Download Supported Self Management - Steve Hindle April 2010

Supported self management for
people living with cancer
Stephen Hindle
Cancer Survivorship Programme Lead
16th April 2010
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Self management support:
Shift 3
“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 patientcaregiver relationship into a collaborative partnership”
(Co creating Health Programme 2008)
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Long 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’.
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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.
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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.
Evidence – Who Benefits?
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Personalised
assessment and
management plan.
Tailored
information
that
enhances
knowledge.
Risk
stratification
– tailoring of
support to
need.
A partnership
relationship with their
health professionals
which enables selfmanagement.
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
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Evidence of benefits
Evidence
Clinician 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/costeffective 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
Health
professional
sharing power
and responsibility
Activated,
engaged and
informed patient.
Supported
Self
Management
Service redesign:
Tailored support
and aftercare
pathways
Self management
programme
Assessment and
care plan
Training in self
management
support for
professionals
Information
prescription
Birmingham East and North PCT – New
pathway for breast cancer
Advanced
Development
programme for
professionals
Service redesign – breast
cancer follow-up and
support pathway:
(1)telephone based care
managers; (2)assertive
case management;
(3)practical support service
Self management education
programme - HOPE
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Health and Well Being Clinics
 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.
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Implementing self management shift depends on
three enablers:
 Self management education
and training programmes
 Skills development for
professionals
 Institutional support for
service redesign
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