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Innovative Exercise and Education community based program for Well Cancer Survivors
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Copyright CanWell Program 2010
CPAC Cancer Workforce SymposiumJan. 25th 2010, MontrealBreakout Session 1C Community
CanWell Program:An Innovative Community Cancer Care
Service Delivery Model
Presented byFidelma Serediuk & Jan Park Dorsay
Copyright CanWell Program 2010
Copyright CanWell Program 2010
CanWell Project Team
Fidelma Serediuk, PT, B.Sc.( PT) Oren Cheifetz, PT, M. Sc., Jan Park Dorsay, RN(EC), MN, NP-‐Adult,CON (C)
Genevieve Hladysh, B. Sc. Kin. Linda Woodhouse, PT, Ph. D.
Copyright CanWell Program 2010
What was the CanWell Project? a demonstration project to create and deliver a community-
based exercise and education program for people with cancer,
made possible through one time funding from Optimizing HealthCompetencies Fund (Health Force Ontario-MoHLTC)
Participant Criteria: over 18 yrs. with any cancer diagnosis or treatment stage,
independent mobility with no gait aides, medically stable. Study Size: 32 enrolled, 18 completed 12 week evaluations
Copyright CanWell Program 2010
CanWell Program Goals
To promote optimal wellness for survivors of cancer To promote inter-agency and inter-professional
collaborative care, knowledge and competencies inthe area of exercise for people with cancer
To develop and establish competencies andexpertise related to exercise for cancer survivors bytesting a model which may be implemented in othercommunities
Copyright CanWell Program 2010
Why CanWell ? The evidence supports; Primary Prevention
Exercise may decrease the risk of developing cancer.
Secondary Prevention
Decreased risk of recurrence in long term follow-up.
Improved QOL and decreased symptoms
Helps manage treatment side effects and toxicities,maintain physical functioning, prevent muscle loss andfat gain, and improve mood and QOL, and
Facilitates completion of difficult treatments
Copyright CanWell Program 2010
CanWell – response to a need
Cancer and Exercise Survey (N=648) > patients’knowledge and preferences (Cheifetz & Park Dorsay, 2007)
adapt knowledge to the local communitycontext >survey conducted at Juravinski Cancer Centre,
Hamilton, ON. 47% of men and 59% of women indicated
interest in an exercise program 21% of breast cancer survivors and 18% of
prostate cancer survivors actively participate inan exercise program
Copyright CanWell Program 2010
CanWell -‐ response to a need
52% of respondents preferred a supervised exerciseprogram
43% plus 25% preferred an exercise program in thehome or community
The majority of respondents reported exercising withstaff knowledgeable about the specific needs ofcancer survivors was important; this contributed totheir feelings of safety and confidence
Copyright CanWell Program 2010
Copyright CanWell Program 2010
The CanWell Pilot Project: Results
Average age 52.6 years (32-73) 72% female, majority breast cancer Statistically significant results: participants walked
faster, further and reported improved quality of life No reported increase in pain or other symptoms Safe: no injuries while exercising More regular exercisers after 12 week program (pre-
CanWell less than 10%, post-CanWell greater than60%)
Copyright CanWell Program 2010
The CanWell Pilot Project: Results “Exercise gives me back some of my self image. I’m
working through my frustration that cancer treatmentisn’t a do it, get it done, over deal.”
“Before cancer, I was fearless. I back packed through18 countries solo. After cancer, I became a personafraid to walk to the store. I became fearful, andagoraphobic. Eight weeks into the CanWell program, Irealized I was no longer fearful or agoraphobic. I’mfine outside of my home now. This is huge for me.Thank you CanWell.”
Copyright CanWell Program 2010
Service Delivery Human Resource Model-‐CanWell
YMCA based; Kinisiologist Fitness Trainers
Hospital & YMCA based Health Professional consultationsupport;
Physiotherapist Nurse Practitioner
Copyright CanWell Program 2010
CanWell Program Model
Intake Screening ProcessCanWell Trained YMCA Kinisiologist HHS
Physiotherapist &Nurse Practitioner
Participant accepted into 12 week Supervised CanWell Exercise & Education ProgramCanWell TrainedYMCA Kinisiologist & Fitness Trainers
Baseline
Consult PRN
Self Referral orHCP Referral
With Physician ClearanceSubmitted to YMCA
6 wk eval.
12 wk eval.
Participant continues independently Accesses CanWell team
as needed
Advise referralsource if notaccepted intoCanWell
Copyright CanWell Program 2010
The CanWell Program Pilot Project: the process andproducts
Physiotherapist and NP developed YMCA staff trainingmaterials based on best available evidence
Two day staff training sessions provided for YMCA staff Physiotherapist and Kinisiologist provided 1-1 staff training on
assessment and evaluation of participants YMCA staff actively engaged in on-going data collection Physiotherapist and NP available for on-going onsite
consultation support to YMCA staff and participants as needed Participant education sessions developed based on participant
requests, delivered by health professionals in the community
Copyright CanWell Program 2010
Challenges-‐ Myth Busting- overcoming beliefs that exercise
is not beneficial to people with cancer! Inter-agency and inter-professional
collaboration requires time+++ andcommitment to achieve effectivecommunication
Timeline of project – originally was 12 months-needed a time extension of 3 months toachieve all project deliverables
Copyright CanWell Program 2010
Strategies for Success Alignment with emerging Community Health Partnership
framework Building community based competencies & capacity through
transfer of knowledge related to cancer and exercise Multiple networking and communication strategies (Rounds, TV
media, CanWell Video, webpage, brochures, posters, word of mouth, newsletters) Building a founding inter-professional team that possessed
diverse skills and strengths Engagement of organizational senior leaders to support the
vision Integrating survey results that identified what people with
cancer needed regarding exercising
Copyright CanWell Program 2010
Strategies for Success
Identification of a service gap;lack of resources for cancer survivors to exercise safely inthe community,participant preferences known from previous study
Knowledge adapted to local context ;opportunity for partnership with HHS-YMCA-McMaster University
Interventions selected, tailored & implemented;CanWell Demonstration Project Oct. 2008 –Dec.2009
Copyright CanWell Program 2010
The CanWellProgram:An InnovativeCommunityCancer CareServiceDelivery Model
CanWell Pilot Research
Les Chater YMCA,2009
CanWellProgram:
Increasing capacity in the community thru
knowledge andskills
development
Cancer and exercise
Survey: JCC 2007,(Cheifetz &
Park Dorsay)
Adding to publishedevidence
on the benefits of exercise for cancer
survivors
Copyright CanWell Program 2010
CanWell Key Learnings; Transfer of cancer and exercise knowledgeand competencies so as to provide a safe andeffective education and exercise program forpeople with cancer in a community setting is
possible For people with cancer - exercise can be both
safe and effective !
Copyright CanWell Program 2010
www.canwellprogram.ca