Translation and Dissemination of the
Evidence-based Chronic Disease SelfManagement for Cancer Survivors
Colorado CPCRN (with Texas A&M)
Steering Committee Call, 2/15/2012
Background: Chronic Disease SelfManagement Program (CDSMP)

Self-management is a component of the Chronic Care Model.
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One of the few evidence-based strategies to meet this need is
the Stanford CDSMP (Lorig K, Bandura A, Sobel D, Byron B et al.)
What is the CDSMP?

Six week, community-led social cognitive behavioral
intervention which uses group problem-solving and education.

High fidelity delivery through peer Master Trainers (Stanford).

RCT (1996) found improvement in outcomes relevant to
survivorship: physical activity, communication with physicians,
self-reported general health, fatigue, self-efficacy, decreased
system use.

These data yielded a cost to savings ratio of approximately
1:4.; many of these results persisted for as long as three years.
The Need: Self-Management & Survivorship

Chronic Care Model applied to survivorship in the
landmark IOM report “Lost in Transition”, 2005.

Recently published evaluation of the LAF Centers of
Excellence in Survivorship found…:”self-management
support was largely limited to health promotion in clinics,
with few COEs providing patients with self-management
tools and interventions.”
Campbell MK, J Cancer Surv 2011; 5(3): 271-82 (our wise friend Marci)
CDSMP, Survivorship, & Colorado CPCRN:
In the right place, at the right time…
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
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A curriculum for cancer
survivors was initially
developed in the U.K. and
piloted in Virginia in 2010.
Marcia Ory is an investigator
in the ongoing nationwide
evaluation of the CDSMP.
Community partner with
over 300 trainers in
Colorado (Consortium for
Older Adult Wellness).
Cancer Thriving and Surviving:
Adaptations to the Chronic Disease Self-Management Program
(---Cancer Specific changes; Boxes = New Modules)
Chronic Disease Self-Management Program
(CDSMP)
SESSION 1:
•
•
•
Overview of Self-Management and Chronic
Health Conditions
*Using your Mind to Manage Symptoms and
Distraction
Making an Action Plan
Cancer Thriving and Surviving
(CTS) Program Changes
*Revised: CANCER
SPECIFIC
Fatigue Management:
Prioritizing Activities &
Asking for Help
SESSION 2:
•
•
•
Feedback/Problem Solving
Dealing with Difficult Emotions
Physical Activity and Exercise
Getting a Good Night’s Sleep
SESSION 3:
•
•
•
•
Better Breathing
Muscle Relaxation
*Pain and Fatigue Management
Endurance Activities: How Much is Enough?
Living with Uncertainty
Making Decisions
Cancer Thriving and Surviving:
Adaptations to the Chronic Disease Self-Management Program
(---Cancer Specific changes; Boxes = New Modules)
Chronic Disease Self-Management Program
(CDSMP)
SESSION 4:
•
•
•
•
Future Plans for Health Care
*Healthy Eating
Communication Skills
Problem-Solving
SESSION 5:
•
•
•
•
•
Medication Usage
*Making Informed Treatment Decisions
Depression Management
Positive Thinking
Guided Imagery
SESSION 6:
•
•
Working with your Health Care Professional and
the Health Care System
Looking Back and Planning for the Future
Cancer
Surviving
CancerThriving
Thriving and
and Surviving
(CTS)
Changes
(CTS)Program
Program Changes
*Revised: CANCER
SPECIFIC
Cancer and Changes
to Your Body
Making Decisions
New Activity: Decision
Making Exercise
Cancer and Relationships
Progress to Date:
Training:
 14 facilitators from Colorado and 4 from Texas were trained in the first
ever CTS Leader Training, led by Drs. Lorig and Seidel in January, 2011.
 Facilitator de-briefing 3 months post-implementation indicated CTS
delivery was feasible and acceptable. COAW trainers are exceptional.
Implementation:
 128 enrolled to date (goal = 300).
 Participants reported over 10 different cancer types.
 10 classes completed since August, 2011 in Colorado.
Evaluation:
 Wait-list control RCT design powered for medium effect size.
 Using Stanford tools for comparison (baseline, post-program and 6 month
follow-up measures).
Lessons Learned:



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RCT design feasible (no dropouts at enrollment)
Most recruiting providers required approval of their own
IRB (allow extra time)
Also allow extra time to meet with management one-onone to answer site-specific questions
Media outreach (TV interviews, periodicals) was a main
source of recruitment during start-up
Working with community partner in delivery presents
initial challenges but works well once procedures set
From participant…“I received much needed insight on
how to cope with being a cancer survivor. It was a
growing experience.”
Next Steps:

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Abstract submitted for presentation to CDC Cancer
Conference in August, 2012.
Manuscript to describe adaptations to EBI, first facilitator
training, potential for dissemination, and evaluation plan in
development (Risendal, Ory, Dwyer, Lorig and U.K.
program developers).
Future grant submissions: possibly a D&I R01, or CMS
application - with other CPCRN partners?
Thank you!