The Northern Health Oncology Department and Cancer Survivorship Surveillance Clinic have implemented an evidence-based assessment tool to measure individuals activation levels, helping clinicians provide more specialised care to their patients.

The Patient Activation Measure (PAM) is a valuable questionnaire tool used to assess an individuals’ knowledge, skill and confidence (referred to as ‘patient activation’) for managing their own health and healthcare.

Patient activation can be increased by offering support and providing opportunities to develop general health knowledge and specific condition knowledge like cancer and skills. Clinicians can proactively align resources and tailor support depending on a patient’s level of activation. Higher activation levels equate to patients with healthy behaviours, overall better outcomes, and fewer episodes of unplanned and emergency care.

Patients with high levels of activation also understand their role when a diagnosis of cancer or other conditions have been made. Individuals with long-term or chronic conditions, who are more highly activated, are more likely to engage in positive health behaviours to manage their health conditions more effectively. People who have low levels of activation are less likely to play an active role in staying healthy and seeking help when they may need it. They may also find it hard to follow advice given by healthcare professionals.

The PAM is a great screening tool for identifying those most at risk for future health issues. Through measuring a patient’s activation level, clinicians are provided with an opportunity to explore concerns of patients that attain a low level, and open discussions that perhaps would not have normally occurred. It also provides valuable insights into patient’s lifestyle risks, quality of life and any long-term effects that can help doctors tailor their strategies to guide patient’s post cancer treatment and transition into their new life.  

The Clinical Leadership, Effectiveness and Outcomes (CLEO) team has facilitated the implementation of the PAM into Oncology and the Cancer Survivorship Surveillance Clinic here at Northern Health.

Patients are asked to complete a short 10-question survey before an initial visit to clinic, and then again, every three months. The survey asks patients to indicate how much they agree or disagree with statements and combines answers to determine a patient’s activation level.

Three core functions or uses for the PAM include its predicative power in risk identification, tailoring support based off a patient’s activation level, and measuring impact over time using the scoring system.

“When I first heard about the PAM, it was a ‘light bulb’ moment for me as a nurse,” said Tracey Webster, Director, CLEO.

“I can now really understand why some patients find it difficult to engage with managing their long-term conditions or may not show interest in their condition. It has been wonderful to be part of the digital health implementation to know that clinicians can now tailor what they are teaching patients or discussing about their condition, and it can be more meaningful for the patient.”

“Clinicians can help patients to develop the confidence and understanding to allow them to participate more fully in the management of their health and care. This will assist patients to improve their health-related behaviours, and result in better outcomes, better experiences of care.”

The Northern Health Cancer Survivorship Surveillance Clinic (CSSC) is a new service developed to improve and support the wellbeing of patients of survived haematology cancers.

Through establishing the survivorship surveillance clinic, clinicians can monitor, follow up and discuss the ongoing importance of surveillance to improve patients physical, psychological and general wellbeing. The clinic screens patients who are at higher risk of developing secondary cancers and provides the opportunity for early interventions. Patients receive a comprehensive care plan that is developed and shared with their GP, whilst also offering patients direct contact for support within the hospital.  

Unlike other cancer survivorship clinics, Northern Health focuses on both surveillance/maintenance while undergoing oral treatment, and survivorship, whilst other programs generally only focus on survivorship.  Northern Health offers patients the opportunity to be seen as early as four weeks post treatment in comparison to many survivorship clinics, where patients are often not seen until one year post-treatment.   

The CSSC is one of the first Northern Health patient cohorts to implement the PAM into its program. Despite being early in its implementation, clinicians are already seeing the value of how the PAM can positively change a patient’s level of activation. 

Clinicians can engage with their patients to generate different types of conversations that would not perhaps have occurred previously. As a survey, patients see the value in being honest with their answers, without having to hide how they are feeling. Having the opportunity to answer truthfully, allows for certain issues to be addressed as patient’s can identify what matters most to them and their lifestyle.   

Associate Professor Wanda Stelmach, Chief Medical Officer, said improving cancer services and the support of cancer patients had always been a career-long aspiration for herself.

“I am delighted to see that our patient’s voices can be heard through this tool. For Northern Health and our clinicians to understand our patient’s struggles and challenges and then to be able to support our patients in their capability to take charge of their lives is an extremely privileged position to be in,” she said.

“I encourage everyone to support this project which will, without doubt, support patients to improve their health-related behaviours and experience better outcomes – and a better survivorship journey.”

The PAM is licensed by Insignia Health and implemented by the CLEO team. For more information, please visit the CLEO Intranet page. If you would like to implement the PAM into your patient cohort, please complete the Expression of Interest form.

Featured image: Karen Matoga, Research Nurse Coordinator and Louise Scolieri, Haematology Nurse Practitioner Candidate.