1. Barriers to Breast Cancer Treatment

2. Barbara A. Given, PhD, RN, FAAN University Distinguished Professor Director of Doctoral Program College of Nursing Bgiven@msu.edu Wednesday, December 12, 2012 – Capital Area Community Nurses Association (CCACNN) Symposium Michigan State University East Lansing, MI

3. Cancer Treatment Who has access? What are some of the barriers?

4. Breast Cancer Patient Experience during Active Treatment Numerous unmet needs  Information – Uncertainty  Depression and Anxiety  Symptoms – Unmanaged  Actual physical  Communication  Lack of coordinated care  Limited choice

5. Barriers in our local area Barriers to supportive care during treatment include:  “Comprehensive” Cancer Care  Coordination of Care - transitions  Systematic Guidelines for Symptom/ Side effect Management – treatment side effect  No Systematic Psycho-Educational Programs  Lack of Electronic Interactive Support Programs  Limited Supportive Care Research other than drug trials  Survivorship Care Plans limited in number and scope

6. Differences for low income and ethnic groups  Generally differences would not be because of race or ethnicity, but low education and income  Lack of communication skills and knowledge, so not sure how to advocate for self  Lack of information and access  Numerous psychological and social barriers to access  Lack of referrals to support care (2 nd opinion to hospice)  Family programs not common

7. Barriers likely to disappear Depends on the programs established.  Do we believe in Psychoeducational Programs for all?  Do we use electronic supportive tools?  Are programs geared to those without the resources and skills to express needs? - screening  Transitions in phases of care need to be seamless.  Use of Electronic Medical Records  Will we have real Medical Homes?  Full use of professional roles

8. Strategies to Remove Barriers  Agree to community standards and guidelines – consistent with national guidelines  Clear outcomes for each phase of the illness – psychological and physical  Screening programs to capture high-risk patients  Tailor and target – individualized plan  Guide and teach for living with breast cancer  Patient-centered care – a priority  Good coordination of care

9. The Key  Evidence-based patient-centered approach across the breast cancer care trajectory for all women.