Strategy to Action: Championing Provincial Change in Oral Chemotherapy Patient Education

Jane Yao, Erin Redwood, Zahra Ismail, Tamara Harth,Monika Krzyzanowska

2

Objectives

• Understand the current clinical landscape in oral chemotherapy patient education (PE)

• Examine the drivers and barriers for adopting an evidence-based tool

• Explore key dimensions of scaling tool uptake in clinical settings

Evidence to ActionAdoption of an evidence-based tool in clinical settings

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Snapshot of Cancer System in Ontario

14 regions/LHINs (Local Health Integration Networks)

77 systemic treatment (ST) facilities

4 levels of care7 level-1 facilities 8 level-2 facilities

19 level-3 facilities 43 level-4 facilities

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Why Focus on Oral Chemotherapy?

Pipeline drugs by disease site and route of administration (2013)

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Access full document here

By 2019, patients and families will experience high-quality education with consistent messaging on the safe handling, storage, administration, adherence, and disposal of oral anti-cancer medication.

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Project Overview

Analyze current state in oral chemo PE

Identify a valid oral chemo PE

tool

Train local champions

Assess local implementatio

n

1 2 3 4

Regional Patient Education (PE) and Quality Leads

Equipped with MOATT®

Implementation & evaluation tools

At site level: Engagement – Planning – Implementation – M&E

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How is Patient Education (PE) for Oral Chemotherapy Delivered?

Note: providers counted more than once if providing education formally and informally

Oncologist Clinic Nurse Chemo Nurse Pharmacist0

5

10

15

20

25

30

Types of Providers Involved & Teaching Format

Formal using standardized tools & proceduresInformal, content depends on individual providerProvider is not involved

Cou

nt o

f Res

pons

es

Surveyed all levels 1 to 3 ST facilities (n = 33, RR = 97%)

40% from CCO and similar public cancer agencies

In-House27%

External 73%

Source of Patient Education Materials

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Finding the Right Tool for Ontario

• Conducted literature search and jurisdictional scan (Canada, US, UK, Australia) in December, 2014

• MOATT® (MASCC Teaching Tool for Patients Receiving Oral Agents for Cancer) identified as the best available provider-facing tool

Advantages Disadvantages • Evidence-based development • Internationally accepted and

adopted • Specific to oral chemotherapy

medications• Key areas of patient assessment

and teaching are addressed

• Not a lot of research on its effects on patient outcome

• Time-consuming

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phone chargerphone laptop laptop charger 4 days worth of underwear 2 days worth of socks 2 days worth of stockings Casual clothes x 1 Conference clothes x 3 paper + pen ID

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2. MOATT PRINCIPLES

& USE

3.BECOMING A

CHAMPION

1. HEALTH LITERACY

MOATT® Workshop – March 6, 2015

Role of a champion*

Build relationshipsEducateAdvocateNavigate boundaries

*Soo S, Berta W, Baker GR. Role of champions in the implementation of patient safety practice change. Healthcare Quarterly 2009; 2: 123-12.

11 LHINs51 Attendees 24 Nurses 22 Pharmacists 2 Oncologists 3 Educators

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MOATT® Workshop – Participants Feedback

n = 51, RR = 88%

Strongly Agree86%

Somewhat Agree14%

Strongly Agree68%

Somewhat Agree32%

Day fulfilled its objectives Day helped for considering how to champion and implement MOATT®

[Strongly agree – Somewhat agree – Neutral – Somewhat disagree – Strongly disagree]

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Provider Confidence Ratings

Q: How confident are you in your knowledge and/or skill(s) of the following?

Championing MOATT within your facility/region

Using MOATT to provide patient education

Strategies to address adherence issues

Precautions to mitigate against low health literacy

Defining health literacy

0 0.5 1 1.5 2 2.5 3 3.5 4

Pre-workshop _x000d_(n = 44) Post-workshop _x000d_(n = 44)Post-3 mo_x000d_(n = 33) Post-6mo_x000d_(n = 9)

Before

worksh

op

After w

orksh

op

Under

discu

ssion

N/A

6

2

3 3

Timing of Adoption (n = 14)

# of

site

s

Follow-Up Results: Tool Adoption

14

AdoptingMOATT

52%

Not using MOATT at all

48%

MOATT uptake (n = 27)

Post-6 mo

+ 1

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Follow-Up Results: Tool Implementation

Initiation

Planning

Implementation in Progress

Implementation Complete

Sustainable

3

3

5

1

1

+ 1

+ 1

Initiation: Team formed. Goals determined. No activities implemented. Planning: Team engaged in strategy development, planning and/or baseline data

collection. Implementation has not yet occurred. Implementation in progress: Roll out in progress. Evaluation activities are typically also

underway. Sustainability plan should be in development. Implementation complete: Project is fully implemented and is transitioning to an

operation plan. Sustainability plan has been developed. Sustainable: Project is ongoing/operational.

Of the sites adopting MOATT…(Note: 1 site skipped response)

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Drivers & Barriers to Tool Adoption

1. Decision to Adopt 2. Implementation

• Management support• Internal needs • Provincial standards

• Management support • Rigorous tool • Workshop attendance

• Lack of resources (HR, $)• Tool is time-consuming • Organizational changes

• Management buy-in • Staff buy-in • Resource constraints (HR, time)

Role Definition

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Who’s Taking Part in Planning & Implementation?

Oncologis

ts

Nurses

Pharmac

ists

Administr

ators

Coord

inators

Unclea

r resp

onse

s0

2

4

6

8

10

12

Types of Providers Engaged

# of

Site

s(n = 14)

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Monitoring and Evaluation (M&E) Evaluation conducted at 3 sites

• Patient satisfaction & approval • Better adherence • Mixed nursing satisfaction

Why hasn’t M&E taken place yet?

Implementation in progress

Lack of time

Organizational changes

Lukewarm senior support

Under consideration

“Patients don’t mind an extra visit for PE if they see value in it”

“Shortcuts were taken to complete multiple tasks”

Lessons Learned & Looking Forward

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Tool Development/

Selection

User Engagement/Socialization

Clinical Uptake

Value

Clinical context

User-friendliness

Education

Value recognition

User buy-in

Senior level support

Communication

Coordination

Convening power Accountability/governance Quality & standards management

Cancer Care Ontario

Thank you!

Jane Yao HBS, MGA Policy Specialist, Cancer Care OntarioContact: Jane.Yao@cancercare.on.ca