the Roles of CHWs Chavely Conde, BHS Kyla Alsman RN, BSN - PDF document

04/20/2018 Patient Navigation in Cancer Survivorship and the Roles of CHWs Chavely Conde, BHS Kyla Alsman RN, BSN Objectives  Understand how cancer is a chronic disease and the impact cancer has on long term health  Understand how CHW can help cancer survivors and education on available resources 1

04/20/2018 A Cancer Survivor is….  …. anyone who has been diagnosed with cancer – from the time of diagnosis and for the balance of his or her life. NCCN: National Coalition for Cancer Survivorship http://www.canceradvocacy.org/ What Does a Cancer Survivor Look Like?  Living cancer-free for the remainder of life  Living cancer-free for many years but experiencing one or more serious, late complications of treatment  Living cancer-free for many years, but dying after a late recurrence  Living cancer-free after the first cancer is treated, but developing a second cancer  Living with intermittent periods of active disease requiring treatment  Living with cancer continuously without a disease-free period 2

04/20/2018 Survivors Are Not One Size Fits All  Some draw closer to family and friends – Some are abandoned by family and friends  Some are young – some are old  Some are able to resume normal activity – some might benefit from MDHHS Focus Groups, physical therapy 2017  Some struggle with depression, anxiety, fear What is a Community Health Worker (CHW)?  Trusted member of the community  Service to community members regardless of race, age, gender, culture, or religion.  Provide one-on-one tailored services to address health and social needs  Guide and connect community members to needed resources and services 3

04/20/2018 Understanding Community Health Workers  Serve as liaison for patients  Provide educational information, emotional support, and advocacy  Empower community members  Engage with community members at local events  Raise prevention awareness for cancers  Navigate community members to screening resources CHWs working and engaging with their community 4

04/20/2018 Estimated and projected number of cancer survivors in the United States from 1977 to 2022 by years since diagnosis . de Moor J S et al. Cancer Epidemiol Biomarkers Prev 2013;22:561-570 Ongoing Survivor Needs • Monitoring for late effects • What are late effects? • Health problems that happen because of cancer and/or treatment • Can be both physical or psychological • May not develop until many years after cancer treatment if finished • Financial Toxicity: – Medical Bills – Supportive Care Services are not often a covered benefit or require specialist copays. 5

04/20/2018 Survivorship care  Risk of having late effects of treatment is influenced by multiple factors – Treatment received – Health behaviors (both good and bad) – Pre-existing problems – Genetics Physical Consequences of Cancer 6

04/20/2018 Health Behaviors • Diet • Exercise • Sun • HPV • Tobacco 14 7

04/20/2018 Programs and Resources  What resources are available to CHWs for cancer survivors? 15 16 8

04/20/2018 Health Eating Resources 17 18 9

04/20/2018 Truman Medical Center 19 Show Me Healthy Women 20 10

04/20/2018 11

04/20/2018 LIVESTRONG at the YMCA • 12-week program with two 75-90-minute sessions per week • Includes cardiovascular conditioning, strength training, balance, and flexibility exercises • Evaluation includes fitness and quality of life assessments before and after participation • Facilitated by YMCA-certified instructors • Requires referral and medical clearance from a physician 23 Genetics  Some cancers are genetic (example: breast cancer in adults, retinoblastoma in children) – Could increase risk of developing secondary cancer  Family history – Example: patient has family history of heart disease and then receives cancer treatment that increases the risk for heart problems  Previvor- – A survivor of a predisposition ( or increased risk) for a disease such as cancer 12

04/20/2018 Ongoing Survivors Needs Physical Well Being Psychological Well Being Diet and Exercise Anxiety Fatigue/ Pain Depression Fertility Fear of Recurrence Monitoring for late effects Cognition/ Attention Survivor Guilt Cancer Survivorship Social Well Being Spiritual Well Being Family Distress Meaning of Illness Roles and Hope Relationships Uncertainty Isolation Inner Strength Finances/Work Roles of CHWs  Health care providers can not measure patient outcomes once they leave the office  CHWs can follow up with patient and monitor their care plan.  CHWs motivate community members to:  Exercise  Eat healthy  Follow prescription directions  Find ways to help with financial barriers  Make lifestyle changes 13

04/20/2018 Community Health Workers aren’t all alike Volunteer CHWs Paid CHWs  Hired as CHW- full or part  Volunteer their time time  Limited hours to  Certification serve/work*  Specific training  Trainings by outreach (extensive)- per hiring organizations organization   Skillsets vary per job Train the Trainer model description for retention 14

04/20/2018 Certification  Some states require certification  Certification is necessary for payment purposes  MO- certification program: 160 hours, 60 service Kansas  Kansas does not have a certification program  KS Community Health Worker Coalition  Education committee  Symposium committee  Advocacy committee 15

04/20/2018 Case Study JJ  30 year old woman with a history of Hodgkin’s Lymphoma at the age of 15.  Past treatment includes history of chest radiation and chemotherapy that increases risk for heart problems.  Patient presents with no health insurance and concern for a lump in her breast.  History of smoking 1 pack per day 16

04/20/2018 Survivorship care is multidisciplinary and take the whole community to provide care Follow Up  Based off JJ’s past treatment she would be due for the following: – Echocardiogram (ultrasound of heart to check function) – Education on Diet and Exercise – Sun Safety- education – Smoking cessation Education – Breast Mammogram and Breast MRI every year  Needs education about resources due to lack of insurance 17

04/20/2018 CHW role before, during and after cancer treatment Before  Listen to needs of community members  Guide to screening resources  Address barriers to getting screened  Help enroll eligible women into the state Breast and Cervical Cancer Program/Navigate them to the resource  Show Me Healthy Women in Missouri  Early Detection Works in Kansas CHW role before, during and after cancer treatment During  Assist with medical appointments  Follow-up to ensure they get to their appointment  Transportation needs/ issues  Find medical interpreting services when needed for diagnostics, and treatment  Connect to social worker if needed  Talk to family about issues and follow-up 18

04/20/2018 CHW role before, during and after cancer treatment After  Follow-up with appointments  Follow-up with family members to see if any issues  Refer to social worker for financial assistance and psychosocial needs  Guide them to appropriate resources to continue positive health behaviors Hispanic Women’s Survivorship Discussion on Barriers  Barriers described-  Language  Financial issues  Health Insurance  Emotional Support  Lack of education in the community/family 19

04/20/2018 Barriers that CHW try to eliminate  Social determinants of health  Socioeconomic  Academic/education  Language  Physical  Psychological  Geographical  Cultural Benefits of CHWs  Health services  Increase access to care  Less ER visits  Decrease no-show appointments  Help to gather data for research projects 20

04/20/2018 Questions? Thank you 21