ICCN 17

Improving health outcomes around the world

Catharine Grimes – Director, Bristol-Myers Squibb Foundation



Can you tell us about the work undertaken by the Bristol-Myers Squibb Foundation?

The Bristol-Myers Squibb Foundation’s mission is to address health disparities and improve health outcomes around the globe. We are currently running six grant programmes in four geographies of the globe so we have an HIV/AIDS in Africa programme; we have hepatitis in Asia, that’s actually in China, India and South-East Asia; we have a diabetes programme, also in China and India; in the US we have two grant programmes, we have a diabetes programme and a mental health programme and then here in Central and Eastern Europe we’ve got the Bridging Cancer Care programme. Again, all of these grant programmes are working to address health disparities and improve health outcomes. Many people ask why cancer in Central and Eastern Europe; we’re focussing on cancer in Central and Eastern Europe because we know that cancer is the second leading cause of death in Europe and both the incidence and mortality rates are higher in Central and Eastern Europe as compared to the rest of the European Union. We had all of our grantees together here as a pre-conference to the ICCN conference over the weekend and we heard from them that not only are the statistics true, the second leading cause of death, their rates of incidence and mortality are higher than the rest of the European Union, but their rates are continuing to increase across most common cancers. So the disparity in incidence and mortality here fits our mission and so really that’s why we brought the Bridging Cancer Care programme to Central and Eastern Europe.

Can you tell us about your focus on nursing?

We started making grants in the region, the Bridging Cancer Care programme came about in 2008, so next year we will be celebrating our five year anniversary, which we’re very excited about. In 2010 after learning a little bit more about the region and talking to a lot of experts about where’s the biggest gap, where can a foundation like ours make the biggest difference? Is it focussing in one specialty area of cancer or on any particular healthcare professional within cancer control? We really heard that there is such a tremendous need to improve nurses’ skills, knowledge, capacity and capability for delivering cancer care in the community. There is very little cancer training at all in the nursing curriculum so we really felt like there was a lot that we could do. We know that the nurses are spending more time at the bedside with patients and families than any other caregiver, but these nurses in Central and Eastern Europe really aren’t equipped with a lot of the knowledge around cancer. And not only caring for the patients at the bedside and their families and the psychosocial issues that are needed when you have a cancer diagnosis, but even helping, we know that nurses can be very effective at doing education campaigns in the community and really starting to… you know when you look at why are there those disparities in Eastern Europe as compared to the rest of the EU, well there are several reasons. There is really lack of information about cancer from the general public, there’s a lot of myth and misunderstanding about cancer; there is also really a lack of prevention in screening efforts and even in countries that have really good cancer screening programmes as a part of their national healthcare system, the uptake rates are very low, the percentage of utilisation is very low. So we really feel that nurses can do a lot of good in terms of health promotion, prevention, driving the population into screening programmes as well as caring for patients at the bedside but they need knowledge, they need education and training in cancer care. So a lot of our programmes have been focussed on developing curriculum and what we’re going to be moving to going forward is, rather than continuing to develop new curriculum in each one of the countries, is to take some of the great curriculum that we have and start to not only work in-country and try to work with schools of nursing and get some of those curriculum embedded so that it does become a part of the formal education for nurses but also start to get it translated and start to share some of the great projects and programmes from any one of the five Bridging Cancer Care countries into the others. The Bridging Cancer Care programme is active in five Central and Eastern European countries. We’re making grants in Russia, Romania, Hungary, Poland and the Czech Republic.

Can you give examples of the programmes presented at the conference?

Yesterday we were very honoured to have a lunchtime symposium at the ICCN. What we did is we highlighted four of our grant programmes that really represented nursing in cancer care, one in prevention, one in early detection, one in capacity building and one in palliative care. So, for example, our prevention programme that was highlighted at the conference is a grant to the ISNCC to do a lot of this really great smoking cessation work that they’re doing. The grant that we have with the ISNCC was to work with nurses in the Czech Republic, train them on some really evidence-based practices around smoking cessation and get them first educated on what some of the practices are to help patients quit and then get them to commit to start to work with each and every patient that they see who is interested in quitting smoking and implement one of these evidence-based best practices they’ve been trained on. So they first did a train the trainer model, they developed the curriculum in Czech with those nurse leader trainers, trained them on the curriculum and then had those trainers all in Czech train. I think they had thirty nurses here, also as a pre-conference, over the weekend where they trained them. So that was an example of one of our prevention programmes.

Our early detection programme that was highlighted here at the conference is a grant to Project Hope to improve early detection of childhood cancers in Poland. The statistics are that where the rest of the European Union childhood cancer is diagnosed in stage 1 and stage 2 around 25%, still a very low number, in Poland it’s only 10%; only 10% of the child hood cancers are diagnosed in stage 1 and stage 2. So this is a programme to train a team of master trainers at the tertiary care cancer centres in five regions in Poland and have those master trainers then go out to the primary care and community setting and train those providers on recognising signs and symptoms of cancer and helping them to detect and refer earlier. So it really is a very grassroots programme to train those primary care professionals who are seeing these paediatricians and the family care doctors and nurses who are seeing these patients for the first time to be better educated around recognising potential signs of cancer so they can get them to the cancer centres and get diagnosed early. So that’s an example of a really powerful programme we have on early detection.

Then we have a palliative care programme where we actually partnered with the Soros, the Open Society, where they funded the part one of the grant that brought nurse leaders from all five of our Bridging Cancer Care countries to Salzburg and trained those nurse leaders on an evidence-based best practice curriculum in palliative care for nursing called ELNEC, the End of Life Nursing Education Consortium. Then our grant funded phase two where we followed each of those nurse leaders back into their countries, paired them with two experts from the US for skills transfer and helped them to then organise training in their own country. I think we’ve just come to the end of that two-year grant and the numbers are something like over 500 nurses have now been trained in this End of Life Nursing Education Consortium and evidence-based best practice that’s been around for a while. So we really do believe that nurses can only practice what they know and nurses do want to help patients at all aspects of their life. Certainly at end of life they want to make sure that their patients are comfortable, have a peaceful death and can die in dignity but they really haven’t heretofore been trained in palliative care so they can really only do what they know. So we think that that’s also just a really wonderful programme that’s providing tremendous benefit and value to these nurses.

Can you tell us about the announcement made at the conference?

We announced our 2012 grants. We’ve got five new grants in the region, we’ve got two grants in Romania, one is to Hospice Casa Sperantei. They’re really going to continue a lot of that work, they were the implementation partner on the first ELNEC grant, the nurse leaders from the Hospice Casa Sperantei were the ones that came to Salzburg and went back and trained nurses in Romania. They are now taking this grant and continuing with it, really establishing themselves as a centre of excellence in palliative care in the region. They’re going to not only develop two additional levels of palliative care education, the ELNEC fits in to the B level, if you will, of palliative care curriculum and they’re going to develop the A, which is the very basic for a more rural community nurse, and a C, which is a more advanced palliative care curriculum which is also going to consist of a leadership component. They’re actually going to be inviting the nurse leaders back that all came to Salzburg that were identified, invite them back now to Romania to do the C level training once it’s developed and go through the nurse leading. So we know that leadership is a huge important skill that’s needed as well along with this basic disease education. So we’re thrilled to see what Hospice Casa Sperantei is going do as they continue as a partner of ours directly this time.

Hospices of Hope is a UK-based organisation doing work also in Romania and they’re looking to pilot a key nurse specialist role. This is part advocate, part navigator, part care co-ordinator so a really innovative programme that’s really going to put nurse at the centre of leading patient care and navigation and advocacy. Then we’re happy to be announcing another grant to the ISNCC to continue their great work they’re doing on smoking cessation, in this case we’re going to expand into Poland so we’re going to continue in the Czech Republic, expand to Poland and they’re going to be developing, piloting and testing an e-learning platform as well as a toolkit to reach these nurses and help them to more effectively help patients quit smoking. Our final two grants are both in Russia, one is to the Russian Nurses Association; this is really a chemotherapy safety and quality improvement initiative. So they’re going to be developing a curriculum training nurses, clinic-based as well as home-based nurses, in chemotherapy safety and quality administration. The final one is to a rural organisation, or an organisation in rural Russia, to really create these nurse-led community centres. So the nurses are going to be working with not only families and family caregivers of patients with cancer but they’re going to also be reaching out to the primary care setting and training other healthcare professionals on early detection, screening, diagnosis. So a real solid resource in the community in this rural area of Russia to improve the awareness and delivery of cancer care and control. So we’re very excited about these new grants.

What impact do you feel you’ve made in this region?

What we’ve learned, and especially we think has been validated being here among all these nurse leaders from around the world at ICCN, is we’ve realised we really are the only source of private funding focussing on nursing and improving nurses’ ability to delivery cancer care in the community. So we feel very proud to be that, we feel very proud to be a partner with all of these wonderful organisations doing this wonderful work. To date, since 2008, we’ve made 29 grants totalling about 3.7 million so we also just feel really proud about really being here with and for these nurses and starting to build the base of our projects and really starting to see some of the great results that we’re getting now.