Concept Testing Concept Testing Approaches Conjoint Analysis.
Concept Analysis Presentation
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Cancer Survivorship CareNU 700
November 4, 2011Abigail L. DeLisa, APRN FNP-BC CWS FACCWS
Concept Analysis Presentation
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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)
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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)
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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
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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
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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
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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
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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/
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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
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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
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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
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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
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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
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Related Concept:Cancer Survivorship
Process beginning at diagnosis Involves uncertainty Life-changing
Positive Negative
Unique to individual with some universality
Doyle, pg 499, 2008
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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
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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)
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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
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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
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A Final Thought Re: Concept of Survivorship Care
Concept clarification provides a heuristic for further inquiry and a basis for theory generation
Doyle, 2008
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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?
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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
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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
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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
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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
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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