Improving Pain and Palliative Care Competency among Non-Oncology Health Professionals

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Improving Pain and Palliative Care Competency
among Non-Oncology Health Professionals

• Pamela Bennett, RN, BSN
• Purdue Pharma, L.P.
• Maureen Lichtveld, MD, MPH
• Tulane University School of Public Health and
  Tropical Medicine
• Alison Smith, BA, BSN, RN
• C-Change

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Thank Yous, Disclosure, Disclaimer

• Thank you to many leaders and experts who have
  contributed to this body of work.
• Thank you to Purdue Pharma, L. P.
• who generously provided
• an unrestricted educational grant
• to C-Change that helped to fund the
• 4 pain and palliative care grant sites
• and the CCCLI Pain Workshop.
• The materials presented reflect the views and
  opinions of the individual presenters

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Workshop Objectives

• By the end of this presentation, attendees will
  be able to
• Describe the basic challenges and contemporary
  issues in pain and palliative care
• Appreciate how other sites have applied the
  competency-based method to achieve measurable
  outcomes
• Outline a competency-based approach for designing
  educational interventions from planning thru
  implementation, and evaluation
• Identify sources for program curriculum, national
  standards, funding, advocacy, etc.
• Move forward with a prioritized list of next
  steps

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Cancer Core Competency Initiative

• Goal
• Strengthen the basic cancer competency
• (knowledge, skills, and attitudes)
• of the non-oncology health workforce

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Pain and Palliative Care Issues and Challenges

• Research
• Practice
• Policy

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Coalition Perspectives

• Your Challenges?
• Your Priorities?

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Cancer Core Competency Initiative

• Goal
• Strengthen the basic cancer competency
• (knowledge, skills, and attitudes)
• of the non-oncology health workforce

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Examples of Success

• Pain Palliative Care
• Grant Site Results

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Examples of Success

• Target audience
• RNs and MAs practicing in rural, long term care
  facilities
• Focus
• Describe palliative and end of life care, and
  explain the role of hospice
• Results
• 40 participants
• 12 increase in knowledge from pre- to post-test
  scores
• Possible addition to Iowa nursing school
  curriculum
• Unique Approach
• Order sets for palliative/hospice care
• Scripts/ talking points for difficult
  conversations

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Examples of Success

• Target Population
• MD, RN, MSWs, and office staff in rural health,
  primary care clinics (mostly FQHCs)
• Focus
• Describe cancer-related symptoms, methods to
  screen for needs, and referral pathways and
  palliative care resources for patients.
• Results
• 90 participants
• 90 reported gaining new knowledge and skills to
  provide better patient care
• Unique Approach
• Interdisciplinary program
• Video with cancer patient perspectives
• Video with a standardized patient scenario

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Examples of Success

• Population
• Native health workers, cancer survivors, and
  caregivers
• Focus
• Address culture-specific cancer pain
• Explain how cancer pain differs from other types
  of pain
• Perform a cancer pain assessment
• Differentiate pain and distress
• Results
• 102 participants
• 120 improvement in confidence
• 7 increase in knowledge
• Unique Approach
• Pre-Assessment with talking circles
• Patient symptom journal
• Discomfort Barometer

South Puget Intertribal Planning Agency (SPIPA)
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Examples of Success

• Population
• Medical students and pediatric residents
• Focus
• Recognize the barriers to effective pediatric
  pain management
• Perform a pediatric pain assessment
• Describe the pathophysiology of pain in children
• Manage pediatric-related pain and analgesic side
  effects
• Preliminary Results
• 310 participants to date
• 32 increase in knowledge
• Unique Approach
• Online, interactive course

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Program Benefits

• Professional
• Professional development

• Learner
• Increased knowledge
• Increased confidence
• Received tangible reference materials
• Enhanced academic experience
• Enhanced professional self-reflection

• Institution
• Enhanced visibility/ credibility
• Provided foundation for future trainings

• Community
• Enhanced relationship with institution
• Addressed needs
• Benefits of better prepared/ increased workforce

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Pilot Site Findings

• UTILITY
• Pilot sites found the cancer core competencies to
  be highly useful
• FLEXIBILITY
• Implementation of the competencies was feasible
  across cancer core continuum, professional
  settings, and disciplines

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Program ResourcesC-Change Toolkit
Order free copies or download
www.cancercorecompetency.org
Examples
Overview How to Guidance
Pilot Site Report Universtiy of Pittsburgh
Medical Center
Summary Publications
Pilot Site Report Marshall University School of
Medicine
Pilot Site Report California University of
Pennsylvania School of Social Work
Pilot Site Report Audrain Medical Center
Addressing the Cancer Workforce Crisis Using a
Competency-Based Approach with Non-Oncology
Professionals Pilot Project Evaluation
Report July 2008
Templates
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Program ResourcesPurdue Pharma L.P. Resource
Guide

• Information, resources, ideas and tools to help
  those suffering with pain
• Pain scales, diaries, medication record and
  advocacy resources
• Tools to facilitate communication with providers
• Tips for living a healthier life
• Financial resources
• Caregiver tips
• Useful websites
• Toolkits may be ordered free of charge at
  www.IntheFaceofPain.com or
• by contacting Kimberley Tiller at
• 203-588-8538

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Building a Competency-Based Pain and Palliative
Care Educational Program
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Why?

• The Challenge and Rationale for a
  Competency-Based Approach

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Scope of the Workforce Supply

• Demand for oncologists is expected to exceed
  supply by 25-30 by 2020 (ASCO, 2007).
• The social work labor force is older than most
  professions, with nearly 30 of licensed social
  workers over age 55 (NASW, 2006).
• By 2020 the projected gap between supply and
  demand for RNs will be 340,000 (three times
  larger than ever experienced in the U.S.).
• By 2020, more RNs will be in their 60s than in
  their 20s (Auerbach Buerhaus Staiger, 2007).
• The average age of a public health worker is 47
  many public health agencies currently face a 20
  vacancy rate (APHA, 2008)
• Cancer registrar vacancies remain difficult to
  fill in some regions of the country and demand
  for registrars is estimated to grow 10 in the
  next 15 years (NCRA, 2006)
• The proportion of minorities in the population
  outstrips their representation among health
  professionals by several fold (IOM, 2004).

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Scope of the Public Demand

• Cancer is the second most common cause of death
  by disease claiming the lives of more than half a
  million people per year (ACS, 2007)
• Cancer rates are expected to increase as baby
  boomers age (CDC, 2000)
• The lifetime probability of developing cancer is
  1 in every 2 men and 1 in every 3 women (NCI,
  2005)
• Five-year cancer survival rates have risen to 64
  for adults (CDC, 2005)

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Who?

• Defining learners / audience

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Discipline, Scope of Practice

• Who?
• Physician
• Nurse
• Social Worker
• Pharmacist
• Public Health Worker
• Nursing Assistant
• Lay Health Worker
• Multi-disciplinary team

• Implications for Program Design
• Levels of education / training
• Areas of expertise
• Scope of practice
• Roles and responsibilities
• Interactions
• Interdependence

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Exercise 1
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What?

• Defining the targeted
• competency improvement

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Blooms Taxonomy

• Verb
• describes
• level of
• independence

EVALUATION
SYNTHESIS
ANALYSIS
APPLICATION
COMPREHENSION

KNOWLEDGE
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Anatomy of a Competency Statement

• Competency statements define what a professional
  should know or do

Define palliative and end-of-life care
Targeted cancer content
Level of complexity and/or independence
Within context Scope of Practice Level of
Expertise Role and Responsibilities
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Breadth Depth of the Competency Statement
Administration Ambulatory Clinics Academics Acute
Care Clinics Cancer Centers Home Health
Agencies Professional Societies Advocacy
Organizations
Allied Health Medicine Nursing Pharmacy Public
Health Research Social Work
StudentsResidents/FellowsField
FacultyPracticing Professionals
Domain I Continuum of Care Prevention / Early
Detection Treatment / Survivorship Palliative
Care
Domain II Basic Cancer Science Etiology /
Epidemiology Clinical Trials Cancer Surveillance

Domain III Communication Collaboration Interdisc
iplinary Care Psychosocial Communication Cross-Cul
tural Communication Grieving
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Palliative and End of Life CareCompetency
Statements

• General
• Define palliative and end of life care
• Assess that resources for palliative and end of
  life care and insurance coverage are consistent
  with current recommendations
• Refer patients to community palliative and end of
  life support resources
• Explain the role of hospice care
• Manage symptoms of the cancer patient
• Incorporate end of life comfort strategies for
  the dying patient

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Palliative and End of Life CareCompetency
Statements

• Pain management
• Explain how cancer pain differs from other types
  of pain
• Describe the methods used to diagnose cancer pain
  throughout the progression of the disease
• Differentiate between acute and chronic pain
  symptoms
• Describe the characteristics used to assess
  cancer pain frequency, intensity and site
• Perform a cancer pain assessment
• Explain the different treatment options for
  cancer pain
• Perform a pain-related history taken during a
  physical exam
• Manage cancer-related pain and analgesic side
  effects

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Exercise 2
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How?

• Developing the learning activity

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Adult Learning Principles

• Adult learning environments are designed to
  minimize dependence and maximize independence.
• Adult instructional strategies adapt to the
  learners previous experiences including skills
  and content.
• Faculty in adult learning settings function as
  both instructors and facilitators.

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Educational Activity Design
Competency to Curriculum
Instructional Design
Learner Assessment

• Verb

Describe
Dialogue
Short Answer
Apply
Case Study
Role Play
Essay Question
Synthesize
Table Top
Standardized Patients
Evaluate
Peer Review
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Curriculum Resources

• See resources list
• Best practice guidelines
• Professional education
• Clinical practice tools
• Patient Education
• Advocacy Materials
• Grant Funding
• e-News
• National Conferences

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Clinical Practice Tools
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Exercise 3
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So What?

• Evaluating Impact

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Planning, Implementation Evaluation Tools
Logic Model
OUTCOMES
INPUTS
OUTPUTS
Program resources
Activities
Participation
Short
Medium
Long-term
Efforts on the part of the program or
intervention staff
Changes in the learners knowledge, skills, and
attitudes
Changes in practice, care delivery system,
patient outcomes
The logic model assures that all of the program
resources directly support the achievement of
the desired competency outcome.
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Evaluation Measures
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Exercise 4
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Now What?

• Taking the next steps
• toward program implementation

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Plan ?Implement ?Evaluate
Build a Balanced Leadership Team
Sustain Efforts Through Sharing
PLAN
EVALUATE
Complete Needs Assessment Interpret Findings
PLAN
IMPLEMENT
Implement Manage with Attention to Details
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Key Aspects of Planning

• Leadership and faculty
• Coalition members, cancer center experts
• Needs assessment
• SPIPA talking circles
• Incentives and program promotion
• CEs, gas card, food, free registration, job
  requirement
• Resources and partnerships
• Iowa long term care facilities, school of
  nursing
• Florida AHEC, cancer centers, university

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Exercise 5
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Map for Next Steps
Validation Template
Curriculum Validation Template
Logic Model
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Tools for Success

• Summary
• Effective method to address the cancer workforce
  shortage and achieving improved pain and
  palliative care competency
• Applicable in a variety of professional
  disciplines and settings
• Provides numerous resources for competency-based
  program development
• www.cancercorecompetency.org
• kcox_at_c-changetogether.org