Extending the reach of Cancer Coaching through technology

Objectives

• Address the gaps in the patients’ physical, emotional, informational, and spiritual care related to their cancer care journey 
• Expand health and social care for cancer survivors beyond the bricks and mortar of the clinic with virtual care technology 
• Help cancer patients and survivors become active participants in their own care

Model

Cancer Coaching is a health and social care program developed by the Ottawa Regional Cancer Foundation (Cancer Foundation). It is available for individuals and their families who have been touched by cancer and would benefit from the support of a Cancer Coach. It combines several best practices, taking elements of each model and applying them to the healthcare landscape in Canada: 

• Canadian Partnership Against Cancer patient navigation models 
• Survivorship Care Plans from the U.S.-based Livestrong Foundation 
• Person-centred care model from the UK’s MacMillan Cancer Support charity 
• HealthChange Methodology from Australia 

Patients are directed to the program by clinicians, community partners, outreach and awareness campaigns, and by word of mouth. A medical referral is not required; individuals seeking cancer coaching have the option to self-enrol online or can be enrolled in person. Self-enrollers can select: 

• Which cancer coach they want to meet with 
• Which location they also want to visit (if they want in-person coaching) 
• How they want to receive their coaching (online, in person) 

Through the Cancer Foundation’s website, patients and their families can download the NexJ Connected Wellness coaching platform onto their smartphone, tablet or computer for free to access an action plan guiding them through their cancer journey. The platform instantly provides virtual access to education, practical guidance, navigation assistance, and content to help meet the health and wellness goals of participants. Individuals can also consolidate their health information and share it with their circle of care, which may include family, friends, advocates, and health care professionals. They can also schedule their own appointments and securely message their coach. 1-on-1 cancer coaching is available for up to 5 hours over a 1 year period as a source of personalized educational contact and guidance to ensure continuity of care during the recovery period. Participants also continue to have access to educational material following their graduation from the coaching phase of the program.

During virtual or in-person coaching sessions, individuals connect with their personal cancer coach (a health care professional with a background in oncology and trained as a health coach) to access self-management support for behavioral change around health, goal setting, problem solving, decision making, skills development, and psychosocial support for practical, informational, physical, emotional and spiritual issues. Recently, the Cancer Foundation has included the use of the Patient Activation Measure (PAM) into the platform to improve the assessment of a participant’s level of activation, thereby providing the health coach with greater insight into how to best support an individual. 

Technology Type:

The NexJ Connected Wellness platform enables care continuation and collaboration, whereby:

• Participants can grant access to members of their extended circle of care, which may include their family, friends, advocates, and healthcare professionals; any member within the patient’s circle of care can efficiently communicate with each other in real-time
• Patient-facing care plans (which include information about the patient’s condition, what treatments have happened to date, and a roadmap to health including what treatments are expected next, etc.) are created for each participant, allowing participants and their family stay informed
• Participants can easily schedule their own appointments and securely message their coach
• Patient education is unlocked sequentially throughout the length of the program based on the timing of treatment and phase of recovery
• The Program is written in lay-language, educational Workbooks can include interactive questionnaires, multi-media content, links to Health Library information, and content such as videos.
• Video calling and secure messaging enables participants to connect remotely and in real-time with their cancer coach from where they are
• Tracking of self-assessed biometrics such as weight, daily activities such as exercise, food intake, as well as subjective information such as how the participant feels. Participants can also automatically capture their personal health information (i.e., distance, weight, sleep) with wearable health devices (i.e., Fitbit, Jawbone UP, Withings) and can view their progress charts to compare multiple trackers against one another.

The online aspect of the program affords a high degree of accessibility, which allows coaches to engage with patients where they are and helps to break down the transportation and financial barriers that can affect program participation and completion.

Outcomes

Patient Activation Results (data collected from Apr. 1, 2018 – Aug.21-2019) 

With the recent addition of the PAM tool to this care model, new data will be available to demonstrate the impact of the coaching model on the activation levels of participants at 3, 6, 9 and 12-month intervals. The PAM tool is a clinically validated measure that has demonstrated significant health system impacts (i.e. reduced ED visits and hospitalizations) as a person’s level of activation improves. 

Clients with an initial PAM score placing them in Level 1 (the lowest category) improved their scores by 6.7 points, resulting in a 70.6% improvement. 
Level 2 clients improved 3.92 points, resulting in 60% improvement 
Level 3 scores improved 3.7 points, resulting in 61% improvement 

Activated patients are more engaged in their care and have a better ability to achieve their quality of life goals.

Change Required to Support the Model

When designing the program, it was essential that all the coaches were registered health care professionals with an oncology background. The model required a shift in mentality, as health coaches working with individuals must be comfortable with stepping out of their advice-giving health provider role and more into a partnership role, to work collaboratively with patients to achieve their goals. Currently the Cancer Foundation has 2.8 FTE staff dedicated to the Cancer Coaching program that includes the virtual care, face to face and telephone service delivery options. The Cancer Foundation also has partners that are coaching on a part-time basis at their organizations (2 professionals coaching approx. half a day per week). 

Adoption Rate

More than 400 individuals/families actively work with a cancer coach each month. The online component, launched in May 2018, has seen 500 patients onboarded on the NexJ Connected Wellness platform. Prior to the addition of a virtual platform, there were no ongoing communication tools in place to facilitate the coach-participant therapeutic relationship. Now approximately 6% of all coaching conversations take place virtually on NexJ Connected Wellness. Of the participants with access to the platform, 69% have become ‘activated’ users on the platform, which includes completing educational workbooks, viewing and responding to messages from their coach between sessions, using trackers, and exploring educational materials. 

The Cancer Foundation aims to increase this percentage with further engagement with their partners, participants and via social media campaigns.

Disclaimer

OTN is an independent, not-for-profit organization funded by the Government of Ontario. The views expressed here are the views of OTN, or the respective authors if a third-party, and do not necessarily reflect those of the Province. For further information, please note the Proprietary Rights detailed within the OTN Terms of Service available at https://otn.stagingotn.ca/terms-conditions/