Stanford University s Chronic Disease Self-Management Program Curriculum and Evidence

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1 Stanford University s Chronic Disease Self-Management Program Curriculum and Evidence What is the Chronic Disease Self-Management Program? The Chronic Disease Self-Management Program (CDSMP), developed by Dr. Kate Lorig at Stanford University, is an evidence-based program offered for two and a half hours, once a week, for six weeks. People with different chronic health problems attend together in community settings such as senior and community centers, churches, libraries, senior housing, retirement communities and physician offices. In Georgia this program is known as Living Well. The workshops are facilitated by two trained leaders; one or both have a chronic condition. The six-week workshop covers techniques to deal with problems such as: frustration, fatigue, pain and isolation; appropriate exercise for maintaining and improving strength, flexibility and endurance; appropriate use of medications; communicating effectively with family, friends and health professionals; nutrition; and how to evaluate new treatments. It is the process in which the CDSMP is taught that makes it effective. Sessions are highly participative, and mutual support and success build participants confidence in their ability to manage their health and maintain active and fulfilling lives. CDSMP is currently offered in 46 states and 19 countries. There are three levels of trainers. T-trainers provide training to Master Trainers. Master Trainers can then train Lay Leaders. Trainings are offered as the need for Lay Leaders and Master Trainers are identified. Assumptions that underlie the CDSMP People with chronic conditions have similar concerns and problems. People with chronic conditions must deal not only with their disease(s), but also with the impact these have on their lives and emotions. Lay people with chronic conditions, when given a detailed leaders manual, can teach the CDSMP as effectively, if not more effectively, than health professionals. The process or way the CDSMP is taught is as important, if not more important, than the workshop s subject matter. Page 1 of 5

2 Six-Week Workshop Curriculum Session One: Principles of self-management Problems caused by chronic illness Difference between chronic disease and acute disease Common elements of various chronic health problems Causes of symptoms Introduction of self-management techniques Overview of "distraction skill" Introduction of action plans as a key self-management tool Session Two: Problem-solving techniques Discussion and management of anger, fear and frustration Benefits of exercise; different types of exercise; choosing an appropriate fitness program Action planning Session Three: Causes of shortness of breath Practice in better breathing techniques Introduction to progressive muscle relaxation Introduction to causes of pain and fatigue Introduction to pain and fatigue management techniques Development and monitoring of an endurance exercise program Action planning Session Four: Overview of good nutrition and rationale for eating better Ways to change eating practices and make healthier eating choices Future plans for health care Techniques for improving communication Practice of problem-solving: helping self and others Action planning Session Five: Medication management Page 2 of 5

3 Differences between drug allergy and side effects Strategies to reduce side effects Overview of depression symptoms and means of managing minor depression Strategies to change negative thinking to positive thinking Action planning Session Six: Communication skills useful for talking with physicians Participant identification of patient s role in care of chronic condition Making a plan to deal with future health problems How was the program evaluated? About 1,000 people with heart disease, lung disease, stroke or arthritis participated in a randomized, controlled test of the program and were followed for up to three years. The Stanford Division of Family and Community Medicine looked for changes in many areas: health status (disability, social/role limitations, pain and physical discomfort, energy/fatigue, shortness of breath, psychological well-being/distress, depression, health distress, self-rated general health); health care utilization (visits to physicians, visits to emergency department, hospital stays, and nights in hospital); self-efficacy (confidence to perform selfmanagement behaviors, manage disease in general and achieve outcomes); and self-management behaviors (exercise, cognitive symptom management, mental stress management/relaxation, use of community resources, communication with physician and advance directives). CDSMP Outcomes CDSMP has undergone extensive evaluation in several countries. The program has been proven effective across socioeconomic and education levels and the health benefits persist over a two-year period even when disability worsens. CDSMP s health and utilization effects, compiled by The Centers for Disease Control and Prevention in partnership with the National Council on Aging, are summarized below. There is strong evidence that CDSMP has a beneficial effect on physical and emotional outcomes and health-related quality of life. Participant outcomes have been evaluated at four months, six months, one year and two years. All Page 3 of 5

4 outcomes reported have statistical significance. Program participants, when compared to non-participants, demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability and social/role activities limitations. They also spent fewer days in the hospital and had fewer outpatient visits and hospitalizations. These data yield a cost-to-savings ratio of approximately 1:10. Many of these results persisted for as long as three years. Does the program replace existing programs and treatments? The Self-Management Workshop will not conflict with existing programs or treatment. It is designed to enhance regular treatment and disease-specific education such as Better Breathers, cardiac rehabilitation or diabetes instruction. In addition, many people have more than one chronic condition. The program is especially helpful for these people, as it gives them the skills to coordinate all they need to manage their health, as well as to help them keep active in their lives. How was the program developed? The Division of Family and Community Medicine in the Department of Medicine at Stanford University received a five-year research grant from the federal Agency for Health Care Research and Policy and the State of California Tobacco-Related Research Project. The purpose of the research was to develop and evaluate, through a randomized controlled trial, a community-based selfmanagement program that assists people with chronic illness. The study was completed in The research project had several investigators: Halsted Holman, MD, Stanford Professor of Medicine; Kate Lorig, DrPH, Stanford Associate Research Professor of Medicine; David Sobel, MD, Regional Director of Patient Education for the Northern California Kaiser Permanente Medical Care Program; Albert Bandura, PhD, Stanford Professor of Psychology; and Byron Brown, Jr., PhD, Stanford Professor of Health Research and Policy. The Program was written by Dr. Lorig, Virginia González, MPH, and Diana Laurent, MPH, all with the Stanford Patient Education Research Center. Ms. González and Ms. Laurent also served as integral members of the research team. The CDSMP process design was based on the experience of the investigators and others with self-efficacy, people s confidence that they can master a new skill or affect their own health. The content of the workshop was the result of focus groups in Page 4 of 5

5 which people with chronic health problems discussed which content areas were the most important for them. For more information, please contact: Chronic Disease Self-Management Coordinator, Atlanta Regional Commission: Serena Weisner The Living Well Chronic Disease Self-Management Program is sponsored by the Atlanta Regional Commission, Area Agency on Aging. Page 5 of 5