concept analysis presentation

Cancer Survivorship CareNU 700

November 4, 2011Abigail L. DeLisa, APRN FNP-BC CWS FACCWS

Concept Analysis Presentation

What is the Definition of a Cancer Survivor?

Primary Antecedent

An individual who experiences cancer from the time of diagnosis throughout the balance of life.

Included in the definition are family, friends and caregivers.

Ganz (2011), Doyle (2008)

Research Interest: A Growing Population w\Chronic Health Care Needs

Since passage of National Cancer Act (1971), the number of cancer survivors has quadrupled

As of Institute of Medicine (IOM) Report (2006), 10 million people in the United States (US) were cancer survivors

By 2020, current projections estimate 20 million cancer survivors in the US

IOM (2006), Erikson, C., Salsberg, E., Forte, G., Bruinooge, S., & Goldstein, M. (2007)

Research Interest: A Growing Population w\Chronic Health Care Needs

“Being cancer-free does not mean being free of cancer effects.”

Dr. Julia Rowland, Director of the National Cancer Institute (NCI),

Office of Cancer Survivorship (2007)

As cited by Mayer, 2011

Research Interest: Survivorship Care

Listening to cancer survivors revealed: Ambivalence and fear about life after

cancer A lack of an organized way to prepare

patients/families & caregivers for a smooth transition from acute cancer care to optimal wellness post cancer

Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011

Research Interest: Survivorship Care

Listening to cancer survivors revealed:Need to: Standardize delivery of care and recognize

survivorship as a distinct phase on cancer continuum

Treat the whole patient, which means palliation of treatment consequences, not just end-of-life care

Globally raise awareness that Survivorship has largely been neglected until recently

Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2005, 2006 & 2008, Mayer, 2011

Merriam Webster Definition of Survivorship

1 : the legal right of the survivor of persons having joint interests in property to take the interest of the person who has died

2 : the state of being a survivor : survival

3 : the probability of surviving to a particular age; also: the number or proportion of survivors (as of an age group or population)

First Known Use of SURVIVORSHIP, circa 1625

http://www.merriam-webster.com/dictionary/survivorship

Another Definition of Survivorship

According to the definitions of survival or survivorship in the literature, the predominate association has been with war. Holocaust survivors Survivors of natural disasters 1960’s reference to Survivor after

Myocardial Infarction (MI)

New England Journal of Medicine, 1985, (313, p. 270-273, Jul)

http://journeyingbeyondbreastcancer.com/2010/09/07/defining-cancer-survivorship/

Define Concept:Survivorship Care

Provided to cancer survivors& co-survivors (family, friends, caregivers)

Multifaceted and interdisciplinary care Creates long-lasting needs for Survivors

returning to lives after cancer as different people

Optimal time for delivery is around completion or near completion of acute cancer treatment

Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011

Define Concept:Survivorship Care

4 components of survivorship care1. Prevention/screening2. Detection3. Promotion of healthy behaviors4. Palliation/care coordination

Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011

Define Concept:Survivorship Care

Empirical ReferentsQuality Of Life (QOL) Domains

1. Psychological2. Physical3. Social4. Spiritual

Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011

Overview of the Concept:Survivorship Care

Actions and tools to deliver Survivorship Care as a Standard of Care Detailed review written cancer treatment

summary (outlining details of cancer treatments/related history/complications)

Provision of Survivorship follow-up Care Plan (SCP) based on National Guidelines

Counseling/education re: long term and late effects of treatment

Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011, Ganz & Hahn, 2008, 2011, American College of Surgeons, 2012

Overview of the Concept:Survivorship Care

Actions and tools to deliver Survivorship Care as a Standard of Care Post cancer surveillance for recurrence and

second cancers Offering holistic evidence-based

interventions to modify, stabilize or remove health risks

Doyle, 2008, Peck, 2008, Ganz, 2011, IOM, 2006 & 2008, Mayer, 2011, Ganz & Hahn, 2008, 2011, American College of Surgeons, 2012

Related Concept:Cancer Survivorship

Process beginning at diagnosis Involves uncertainty Life-changing

Positive Negative

Unique to individual with some universality

Doyle, pg 499, 2008

Concept Analysis: ProgressAspects of Positive Progress

American Society of Clinical Oncology (ASCO), 2011, National Meeting Focus of meeting was Survivorship CareAmerican College of Surgeons (2011) Standards of Care Mandate for accredited cancer centers to have Survivorship

Care Program by 2015Connecticut Regional Cancer meeting at Yale, October 18,2011 Focus on Survivorship and Palliative Care, research and

implementation

Concept Analysis: Progress

Aspects of Positive Progress

Understanding the process of living with and beyond cancer is not likely to be linear and creates opportunities with polar resolutions

(Mullan, 1985, Jones, 2011)

Pathways correctly Navigated lead to progress“Caring Begins with Patients”

(Sledge, 2011)

Concept Analysis: Barriers

Aspects of Barriers to Progress

Concept of Survivorship Care relatively new and lacks awareness

Survivorship is part of Cancer Navigation continuum, also new, care not well standardized

Not all patients embrace or welcome the label, “Cancer Survivor.”

Rowland, Hewitt & Ganz, 2006, Taplin, Clauser, Rodgers, Breslau & Rayson, 2010

Concept Analysis: Barriers

Aspects of Barriers to Progress

Palliative care, a component of Survivorship Care, also lacks awareness

Currently a linear focus on tools and models of delivery dominate the conceptual framework

Rowland, Hewitt & Ganz, 2006, Taplin, Clauser, Rodgers, Breslau & Rayson, 2010

A Final Thought Re: Concept of Survivorship Care

Concept clarification provides a heuristic for further inquiry and a basis for theory generation

Doyle, 2008

Questions to the Group

Do you believe the component of care has been well defined in the concept of Survivorship Care?

Do you think defining the contextual attributes of Survivorship Care is important in the process of concept analysis?

References

Adler, N. E., Page, A., & National Institue of Medicine (U.S.). Committee on PsychosocialServices to Cancer Patients / Families in a Community Setting. (2008). Cancer care forthe whole patient : meeting psychosocial health needs. Washington, D.C.: NationalAcademies Press

Doyle N (2008) Cancer Survivorship: Evolutionary Concept Analysis. Journal of AdvancedNursing. 62: 499-509. http://www3.interscience.wiley.com/cgibin/fulltext/119403837/PDFSTART

Erikson, C., Salsberg, E., Forte, G., Bruinooge, S., & Goldstein, M. (2007). Future supply anddemand for oncologists : challenges to assuring access to oncology services. J OncolPract, 3(2), 79-86. doi: 10.1200/JOP.0723601

Ganz, P. A., & Hahn, E. E. (2008). Ensuring quality care for cancer survivors:implementing the survivorship care plan. Semin Oncol Nurs, 24(3), 208-217

http://www.advisory.com/Research/Oncology-Roundtable/Studies/2011/Delivering-Sustainable-Survivorship-Care

References

http://www.cancerkansas.org/download/Cancer_Survivor_Plans.pdf

http://www.cdc.gov/cancer/survivorship/basic_info/

http://www.cdc.gov/cancer/survivorship/what_cdc_is_doing/action_plan.htm

http://chicago2011.asco.org/ASCODailyNews/Summary.aspx

http://www.curetoday.com/index.cfm/fuseaction/blog.showIndex/kathylatour/2011/2/17/When-does-cancer-survivorship-be

http://jco.ascopubs.org/content/24/32/5101

http://jncimono.oxfordjournals.org/content/2010/40/104.full

http://journeyingbeyondbreastcancer.com/2010/09/07/defining-cancer-surv

http://legislative.cancer.gov/history/phsa/1971

References

http://www.merriam-webster.com/dictionary/survivorship

http://www.ncbi.nlm.nih.gov/pubmed/21310037

http://www.ncbi.nlm.nih.gov/pubmed/21731511

http://www.nccn.org/index.asp

http://www.ncsdinfo.com/docs/shiftingperspectives.pdf

http://www.ucdenver.edu/academics/colleges/CLAS/Departments/hbsc/Students/Documents/Jones_CancerSurvivorshipParadigmShift_2010-2011.pdf

J. Rowland, M. Hewitt, P. Ganz, “Cancer Survivorship: A New Challenge in Delivering Quality Cancer Care,” Journal of Clinical Oncology 24 (2006):5101-5104.

Journal of Clinical Oncology, Vol 24, No 32 (November 10), 2006: pp. 5101-5104 Published by the American Society of Clinical Oncology DOI: 10.1200/JCO.2006.09.2700

References

M. Hewitt, P. Ganz, Implementing Cancer Survivorship Care Planning: Workshop Summary, National Academy of Sciences (2007).http://tinyurl.com/269rlc

M. Hewitt, S. Greenfield, E. Stovall, From Cancer Patient to Cancer Survivor: Lost in Transition. National Academy of Sciences (2006).

Mullan, F. (1985). Seasons of survival: reflections of a physician with cancer. New England Journal of Medicine, 313(4), 270-273. doi: 10.1056/NEJM198507253130421

National Cancer Institute: Cancer Survivorship Research Web site. http://dccps.nci.nih.gov/ocs/

National Cancer Institute, Facing Forward: Life After Cancer Treatment (2006). Accessed February 13, 2007 fromhttp://www.cancer.gov/cancertopics/life-after-treatment.pdf

National Cancer Institute, Office of Cancer Survivorshiphttp://cancercontrol.cancer.gov/ocs/definitions.html

References

National Coalition of Cancer Survivorshiphttp://www.canceradvocacy.org/about/org/history.html

Rodgers B.L. (1989) Concepts, analysis and the development of nursing knowledge: the evolutionary cycle. Journal of Advanced Nursing 14, 330–335.

Rodgers B.L. (2000a) Concept analysis: an evolutionary view. In Concept Development in Nursing: Foundations, Techniques and Applications, 2nd edn (RodgersB.L. & KnaflK.A., eds), WB Saunders, Philadelphia, PA, pp. 77–102.

Victorson D, Cella D, Wagner L, Kramer L & Smith ML (2007) Measuring Quality of Life in Cancer Survivors. Chapter 6 in Feuerstein M (2007) (ed.) Handbook of Cancer Survivorship Springer, Bethesda

www.facs.org/cancerprogram/index.html

Zwahlen, D., Hagenbuch, N., Carley, M. I., Jenewein, J., & Buchi, S. (2010). Posttraumatic growth in cancer patients and partners;effects of role, gender and the dyad on couples' posttraumatic growth experience. Psycho-Oncology, 19(1), 12-20. doi: 10.1002/pon.1486