Outcomes of Targeted, Tailored Outcomes of Targeted, Tailored Outreach to Older Adults Outreach to Older Adults Affected by Cancer and their Affected by Cancer and their Family Caregivers Family Caregivers Paula Klemm, PhD, RN, OCN Paula Klemm, PhD, RN, OCN Veronica F. Rempusheski, PhD, RN, FAAN, FGSA Veronica F. Rempusheski, PhD, RN, FAAN, FGSA Janet Teixeira, MSS, LCSW Janet Teixeira, MSS, LCSW Claudine Jurkovitz, MD, MPH Claudine Jurkovitz, MD, MPH Wei Zhang, MS Wei Zhang, MS Jessica R. Perry, MHP Jessica R. Perry, MHP Marissa Alligood-Merson; Amy Exner Marissa Alligood-Merson; Amy Exner September 14, 2012: CANS Conference, Washington, D.C. September 14, 2012: CANS Conference, Washington, D.C. This project (Academic-Community-Clinical Engagement for Support and Successful outcomes – ACCESS) was supported by grants from the National Center for Research Resources - NCRR (5P20RR016472-12) and the National Institute of General Medical Sciences - NIGMS (8 P20 GM 103446-12) from the National Institutes of Health. 9/3/09-9/2/12 College of Health Sciences School of Nursing
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Outcomes of Targeted, Tailored Outreach to Older Adults Affected by Cancer and their Family Caregivers Paula Klemm, PhD, RN, OCN Veronica F. Rempusheski,
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Outcomes of Targeted, Tailored Outcomes of Targeted, Tailored Outreach to Older Adults Affected by Outreach to Older Adults Affected by Cancer and their Family CaregiversCancer and their Family Caregivers
Paula Klemm, PhD, RN, OCNPaula Klemm, PhD, RN, OCNVeronica F. Rempusheski, PhD, RN, FAAN, FGSAVeronica F. Rempusheski, PhD, RN, FAAN, FGSA
This project (Academic-Community-Clinical Engagement for Support and Successful outcomes – ACCESS) was supported by grants from the National Center for Research Resources - NCRR
(5P20RR016472-12) and the National Institute of General Medical Sciences - NIGMS (8 P20 GM 103446-12) from the National Institutes of Health. 9/3/09-9/2/12
Presentation OutlinePresentation Outline• Background & Significance• Purpose• Building & sustaining research team• Hypothesis• Methods• Measures• Data Analysis• Results• Conclusion
College of Health Sciences
School of Nursing
BackgroundBackground• Cancer is the 2nd most common cause of death in
the US. In 2012, ~ 1.6 million new cancer cases will be diagnosed in the US & >577,000 people will die of this disease (Cancer Facts & Figures, 2012).
• Increasing age is a risk factor for most types of cancer (i.e. most often a disease of older people)
• Gaps in communication between HC professionals & the community to meet the social, economic & cultural needs of persons with cancer.
• Focused outreach is needed to support persons affected by cancer & their family caregivers.
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DE is among the top 10 states in # of persons who get cancer
DE is ranked 11th in cancer death rates
8 cancer clusters identified in Delaware: 6 in New Castle County 1 in Kent County 1 in Sussex County
~13% of DE’s population is 65+ years old
By 2030, DE a top 10 state by age: older adults projected to comprise 30% of population Largest % in 85+ y/o
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Background Background
New Castle County
Kent County
Sussex County Most growth of elderly
(>200% from 2000)
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Background Background
SignificanceSignificance• Older adults with cancer may receive the best
cancer treatment, but lack awareness about where to find answers to everyday economic, lifestyle & social concerns.
• Aging Americans (who have higher rates of cancer) will benefit from partnerships between community organizations & researchers to meet psychosocial & informational needs.
• Of crucial relevance are the economic, healthcare & psychological benefits that can result from this partnership.
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PurposePurpose
Evaluate outreach strategies using a community-based participatory research (CBPR) approach to older adults and their family caregivers in Delaware’s eight (8) cancer clusters.
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Project AimsProject Aims
1. Expand outreach to older adults affected by cancer and their family caregivers in Delaware
2. Evaluate outreach to older adults affected by cancer and their family caregivers in Delaware
3. Develop a model to sustain outreach to older adults affected by cancer and their family caregivers in Delaware.
College of Health Sciences
School of Nursing
HypothesisHypothesis
Tailored and targeted outreach to older adults and their family caregivers in Delaware’s 8 cancer clusters will increase the number of telephone calls to Cancer Care Connection (CCC) from older adults affects by cancer and their family caregivers.
College of Health Sciences
School of Nursing
The Research TeamThe Research Team
• Partner # 1:• University of Delaware,
School of Nursing:• Researcher #1:
Expertise in oncology and recruitment in the community
• Research #2: Expertise in gerontology and community outreach
• Partner #2: – Cancer Care
Connection: with large multi-year database (iCarol) http://www.cancercareconnection.org/
• Partner #3: – Christiana Care Center
for Outcomes Research: large data base & statistical experts http://www.christianacare.org/CenterforOutcomesResearch
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BackgroundBackground
Cancer Care ConnectionCancer Care Connection
Telephone-based support to persons affected by cancer including the patient and their caring circles
In 2008, of 500 calls received @ CCC, estimated that <31% were from or for older adults
CBPR principles:Start at the community level – stakeholders
Emphasize & build on community strengths & resources
An authentic self & dialogue dominate
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Role of The Steering Role of The Steering CommitteeCommittee
Six community stakeholders met quarterly to:
o Guide the researchers in expanding outreach to the elderly with cancer in Delaware
o Identify individuals (e.g., residents, family caregivers, employees) at older adult sites (nursing homes, assisted living facilities, senior centers) located in the 8 Delaware cancer clusters
o Engage these individuals collectively & individually to generate additional recommendations for outreach
o Participate in outreach strategies
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MethodsMethods
Outreach strategies recommended by the community stakeholders (i.e., the Steering Committee) were:
– Delivered in English and Spanish….– To 67 sites (senior centers, assisted living
facilities, community centers, nursing homes, senior sporting events)….
– In Delaware’s 8 cancer clusters
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MeasuresMeasuresiCarol caller database developed by CCC
Electronic form that guided caller intake and included:Caller demographics (age, gender, relationship to
Table 3. Five most frequent call categoriesTable 3. Five most frequent call categories
Figure 1: Most frequent reasons for calling CCC:
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Table 4: Five most frequent call categories by age before & after outreach
ResultsResults
Targeted, tailored outreach significantly increased access of, and use by older adults affected by cancer and their family caregivers to a telephone-based support program (p = <.0001)
Hypothesis supported
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ConclusionsConclusions
This study advanced knowledge about targeted, tailored outreach using a CBPR approach AND about the optimal use of a telephone-based support service by older adults affected by cancer and their caregivers
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ImplicationsImplicationsResearch
Informational needs of older adults with cancer & their family caregivers are not being met.
States with high cancer rates are projected as possible testing sites for the ACCESS Outreach Sustainability Model.
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Questions?Questions?
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Conclusions: Impact of ACCESS grant Conclusions: Impact of ACCESS grant on Cancer Care Connectionon Cancer Care Connection
ActivityActivity1. Staff hires
2. Access to communication experts
3. Community exposure
4. Engagement
5. Evaluation
6. Leveraged ACCESS grant to obtain additional funding
enthusiasm; vote of confidence5. Quantified & added electronic
access to caller satisfaction survey6. Positive responses to requests for
$ to maintain & build on NIH-funded outreach >$190K
7. ACCESS-funded brochures, bags, etc
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School of Nursing
Contextual Antecedents Phase I: Identification of Individual Attributes
“who”
Phase II: Identification of System Attributes
“what” & “where”
Phase III: Implementation“when” & “how”
Phase IV: Outcomes
Characteristics of Population of Interest -Live in Cancer clusters-System Structure -Senior Centers -Assisted Living Facilities -Nursing Homes-Age-Potential for cancer diagnosis
Characteristics of Person/Organization Providing Outreach -Knowledgeable about topic of interest-Bilingual-Persistence-Intuitive-Articulate-Good interpersonal skills-Resourceful-Flexible-Seizes opportunities/maximizes opportunities-Credibility-Mission-focused
-Environment -Institution -Community -Culture, race or ethnic group -Language -Beliefs-Activity level of population of interest -Sedentary -Action-oriented-Geography & transportation-Networks-Resources -People -Money -Marketing materials-Educational background-Technology available
-Stakeholders-Entry structural rules & process-Power structure & process-System entry points-Layers of access -Complexity -Privacy -Security -Trust-Vulnerability of population of interest-Visibility of population of interest-Perceived need
-Engagement-Interaction-Presentation-Timing of encounters-Matching schedules
Population of Interest Accesses Organization
Population of Interest Receives Needed Services & Resources
FEEDBACK LOOP
KEY Roadblock necessitating feedback loop & return to previous phase Two-way communication between phases