It’s been 10 years since the Prospective Surveillance Model (PSM) was published. This landmark literature has changed our entire paradigm of how we treat people with cancer.
We know that PSM is cost-effective, can prevent functional decline, can result in better treatment outcomes, & helps patients get back to what is most important to them faster.
So why is it still so rare to see it implemented?
That’s exactly what Dr. Nicole Stout & I are diving into, as well as what we MUST do about it in today’s episode.
What is the Prospective Surveillance Model?
As Nicole explains:
A cancer rehab provider in the cancer care delivery system to prospectively evaluate & monitor individuals going through cancer treatments. We evaluate their function & monitor them over the course of treatment to identify clinically meaningful changes so that we can intervene early.
The PSM is a “screen & triage” model, meaning that we evaluate patients for a problem & then get them connected with the next appropriate step.
In some cases, this means a full PT evaluation, plan of care, & treatment sessions. But for many patients, we’ll schedule them to come back in 3-6 months if they’re not demonstrating any impairments (or risks of impairments).
This approach helps monitor patients for developing impairments with consideration for the financial toxicity many patients experience due to their cancer.
The double edge sword of this landmark achievement
PSM literature changed the game for cancer rehab. But it’s still not taking
For a prospective surveillance model to work, all parties involved must work towards it.
AND: we have to work smarter towards this goal. Nicole discusses how we have to use different metrics & outcomes to demonstrate how beneficial PSM is. This has to change from how we typically demonstrate “efficacy” & “success” in orthopedic outpatient physical therapy.
This approach dooms Cancer Rehab to fail:
If you’re trying to fit cancer rehab into the typical “orthopedic outpatient PT mill,” cancer rehab is destined to fail.
If you’re trying to fit one model of PSM into your practice & it’s not working, then make it work for your patients & your practice.
Nicole encourages us to re-examine how we are trying to get buy-in from oncologists, patients, & other stakeholders in the cancer care continuum. There is no one-size-fits-all.
It’s critical to understand how to insert cancer rehab into the current system effectively: where can you intersect with the patient & “bring the least amount of burden to other providers”?
So how do we make PSM work? Through Implementation Science:
Nicole dropped STRAIGHT FIRE on how to really make PSM work through the lens of critical analysis (no calculator required). Make sure to check out the resources she shared:
- This is the NCI’s Training Institute for Dissemination and Implementation Research in Cancer. These are FREE training modules on implementation science: https://cancercontrol.cancer.gov/is/training-education/training-in-cancer/TIDIRC-open-access
- This is the Consolidated Framework for Implementation Research website. They have tools and templates, provide evidence-based materials to support implementation efforts: https://cfirguide.org/
- This is the RE-AIM and PRISM implementation website. More frameworks here. RE-AIM is more of an evaluative framework of implementation efforts: https://re-aim.org/
- This is the EPIS framework. EPIS (explore, prepare, implement, sustain) is one of the most simple frameworks to guide implementation and I think one of the easiest for clinicians to grasp and follow: https://episframework.com/
- This is an excellent FREE meeting for folks interested in engaging in cancer-related implementation science can attend: https://cancercontrol.cancer.gov/is/initiatives/ccis
Want more from Nicole Stout?
Nicole, Shana Harrington, Chris Wilson, & Chris Barnes are all presenting on how to effectively Implement Cancer Rehab at APTA-CSM 2023. Don’t forget to register for their session on Friday, February 24 at 3:00-5:00pm!
Until next time, this is Elise with TheOncoPT. And remember you are exactly the physical therapist that your patients with cancer need. So let’s get to work.
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