2C-1 – Personalized Health Information Navigator (PHIN): Interactive Mobile Tablet Technology Based Psychoeducational Intervention

Jennifer Damonte, Janelle Barrera Ikan, Said Adjao, Stephanie Avakian, Fabryann Tillman, Brian Rivers
H. Lee Moffitt Cancer Center, Tampa, FL, USA

Abstract: Background: Prostate cancer uniquely challenges patients due to numerous treatment options with a)unknown outcome certainties; b)similar 10-year prognosis; and c)varying impacts on quality of life, psychological functioning, and physical wellness. With 5-year survival rates reaching 100%, patients need to consider both treatment procedures and their potentially permanent side effects, and supportive care. Studies have suggested being knowledgeable about cancer improves patients’ coping and decision-making abilities during diagnosis, treatment, and post-treatment. However, the increasing complexity of information across the prostate cancer continuum challenges patients in acquiring adequate and reliable resources. Even men with sufficient access to information continue to report unmet informational needs. The iPad app, “Personalized Health Information Navigator (PHIN)”, was developed as a psycho-educational intervention. It presents the National Comprehensive Cancer Network Guidelines for Prostate Cancer Patients using Concept Maps based on theories of knowledge and learning. An interactive interface presents information in a non-linear fashion according to users’ understanding, and interests. Its integrated multimedia resources (e.g., videos, images) facilitate learning. This study explores men’s perception of PHIN’s general and study specific ease of use. Methods: 53 men were recruited from local communities. After brief interactions with PHIN, participants rated 34 statements assessing PHIN’s General and Study Specific Ease of Use. Available responses were 1(Strongly Disagree)–5(Strongly Agree). Results: Overall, participants found PHIN to be generally, and Study Specifically easy to use. Furthermore, demographic factors (education, income) did not significantly impact their perception of its general, and Study Specific Use. Discussion: The increasing complexity of information across the prostate cancer continuum challenges patients in acquiring adequate and reliable resources. PHIN will deliver consistent educational content thereby reducing the information variation often associated with patient education, and accommodating different learning styles. More importantly, neither participants’ education nor income levels had significant effect on their evaluation of PHIN, confirming it to be an effective intervention tool. Relation to Theme: PHIN is an Interactive Mobile Tablet Technology Based Psychoeducational Intervention aiming to provide education to cancer patients. Little is known about how education delivered on iPad is perceived by diverse and underserved populations. This project provides evidence that people regardless of their Socioeconomic Status find it ease to use. Learning Objectives: The participant shall be able to: 1. Identify benefits of Interactive Mobile Tablet Technology Based Psychoeducational Intervention. 2. Define Prostate Cancer Knowledge Model. 3. Identify components of concept maps. 4. Identify information dissemination methods with broad based utility across socioeconomic groups. 5. Identify the impact of patient knowledge about possibility and likelihood of side effects on patient prostate cancer treatment choice. 6. Identify ways to engage patients to assist doctors in selecting the most desirable treatment alternative available. References: 1. Chambers, S. K., Ferguson, M., Gardiner, R. A., Aitken, J., & Occhipinti, S. (2013), Intervening to improve psychological outcomes for men with prostate cancer. Psycho-Oncology, 22, 1025–1034. doi: 10.1002/pon.3095. 2. Loiselle, C. G., Edgar, L., Batist, G., Lu, J., & Lauzier, S. (2010). The impact of multimedia informational intervention on psychosocial adjustment among individuals with newly diagnosed breast or prostate cancer: A feasibility study. Patient Education & Counseling, 80 (1), 48-55. doi: 10.1016/j.pec.2009.09.026.

2C-2 – Cancer Related Brain Fog: Facing the Challenge and Providing a Solution

Heather Palmer¹, Massey Nematollahi^2
1Maximum Capacity Inc., Bradford, Canada, ²Stronach Regional Cancer Centre, Newmarket, Canada

Abstract: Background: Cancer related brain fog refers to a constellation of cognitive symptoms that can include changes in memory, multi-tasking, strategic processing, word finding and motor coordination. Although the condition is commonly referred to as ‘chemo brain’, those who have not received chemotherapy often experience the same set of symptoms. As many as 80% of all cancer survivors may experience brain fog. Internationally, changes in thinking is identified as one of the top three concerns amoung cancer survivors surveyed (fatigue and fear of recurrence being the other two). Description: Since 2006 Maximum Capacity, in collaboration with cancer support centres, has been offering a multidimensional, ecologically valid and evidence-based, 8 week program to address cancer related brain fog. Over 4000 cancer survivors have been supported by one of 25 program leaders who run the program across Canada and in the US. Evaluation: Since the inception of the program in 2006, the condition has become more widely accepted amoung healthcare professionals, scientists, insurance companies and cancer communities. As a result of increased awareness, more research is being carried out, more programs are being developed and accommodations are being made for those returning to work. The ‘Brain Fog’ program is well received, positively impacts lives and continues to be one of the most in demand programs at the centres where it is offered. Usefulness: Despite the considerable progress that has been made in the last 9 years, many communities and rural regions still do not have access to brain fog programs. This talk will: 1) briefly outline the current understanding regarding the causes and symptoms of cancer related brain fog, 2) review neuroplasticity and its influence in the Maximum Capacity approach, 3) discuss the role of video conference technology in providing brain fog to under-serviced regions, and, 4) view ‘impact’ testimonials from former participants. Relation to Theme: The Maximum Capacity ‘ Brain Fog’ program is innovative. It is the first and most readily available evidence-based, face-to-face, comprehensive brain fog program with a 9 year proven track record of impacting lives. The video conference version of the program has been successful in reaching diverse populations. Objectives: The participant shall be able to: 1. Discuss at least 3 possible causes of cancer related brain fog, 2. Identify at least 4 symptoms of cancer related brain fog. 3. Utilize theories of neuroplasticity to support cognitive changes in cancer survivors. 4. Learn about video conference possibilities for programming purposes. References: 1. Hot off the press: http://www.theglobeandmail.com/life/health-and-fitness/health/cutting-through-the-fog-of-chemo-brain-to-improve-cancer-therapy/article24189998/ 2. Nelson, W.L., Suls, J., & Padgett, L. (2014). Understanding ‘ChemoBrain’ : A Challenge and Invitation to Psychological Scientists. Observer, Vol. 12, No. 2. 3. (http://www.psychologicalscience.org/index.php/publications/observer/2014/february-14/understanding-chemobrain.html) 4. Von Ah, D., Carpenter, J. S., Saykin, A., Monahan, P., Wu, J., Yu, M., . . . Unverzagt, F. (2012). Advanced cognitive training for breast cancer survivors: A randomized controlled trial. Breast Cancer Research and Treatment, 135, 799–809. 5. Wefel, J. S., & Schagen, S. B. (2012). Chemotherapy-related cognitive dysfunction. Current Neurology and Neuroscience Reports, 12, 267–275.

2C-3 – “If I Had Only Known”: Family Members’ Overcoming Challenges of Giving Social Support to the African American Cancer Survivor

Jill Hamilton¹, Valarie Worthy², Nakia, Best³, Kayoll Galbraith^3
1School of Nursing Johns Hopkins University, Baltimore, MD, USA, ²Duke University, Durham, NC, USA, ³School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Abstract: Background/Purpose: Historically, African Americans have depended on social support from networks of family, friends, and fellow church members for their survival during adversity and illness situations. However, in comparison to Caucasians, African American cancer survivors have unmet needs [1] and declines in social support following their diagnosis [2]. A network of immediate and extended family and friends have reported feeling helpless, unsure, and lacking information when attempting to support the survivor [3]. In this study, we examine the responses from immediate and extended family of African American cancer survivors to these challenges with their recommendations for targeted interventions. Methods: A qualitative descriptive study using thematic analysis of semi-structured interviews. Participants were 22 family members that included spouses and adult children and grandchildren. Results/Findings: Participants struggled to overcome fears, confronted widespread stigmatizing attitudes toward cancer, attempted to maintain normalcy. Community-wide interventions to alleviate fears and fatalistic attitudes toward cancer were recommended. Discussion: Among African Americans, immediate and extended family are important sources of social support but may not be prepared to respond to the challenges of giving support. Interventions and programs are needed to inform and educate both immediate and extended family members to better support the African American cancer survivor. Relation to Theme: This research addresses cancer health disparities through recommendations for strategies to increase social support to the African American cancer survivor. Participants included spouses, adult children and grandchildren and ways in which they responded to challenges in giving support. Also included are recommendations for more informative interventions and supportive programs. Learning Objectives: The participants shall be able to describe at least two challenges encountered among family members in their attempts to give support to the African American survivor after diagnosis. The participants shall be able to describe two strategies that would inform a network of immediate and extended family of ways to increase the social support they give to the African American cancer survivor after diagnosis. References: 1. Mosavel, M. and K. Sanders, Needs of low-income african american cancer survivors: multifaceted and practical. J Cancer Educ, 2011. 26(4): p. 717-23. 2. Thompson, T., et al., Perceived social support change in patients with early stage breast cancer and controls. Health Psychol, 2013. 32(8): p. 886-95. 3. Cooper, D.L., B.D. Powe, and T. Smith, Social support provided by and strain experienced by African-American cancer caregivers. Support Care Cancer, 2013. 21(10): p. 2719-25.

2C-4 – Patients and Families for change – lessons learned from the implementation of RENEW, a post treatment education initiative

Paul McCann
Windsor Regional Hospital Cancer Program, Windsor, Canada

Abstract: Background/Purpose: As survival rates improve, people are living with and beyond cancer longer. The transition to life after cancer is cavernous for patients and family. At the Cancer Program at Windsor Regional Hospital in Ontario, Canada, educational intervention traditionally centered on diagnosis to end of treatment. During the survivorship phase, a significant informational need was largely unmet. The disparity, validated through quantitative, qualitative and anecdotal evidence, resulted in a focused effort to close gaps. Various educational interventions were used to provide support into the survivorship phase. Uniquely, patient representatives were used for program development, feedback and quality improvement for what is now known as RENEW: A Life After Cancer Education Series. Description: RENEW is a patient education led initiative to educate and support patients and family in their transition to life beyond cancer. RENEW stands for Resources, Education, Nutrition, Exercise and Wellness. The facilitated program has three main components: 4 education sessions; 10 week exercise class; 8 week Yoga class. The goal of this evidence-based program is to provide information and support, and to link participants to community resources. Evaluation: RENEW is intended to: Involve patients in program development; Increase knowledge and competence; Improve self-management; Improve quality of life; It is evaluated through key metrics, including: Attendance,      Increased knowledge of survivorship issues, Increased confidence in self care, Program satisfaction, Improved patient experience, Data collection results from program records, surveys, evaluation forms, and feedback sessions. Usefullness: Evaluating the impact and usefulness of RENEW is ongoing. Presently, data indicates that the program was implemented as planned, with strong attendance in the education sessions, exercise program and Yoga classes. Overall, participants express a high degree of satisfaction and have displayed quantitative improvement in physical fitness measures. Relation to Theme: Innovation in Cancer Education – the session presents findings from the innovative education series RENEW. Participants will take away strategies and lessons learned from program development, implementation and evaluation. The impactful session is co-presented by a patient representative, to discuss experiences in program development and using patient voice in quality improvement. Learning Objectives: The participants of this session shall be able to: 1. Outline at least two methods for including the patient voice in the development of a survivorship education program. 2. Identify at least two benefits to a partnership with local community resources in developing an exercise program for cancer survivors. 3. Identify at least three strategies to evaluate the impact and effectiveness of a survivorship education program. References: 1. Brown JC. et al. Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a metaanalysis. Cancer Epidemiol Biomarkers Prev. 2011;20:123-133. 2. Cancer Care Ontario, Models of care for cancer survivorship. Program in Evidence-based Care Evidence- Based Series, Toronto (ON); 2012 Oct. 26. No.: 26-1. 3. Rock, C. L. et. al. (2012), Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians, 62: 242–274. doi: 10.3322/caac.21142. 4. Wolin KY, Colditz GA, & Proctor EK. Maximizing benefits for effective cancer survivorship programming: defining a dissemination and implementation plan. Oncologist. 2011; 16(8):1189-96.

2C-5 – Implementing Integrated and Integrative Psychosocial, Supportive, and Survivorship Services in Cancer Care

Leila Ali-Akbarian
University of Arizona Cancer Center, Tucson, AZ, USA

Abstract: Background/Purpose: Throughout cancer care, patient need for psychosocial, supportive, and survivorship services is well established. Further, integrative medicine, which combines conventional treatments with evidence-based complementary modalities, provides additional needed patient resources. Successful implementation of these services requires significant educational effort and resource allocation. Many oncology professionals lack knowledge about the impact of unmet psychosocial needs, and many are unaware of, or are uncomfortable with the use of complementary modalities. Consequently, disparities in access to these services is notable given that over 40% of cancer patients experience distress, and half use complementary therapies. At the University of Arizona Cancer Center, the goals of Supportive Care for Healing (SCH) are to reduce patient distress, promote wellness, provide evidence-based integrative supportive care, and patient education. Description: SCH is a multi-disciplinary patient-centered model of psychosocial, supportive, survivorship, and integrative medicine services. These include distress screening, psychosocial services, psychiatric treatment, symptom management, survivorship planning and primary care, individual and group stress-reducing interventions, integrative medicine, complementary therapies, movement classes, nutrition and general lifestyle counseling. Implementation has required education of oncology professionals, patients, caregivers, and the general community. Education includes teaching, outreach, inter-disciplinary case conferences, and marketing. Funding from multiple streams is justified with evidence and evaluation. Specialized training of psychosocial staff, psychiatry and family medicine residents, and integrative medicine fellows also assures sustainability. Evaluation: Evaluation is integral to SCH. Metrics include proportions of patients served and services utilized. Assessments vary depending on the SCH service, but generally include dimensions of distress, quality of life, and patient satisfaction. Usefulness: SCH is a flexible model of integrated care replicable in diverse cancer centers and communities. With an overarching philosophy of patient-centered and inter-disciplinary team care, services may be provided on-site or through well-coordinated referrals. Educational activities and evaluation may be strategically tailored to gain support and maintain sustainability within individual cancer centers and communities. Relation to Theme: Our abstract highlights the development of an interdisciplinary approach to oncology supportive care and survivorship care. We provide team-based and individualized whole person care to our cancer patients during and after cancer treatment. These integrated services are sustained through targeted educational activities and evaluation processes. Learning Objectives: Participants should be able to examine local oncology resources and personnel to begin the development of team-based supportive and survivorship care to meet the psychosocial and other medical needs of their cancer population. They will understand the value of offering integrative and complementary services in the supportive care setting. They will also become familiar with different types of outreach and teaching activities in order to educate patients and families, and gain to support from key stakeholders. References: 1. Frenkel M, Sierpina V, Sapire K. Effects of complementary and integrative medicine on cancer survivorship. Curr Oncol Rep. 2015 May;17(5):445. 2. Grassi L1, Caruso R, et al. Psychosocial screening and assessment in oncology and palliative care settings. Front Psychol. 2015 Jan 7;5:1485.