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                                                             www.jeffbelkora.com/evidence
                                                              List of references to literature                      Initial Setting: UCSF Breast Care Center
                                                               www.jeffbelkora.com/thanks
                                                          Sources of inspiration and support                  600+ new patients annually making 1,300+ decisions

                                                                                                               Surgery                                           Chemotherapy
                                                                                                               Lumpectomy                52%                     No chemotherapy          60%
                                                                                                               Mastectomy                12%                     Adjuvant                 27%
                    The Patient Support Corps                                                                                                                    Neo-adjuvant             12%
                                                                                                                 w/Reconstruction        27%
                                                                         Jeff Belkora, PhD                     No Surgery                 9%                     Chemo no surgery          1%
                                             Associate Professor, Surgery and Health Policy                    Radiation                                         Hormone therapy
                                                      University of California, San Francisco                                                                    No                       64%
                                                                                                               Yes                       35%
                                                                                                               No                        65%                     Yes                      36%
Disclosure/Acknowledgment of current funding sources
University of California, San Francisco
The Dartmouth Institute for Health Policy and Clinical Practice
Informed Medical Decisions Foundation
California Breast Cancer Research Program
Robert Wood Johnson Foundation                                                                                                                                  Dr. Laura Esserman
Quantum Leap Healthcare Collaborative                                                                                                                                 Director
The Cancer Support Community




                                                                                                  3                                                                                                       4



          Information and communication needs of patients                                                     Decision and communication aids to address needs
                                                                                                      Reviewing decision                    Question-listing                    Summaries &
   •   At diagnosis: “Too much, too little, conflicting information”                                    aids increases                    increases question-                recordings increase
                                                                                                        knowledge (1)                          asking (2)                   information recall (3)
   •   During visit: “I forgot to ask questions that were keeping me awake”

   •   After the visit: “I can’t recall – it all went in one ear and out the other”




                                                                                                                  Informed and involved patients have better outcomes (4)
                                                                                                                           (1) O'Connor et al: Decision aids…. Cochrane Syst Rev, 2003
                                                                                                             (2) Kinnersley et al: Interventions before consultations …. Cochrane Syst Rev, 2007.
                                                                                                         (3) Pitkethly et al: Recordings or summaries of consultations … Cochrane Syst Rev, 2008.
                                                  Image courtesy of www.speakingaboutpresenting.com     (4) Griffin et al: Effect on health-related outcomes of interventions . Ann Fam Med, 2004. 2(6)




                                                                                                  5                                                                                                       6
                                                                                                                                     Post-bac, pre-med interns =
                                                                                                                                     coaches at UCSF Breast Care Center
                 How coaches can support patient needs
                                                                                                      2005

       Before Visit                         During Visit                      After Visit
                                                                                                             2006
1. Send decision aids              3. Take Notes                        5. Burn CD                                            2007



                                                                                                                                        2008     2009



                                                                                                                                                2010
                                                                                                                                2011
2. List questions                  4. Make audio-recording              6. Print notes


                                                                                                      2012




                                                                                                  7                                                                                                       8


                      RE-AIM Outcomes 2005-2010
                                                                                                                      Patient Support Corps - Strategic Direction
                  DA/CAs = decision/communication aids

   •   Reach:                                                                                            •   Purpose
        – DAs: 208 to 1,027 annually for a 5-year total of 3,208.
                                                                                                              – Patients are informed and involved in their treatment decisions.
        – CAs: from 142 to 348 annually for a 5-year total of 1,228.
   •   Effectiveness                                                                                     •   Vision
        – DAs: improvements in knowledge, decisional conflict                                                 – All patients have the support they need to be informed and involved.
        – CAs: improvements in self-efficacy, question-asking, recall
   •   Adoption:                                                                                         •   Mission
        – DAs: 76% respondents review videos, 93% review booklets                                             – Provide volunteers to assist patients with information and other needs .
        – CAs: 83% respondents review summaries, 56% review recordings
   •   Implementation:
        – 63 pre-medical interns to date performed with high fidelity and satisfaction
                                                                                                                         Expanded in 2012 from UCSF to Dartmouth
   •   Maintenance/Sustainability:
                                                                                                                     Now seeking funds to replicate program nationally
        – Now expanding capacity with UC Berkeley student volunteers
        – Spreading to other clinics around UCSF (e.g. orthopaedics, urology)

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The Patient Support Corps

  • 1. 2 www.jeffbelkora.com/evidence List of references to literature Initial Setting: UCSF Breast Care Center www.jeffbelkora.com/thanks Sources of inspiration and support 600+ new patients annually making 1,300+ decisions Surgery Chemotherapy Lumpectomy 52% No chemotherapy 60% Mastectomy 12% Adjuvant 27% The Patient Support Corps Neo-adjuvant 12% w/Reconstruction 27% Jeff Belkora, PhD No Surgery 9% Chemo no surgery 1% Associate Professor, Surgery and Health Policy Radiation Hormone therapy University of California, San Francisco No 64% Yes 35% No 65% Yes 36% Disclosure/Acknowledgment of current funding sources University of California, San Francisco The Dartmouth Institute for Health Policy and Clinical Practice Informed Medical Decisions Foundation California Breast Cancer Research Program Robert Wood Johnson Foundation Dr. Laura Esserman Quantum Leap Healthcare Collaborative Director The Cancer Support Community 3 4 Information and communication needs of patients Decision and communication aids to address needs Reviewing decision Question-listing Summaries & • At diagnosis: “Too much, too little, conflicting information” aids increases increases question- recordings increase knowledge (1) asking (2) information recall (3) • During visit: “I forgot to ask questions that were keeping me awake” • After the visit: “I can’t recall – it all went in one ear and out the other” Informed and involved patients have better outcomes (4) (1) O'Connor et al: Decision aids…. Cochrane Syst Rev, 2003 (2) Kinnersley et al: Interventions before consultations …. Cochrane Syst Rev, 2007. (3) Pitkethly et al: Recordings or summaries of consultations … Cochrane Syst Rev, 2008. Image courtesy of www.speakingaboutpresenting.com (4) Griffin et al: Effect on health-related outcomes of interventions . Ann Fam Med, 2004. 2(6) 5 6 Post-bac, pre-med interns = coaches at UCSF Breast Care Center How coaches can support patient needs 2005 Before Visit During Visit After Visit 2006 1. Send decision aids 3. Take Notes 5. Burn CD 2007 2008 2009 2010 2011 2. List questions 4. Make audio-recording 6. Print notes 2012 7 8 RE-AIM Outcomes 2005-2010 Patient Support Corps - Strategic Direction DA/CAs = decision/communication aids • Reach: • Purpose – DAs: 208 to 1,027 annually for a 5-year total of 3,208. – Patients are informed and involved in their treatment decisions. – CAs: from 142 to 348 annually for a 5-year total of 1,228. • Effectiveness • Vision – DAs: improvements in knowledge, decisional conflict – All patients have the support they need to be informed and involved. – CAs: improvements in self-efficacy, question-asking, recall • Adoption: • Mission – DAs: 76% respondents review videos, 93% review booklets – Provide volunteers to assist patients with information and other needs . – CAs: 83% respondents review summaries, 56% review recordings • Implementation: – 63 pre-medical interns to date performed with high fidelity and satisfaction Expanded in 2012 from UCSF to Dartmouth • Maintenance/Sustainability: Now seeking funds to replicate program nationally – Now expanding capacity with UC Berkeley student volunteers – Spreading to other clinics around UCSF (e.g. orthopaedics, urology)