canwell program cpac presentation 2010

Copyright CanWell Program 2010

CPAC Cancer Workforce SymposiumJan. 25th 2010, MontrealBreakout Session 1C Community

CanWell Program:An Innovative Community Cancer Care

Service Delivery Model

Presented byFidelma Serediuk & Jan Park Dorsay


CanWell Project Team

Fidelma Serediuk, PT, B.Sc.( PT) Oren Cheifetz, PT, M. Sc., Jan Park Dorsay, RN(EC), MN, NP-‐Adult,CON (C)

Genevieve Hladysh, B. Sc. Kin. Linda Woodhouse, PT, Ph. D.


What was the CanWell Project? a demonstration project to create and deliver a community-

based exercise and education program for people with cancer,

made possible through one time funding from Optimizing HealthCompetencies Fund (Health Force Ontario-MoHLTC)

Participant Criteria: over 18 yrs. with any cancer diagnosis or treatment stage,

independent mobility with no gait aides, medically stable. Study Size: 32 enrolled, 18 completed 12 week evaluations


CanWell Program Goals

To promote optimal wellness for survivors of cancer To promote inter-agency and inter-professional

collaborative care, knowledge and competencies inthe area of exercise for people with cancer

To develop and establish competencies andexpertise related to exercise for cancer survivors bytesting a model which may be implemented in othercommunities


Why CanWell ? The evidence supports; Primary Prevention

Exercise may decrease the risk of developing cancer.

Secondary Prevention

Decreased risk of recurrence in long term follow-up.

Improved QOL and decreased symptoms

Helps manage treatment side effects and toxicities,maintain physical functioning, prevent muscle loss andfat gain, and improve mood and QOL, and

Facilitates completion of difficult treatments


CanWell – response to a need

Cancer and Exercise Survey (N=648) > patients’knowledge and preferences (Cheifetz & Park Dorsay, 2007)

adapt knowledge to the local communitycontext >survey conducted at Juravinski Cancer Centre,

Hamilton, ON. 47% of men and 59% of women indicated

interest in an exercise program 21% of breast cancer survivors and 18% of

prostate cancer survivors actively participate inan exercise program


CanWell -‐ response to a need

52% of respondents preferred a supervised exerciseprogram

43% plus 25% preferred an exercise program in thehome or community

The majority of respondents reported exercising withstaff knowledgeable about the specific needs ofcancer survivors was important; this contributed totheir feelings of safety and confidence


The CanWell Pilot Project: Results

Average age 52.6 years (32-73) 72% female, majority breast cancer Statistically significant results: participants walked

faster, further and reported improved quality of life No reported increase in pain or other symptoms Safe: no injuries while exercising More regular exercisers after 12 week program (pre-

CanWell less than 10%, post-CanWell greater than60%)


The CanWell Pilot Project: Results “Exercise gives me back some of my self image. I’m

working through my frustration that cancer treatmentisn’t a do it, get it done, over deal.”

“Before cancer, I was fearless. I back packed through18 countries solo. After cancer, I became a personafraid to walk to the store. I became fearful, andagoraphobic. Eight weeks into the CanWell program, Irealized I was no longer fearful or agoraphobic. I’mfine outside of my home now. This is huge for me.Thank you CanWell.”


Service Delivery Human Resource Model-‐CanWell

YMCA based; Kinisiologist Fitness Trainers

Hospital & YMCA based Health Professional consultationsupport;

Physiotherapist Nurse Practitioner


CanWell Program Model

Intake Screening ProcessCanWell Trained YMCA Kinisiologist HHS

Physiotherapist &Nurse Practitioner

Participant accepted into 12 week Supervised CanWell Exercise & Education ProgramCanWell TrainedYMCA Kinisiologist & Fitness Trainers

Baseline

Consult PRN

Self Referral orHCP Referral

With Physician ClearanceSubmitted to YMCA

6 wk eval.

12 wk eval.

Participant continues independently Accesses CanWell team

as needed

Advise referralsource if notaccepted intoCanWell


The CanWell Program Pilot Project: the process andproducts

Physiotherapist and NP developed YMCA staff trainingmaterials based on best available evidence

Two day staff training sessions provided for YMCA staff Physiotherapist and Kinisiologist provided 1-1 staff training on

assessment and evaluation of participants YMCA staff actively engaged in on-going data collection Physiotherapist and NP available for on-going onsite

consultation support to YMCA staff and participants as needed Participant education sessions developed based on participant

requests, delivered by health professionals in the community


Challenges-‐ Myth Busting- overcoming beliefs that exercise

is not beneficial to people with cancer! Inter-agency and inter-professional

collaboration requires time+++ andcommitment to achieve effectivecommunication

Timeline of project – originally was 12 months-needed a time extension of 3 months toachieve all project deliverables


Strategies for Success Alignment with emerging Community Health Partnership

framework Building community based competencies & capacity through

transfer of knowledge related to cancer and exercise Multiple networking and communication strategies (Rounds, TV

media, CanWell Video, webpage, brochures, posters, word of mouth, newsletters) Building a founding inter-professional team that possessed

diverse skills and strengths Engagement of organizational senior leaders to support the

vision Integrating survey results that identified what people with

cancer needed regarding exercising


Strategies for Success

Identification of a service gap;lack of resources for cancer survivors to exercise safely inthe community,participant preferences known from previous study

Knowledge adapted to local context ;opportunity for partnership with HHS-YMCA-McMaster University

Interventions selected, tailored & implemented;CanWell Demonstration Project Oct. 2008 –Dec.2009


The CanWellProgram:An InnovativeCommunityCancer CareServiceDelivery Model

CanWell Pilot Research

Les Chater YMCA,2009

CanWellProgram:

Increasing capacity in the community thru

knowledge andskills

development

Cancer and exercise

Survey: JCC 2007,(Cheifetz &

Park Dorsay)

Adding to publishedevidence

on the benefits of exercise for cancer

survivors


CanWell Key Learnings; Transfer of cancer and exercise knowledgeand competencies so as to provide a safe andeffective education and exercise program forpeople with cancer in a community setting is

possible For people with cancer - exercise can be both

safe and effective !


www.canwellprogram.ca

canwell program cpac presentation 2010

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