awareness of the survivorship program and improve interdepartmen-tal relationships,wedeliveredpresentationstovarioushospitaldepartments.Weinvitedmar-ketingstafftoparticipateinourcancersurvivorshipcommitteemeetingsandprovideuswithinput.Inthefuture,weplanoneducatingnewstafforstaffwithlimitedoncologyexperiencepriortoprogramimplementa-tionsothatthey“buyinto”theinitiativefromthebeginning.Wealsoplanondeliveringsurvivor-

shippresentationstovarioushospitalcommitteescomposedofhospitalemployeesfromdifferentdepartments.

■■ To share information about the survivorship program with our local community,wehaveplacedsignagethroughoutthehospitalandsurvivorshippublicationsinthemonthlyactivitiescalendarmailing.Weplanondistribut-ingflyersandannouncementstolocalchurcheswithhealthmin-istries.Wealsoplantomeetwithestablishedsupportgroupsandcommitteestocreateawarenesswithinthosegroups.

■■ To provide education and create awareness to patients,wecre-atedinformationaltentcardstoplaceatcheck-inandcheck-outstations.Thesetentcardsletpatientsknowwhatresourcesareavailableandhowwecanservethem.Whilethesurvivorshipclinicvisitrequiresaphysicianreferral,educationalclassesareopentoallcancersurvivors.

■■ To improve the web presence of the survivorship program,wemadechangestothehospital’sintranetandInternetwebsites.Withthesechangeswebrandedourinitiativesclearlyandkeepthemintheforefrontofthemindsofbothpatientsandemployees.Thisisoneareathatwasparticularlychallenging,somarketingorITstaffskilledatwebdevelopmentiskey.Wefoundthatupdatingthesewebpageswasverytimeconsumingandinvolvedseveralstepsforeachupdateorchange.Often,therequestcouldnotbedone

becauseofdesignlimitationsofthewebpages.Therearemanynuancestowebupdating,suchasdifferentfilerequirementstouploadadocumenttobeviewedonlyascomparedtoadocumentthatwillbeviewedandalsoprinted.Inaddition,wewerechallengedbylimitedresources.Consideringthesizeofourhos-pital,ourmarketingdepartmentisquitesmall.Further,thereareseveralmajorprogramsdevel-opingwithinourcancercentersimultaneously.Consequently,marketingstaffcouldspendonlyasmallamountoftimeoneachnewinitiativeorprogram.

■■ To measure the success of our survivorship program,oursurvivorshipcliniccoordina-torcollectedquarterlydatasummarizingreferralpatterns.Datacollectedrelatedtowhichoncologistshadhigherreferralsandwhattypesofreferralsweregeneratedasaresultofthesur-vivorshipvisit.Usingthisinfor-mation,wedevelopedabusinessplanthatincludeddownstreamrevenueandqualitativebenefitstosurvivorshipcare.Webench-markedourdataagainstotherNCCCPsurvivorshipprojectsandparticipatedinmonthlycon-ferencecallswithotherNCCCPsites.QualityOncologyPerfor-manceObjectivechartauditinginthefallandspringfollowingimplementationrevealeda90percentadherencetothesixsur-vivorshipchartauditingques-tion,anincreasefromthetwopreviousauditingperiods.Wesharedouroutcomesdatawithadministrationandphysicians,resultinginanincreaseinrefer-ralstooursurvivorshipclinic.

Success Stories & Lessons Learned

40 Oncology IssuesJanuary/February 2012

Oncology IssuesJanuary/February 2012 41Oncology IssuesJanuary/February 2012 41

andfamiliestoconnect,encourage,andbuildbondswithoneanother,aswellastoaskoncologyprofessionalsanyquestionsthatmayhavearisen.There isnochargeforanyoftheeducationalclassesforsurvivors.

Aswecontinue todevelopandmarketour survi-vorshipprogramandeducateproviders,patients,andthecommunityabouttheprogram,wesharethefollowingrecommendations:■■ Seekmarketingstaffexperiencedinoncology.Learn-

ingaboutcancertomarkettheoncologyservicelineisdifficult;learningnewinitiatives,suchassurvivorship,inadditiontooncology“basics”isevenmoredifficultfornon-medicalpersonnel.

■■ Meetface-to-facewithphysicianstodiscussoutcomedata and the benefits of the survivorship clinic visit.Thesepersonalmeetingswerethemosteffectivetoolsforgainingphysicianbuy-inandreferrals.

■■ Personallyinvitepatientsandfamiliestoparticipateinthevarioussurvivorshipeducationalclasses.Wefoundittobethemosteffectivemethodforincreasingpro-gramparticipation.

■■ Brandyoursurvivorshipprogram—internally(tostaff)andexternally(topatientsandthegeneralpublic).

■■ Personalize informationabout theneedforsurvivor-shipcareinyourcommunity.

■■ Ensurethatyourwebsiteaccuratelydepictsthearrayof your survivorship services. Most important, theinformation must be highly visible, easy to use, and

easytoupdate.

Today, survivorship care clin-ics andeducationalprogramsarerecognized as a valuable compo-nent of the cancer care contin-uum.Whencancerpatientsmovebeyondtheactivetreatmentphaseof care, they often experience ahostoflatentsideeffects,feelingsofuncertaintyandloneliness,anda fear of recurrence. Successfulsurvivorship programs addressthese specific issues and equippatients with the knowledge andtoolstolivelifeaftercancer.

Regina Franco, MSN, NP-C, is survivorship program coordina-tor at Gibbs Cancer Center, Spartanburg, S.C. Marietta P. Stanton, PhD, RN, CCM, NEA-BC, CMAC, CNL, is professor and assistant dean of the Graduate Program Capstone College of Nursing at the University of Alabama, Tuscaloosa, Ala. Stacey S. Kindall, MPH, is a cancer research study coordinator.

References1Butler JT. Principles of Health Education and Promotion, 3rd ed.Wadsworth/ThomsonLearning:Belmont,Calif;2001.2Paton N. A new marketing playbook. Marketing Health Services.2010;30(2):8-9.RetrievedfromBusinessSourcePremierdatabase.3MacStravic S. Internal champions. Marketing Health Services.2004;24(4):26-30.RetrievedfromBusinessSourcePremierdatabase.4AlcornS,CampanelloM&Grossman,D.(2008,Fall2008).TheInsideStory. Marketing Health Services, pp. 10-16. Retrieved from BusinessSourcePremierdatabase.5MurphyR.Builtbrandtough.Marketing Health Services.2007;27(2):29-31.RetrievedfromBusinessSourcePremierdatabase.6ChangC,ChangH.Perceptionsofinternalmarketingandorganizationalcommitmentbynurses.J of Adv Nurs.2009;65(1):92-100.RetrievedfromCINAHLPluswithFullTextdatabase.7Hewitt M, Greenfield S, Stovall E. From Cancer Patient to Cancer Survivor: Lost in Transition. Institute of Medicine and NationalResearch Council of Academies. Washington, DC: The NationalAcademiesPress;2005.8LeiderH.Gainingphysicianbuy-infordiseasemanagementinitiatives.Disease Management & Health Outcomes.1999:6(6):327-333.RetrievedfromCINAHLPluswithFullTextdatabase.

Before a

lasting

patient and

hospital

relationship

can be

developed,

however,

there must

first be a

hospital

and staff

relationship.