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Copy of Copy of Yoga: Its Effect on Mind, Body, Spirit

It is my hope that this presentation will 1.) examine yoga as a practice through research 2.) provide an example of its acclaimed mental, physical and spiritual benefits through my own experiences with the mind-body exercise.
by

Rachel Francis

on 16 March 2015

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Transcript of Copy of Copy of Yoga: Its Effect on Mind, Body, Spirit

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The Effect of a Yoga Therapy Program among Cancer Patients: An Analysis of Personal, Psychological, and Economic Impacts
Background Information
CANCER

Cancer is the 2nd leading cause of death in the U.S. and accounts for 1 of every 4 deaths (ACS, 2013).
Deaths from cancer are projected to hit approximately 13.1 million deaths in the year 2030 (WHO, 2013).
The cost associated with the 13.2 million people diagnosed with cancer world-wide in 2010 was an estimated $290 billion (ACS, 2013).
Some estimates suggest as many as 96% of people report experiencing some sort of side effect to cancer treatment (Metcalf, 2008).

YOGA

Current estimates suggest that almost 7% of American adults currently practice yoga (Macy, 2008).
Over half of cancer survivors in the U.S. turn to CAM after cancer diagnosis (Park et al.,


Target Population:
Individuals over the age of 18
diagnosed with a form of cancer
requiring chemotherapy or radiation treatment
Intervention
A yoga and meditative practice to be conducted simultaneously with chemotherapy/radiation treatments
30 minute sessions 3 times per week for 12 weeks taught by a certified yoga instructor
Different levels of program to allow for a variety of different individual capabilities to participate
Collaboration with physicians and insurance companies to increase referrals and gain financial support
Program Benefits
Reduced Absenteeism
Healthier employees spend fewer days away from work due to illness, saving the company thousands of dollars on down time and temp help. Wellness programs also alleviate depression and help employees manage their time and stress levels, which contribute to productivity loss.
The average cost of absenteeism per employee is $1,387/year.
On-site employee wellness programs reduce overall absenteeism by 19%, resulting in a savings of $264 per employee, per year.
Employees participating in wellness programs take 70% fewer sick days than those opting out of wellness. (Source: WELCOA)
Analysis

Cancer is one of the most costly and disabling conditions

Many health promotion programs typically focus on prevention of such conditions

Cancer treatments typically include chemotherapy and radiation which target not only cancerous cells, but healthy cells as well
This leads to adverse side effects experienced during treatment

Although not much research exisits on non-traditional treatments and cancer, the studies that have been conducted do show some favorable support for the reduction of adverse side effects

Positive effects on mental and emotional benefits
SMART Model

Phase I - Preliminary Planning
Phase II - Consumer Analysis
Phase III - Market Analysis
Phase IV - Channel Analysis
Phase V - Develop Interventions, Materials & Pretest
Phase VI - Implementation
Phase VII - Evaluation
Rationale

Overall cancer diagnoses and deaths have been declining
As of 2010, an estimated 767,000 deaths from cancer have been avoided
However, 1500 people still die every day as a result of cancer
Cancer is the leading cause of death in the U.S. for individuals ages 40-79
The probabilty of developing cancer in a lifetime is 44% for men and 38% for women
Despite health promotion initiatives to prevent cancer, anyone is at risk
By the year 2030, it is estimated that 2.3 million people in the U.S. will be living with a diagnosis of cancer (compared to 1.6 million in 2010)
Prevelance rates of chronic pain is 30-50% of cancer patients currently undergoing treatments
That number increases to 70-90% of individuals with advanced stage cancer
Locally, 9200 people are diagnosed with cancer per year from the Northeast PA region, 1,373 people are from Lackawanna County alone
Although there are a few local programs promoting wellness for individuals with cancer, services are not offered simultaneously or consistently
Mission Statement
The StrongCalm&Balanced Program is a community-based program dedicated to empowering cancer patients and survivors to improve their quality of life through yoga and meditative practices.
Program Goals
Short-term Goals
•Increase awareness of available yoga & meditative programs
•Increase participation in yoga & meditative programs
•Increase physical and mental wellness during chemotherapy and radiation treatments
•Increase commitment to adopt effective programs and policies for physical and mental wellness for individuals with cancer
•Increase number of effective physical and mental wellness programs adopted
•Increase access to physical and mental wellness programs for cancer patients and survivors
•Increase provider recommendation to yoga and meditative programs
Long-term Goals
•Increase patient adherence to yoga and meditative programs during chemotherapy and radiation treatments.
•Reduction in reported physical and mental ailments associated with chemotherapy and radiation treatments
•Reduction in time off work and time away from personal events
•Reduction in severity and duration of side effects associated with radiation and chemotherapy treatments
Program Objectives
•Development of cancer wellness programs for the NEPA region
•Reduction in barriers to yoga and meditative programs
•Involvement of insurance companies
•Increased adoption of provider and patient reminder systems
•Increased knowledge and improved attitudes about the need for yoga and meditative programs
•Increased provider knowledge of yoga and meditative programs available to cancer patients
Theoretical Base
Community Readiness Model

Nine Stage Model
No awareness
Denial
Vague Awareness
Preplanning
Preparation
Initiation
Stabilization
Confirmation/Expansion
Professionalism
Intervention
Logic Model
Agenda
Background/Literature Review
Study Design & Methodology
Population & Study Sample
Results
Theoretical Integration of Findings
Recommendations
Conclusion
SMART Model - Phase I

1.Cancer patients undergoing chemotherapy and/or radiation treatments experience side effects to the treatments often including physical, mental and emotional side effects. The proposed program will target this population and offer a yoga and meditative program simultaneously to their chemotherapy and radiation treatments.

2.General Goals
a.Reduce severity and duration of side effects associated with radiation and chemotherapy treatments
b.Increase community awareness of wellness programs for cancer patients
c.Increase physician and insurance company participation
d.Reduction in barriers to yoga and meditative programs for cancer patients

3.Evaluation
a.Program evaluation will occur in a series of stages:
i.Preliminary surveys to identify the extent to which individuals are aware of the benefits of meditative practices,
actively practice, would begin practice and under which conditions practice would occur
ii.Evaluation of physical and mental wellness prior to beginning a meditative program (for individuals with and
without cancer to account for mental impact of being recently diagnosed).
iii.Evaluation during meditative practice
iv.Evaluation following the completion of an 8-12 week meditative practice regimen.

4.Projected Costs
a.Start-up costs to begin the yoga and meditation program including studio space to practice plus cost for instructors
and studio maintenance
b.Costs related to advertising for program
c.Costs related to marketing and sales initiatives for physicians and insurance companies
SMART Model - Phase II

1.Priority Population
a.Cancer patients receiving chemotherapy and/or radiation treatments

2.Formulative Research
a.Conduct in-depth analysis on incidence and prevalence rates of cancer nationally, regionally, and locally
b.Gather information on locally offered program for cancer patients, including cost, frequency of participation and evaluations on effectiveness
c.Conduct a local survey of target population to identify needs, barriers, preferences and risks
d.Collect information on nationally, regionally and locally insurance funded programs for cancer patients that are
used simultaneously with cancer treatments
e.Conduct a regional and national survey on cost of non-traditional treatment programs for cancer patients
(insurance funded or free standing)

3.Consumer wants, needs, and preferences
a.Wants – Cancer patients wants may include; less intense/no side effects from chemotherapy and radiation treatments
b.Needs – Cancer patients needs may include programs and space to engage in mild/gentle forms of exercise and
meditation to lessen side effects associated with the cancer treatments
c.Preferences – Cancer patients preferences may include choices and options on types of yoga and meditation they choose
to practice, options on where to practice (home vs. studio), and cost consciousness for these proposed programs

4.Preliminary Ideas for Interventions
a.Set up an active yoga and meditation program for cancer patients
b.Encourage participation from physicians and insurance companies to generate referrals and provide an insurance covered options for greater access to program by cancer patients
SMART Model - Phase III

Establish and define the Market Mix (4 P’s)
Product – Service
Yoga instruction modified to individual level of ability for 30 minutes 3 times per week. This will be conducted in either a group or individual setting per the preference of the individual and led by a specialized instructor trained at the 200 hour yoga-certification level with experience leading cancer patients in yoga and meditative practices.

Price – Time & Energy, Money
Individuals receiving chemotherapy and radiation treatments may have limited energy to complete the abovementioned program. This will require them to expend an effort on their part to attend classes 3 times per week and endure 30 minutes of guided yoga and meditation.
Individuals may be required to pay for classes if not covered by their insurance company or if they have no insurance.

Place – Location & Accessibility
Local yoga studios will be encouraged to participate in this network to offer a variety of classes at many locations throughout the area.
Use of Facetime and IPad2/IPhone apps for use in an individual’s home if group classes are not an option.
Availability of instructors for individual sessions in patients home

Promotion – Increasing Awareness
Direct Marketing – Informing cancer patients of program through physicians and insurance companies. Availability of literature to target group.
Internet/Interactive Marketing – Use of program website, along with current social outlets such as Twitter, Facebook, e-mail lists, RSS feeds, etc.
SMART Model - Phase IV

Identify appropriate communication messages, strategies and channels
Need for available and pertinent literature about yoga and meditation for cancer patients and their families.
Online advertising via program website along with websites of collaborative yoga studios
Organizational communication via physicians, insurance companies and health care providers to cancer patients and their families.

Assess options for program distribution
Utilization of local yoga studios will be encouraged to participate in this network to offer a variety of classes at many locations throughout the area.
Use of Facetime and IPad2/IPhone apps for use in an individual’s home if group classes are not an option.
Availability of instructors for individual sessions in patients home

Identify communication roles for program partners
Information for cancer patients that can be available at local yoga studios
Information for cancer patients available through physician’s offices
Information provided by health promotion programs
Use of health and wellness fairs and job and worksite wellness campaigns
SMART Model - Phase V

Develop program interventions and materials using information collected in consumer, market and channel analyses.
In depth analysis of national and local cancer incidence and prevalence rates
Types of programs offered locally to cancer patients and frequency of use
Information from physicians and patients about preferences, barriers and needs

Interpret the marketing mix into a strategy that represents exchange and societal good
Design a marketing strategy to promote healthy lifestyles for cancer patients that will engage the community participants

Pretest and refine the program
Launch a small-scale pilot program on a target population of 10-20 patients
SMART Model - Phase VI

Communicate with partners and clarify involvement
Follow-up with physicians and insurance companies with regards to referrals and information
Ensuring that all parties involved (physicians, health care providers, yoga studios, insurance companies) have all necessary materials for distribution
Confirming participation of all involved parties

Activate communication and distribution strategies
Begin the process of direct mailings and communications
Actively participate in advertising of the program
Initiate referral process
Begin yoga instruction

Document procedures and compare progress to timelines
Gather statistics on performance and participation by target community
Document and streamline referral process

Refine the program
Based on gathered statistics as well as patient feedback, make modifications to program as necessary
SMART Model - Phase VII
Assess the degree to which the priority population is receiving the program
Initiate evaluation process from Phase I
Begin to compile data from earlier evaluations that took place prior to program initiation

Assess the immediate impact on the priority population and refine program as necessary
Evaluations on efficacy of program on patients health and improvements
Refine program as necessary

Ensure that program delivery is consistent with established protocol
Spot check yoga classes to ensure instruction is consistent with outlined program and modifications

Analyze changes in priority population
Compile data from post program evaluations to determine improvements in health from self report data
Assess adherence to yoga and meditative programs once program is completed
Rationale
Several benefits can be anticipated from the StrongCalm&Balanced Program

Reduction in adverse side effects associated with chemotherapy and radiation treatments
Participation and support of physicians and insurance companies
Reduction in mental and emotional effects of living with cancer

Potential for Success

Large community involved in yoga wellness practicing currently
A few local programs assisting cancer patients and survivors have been successful in the community of Northeast PA
Program will be well planned and will meet the needs and interests of the cancer community memebers

Healthy People 2020

Helps to achieve the Healthy People 2020 goal of reducing illness and disability of individuals with cancer.
Program Objectives

•Development of cancer wellness programs for the NEPA region
•Reduction in barriers to yoga and meditative programs
•Involvement of insurance companies
•Increased adoption of provider and patient reminder systems
•Increased knowledge and improved attitudes about the need for yoga and meditative programs
Intervention

3 weekly gentle yoga classes for 30 minutes
Program will run for 12 weeks
Taught by a yoga instructor certified by the National Yoga Alliance
at the 200 hr level or higher with cancer-specific training
Yoga classes will be offered in collaborative studios, health centers and the home of individual patients
Closed group format with no more than 12 members per class
More classes will be added to schedule to accomodate increasing class sizes

Home yoga is discouraged without supervision of a yoga instructor
Encouragement to continue with a yoga regimen once program is completed

The 12 week series will combine asanas, pranyama, and savasana
Classes organized in a tiered level so that multiple levels can participate in classes
Intervention

Modified Versions

•Relaxation I – Require little to no movement or transition into different asanas. Encourages the practice of pranayama in standing, seating or supine positions
•Relaxation II – Minimal movement or transition into asanas. Encourages the practice of pranayama in greatly modified positions. Individuals will be guided by the instructor into different asanas
•Yoga Practice I – Moderate movement or transition into asanas. Encourages the practice of pranayama in moderately modified positions. Individuals can progress through asanas and pranayama either on their own or with the assistance of the instructor
•Yoga Practice II – Full range to minimal modification of asanas. Encourages the practice of pranayama through full expression of the positions. Little to no assistance from instructor.
•Savasana – All levels will participate in guided savasana for 10 minutes at the end of each class
Evaluation

Pilot Testing
Social Survey on Non-Traditional Treatment Awareness
SF-12 Health Survey
Functional Assessment of Cancer Therapy (FACT-G)
Program Evaluation
References

Cella, D.F., Tulsky, D.S., & Gray, G. (1993). The Functional Assessment of Cancer Therapy Scale:
Development and Validation of the General Measure. Journal of Clinical Oncology. 11. 570-579

Guy, D. (2011). Yoga Poses for Cancer Treatment. Retrieved from: http://nebraskacancercare.com/yoga-poses-for-cancer-treatment.html

Healthy People 2020 (2011). Retrieved from: http://www.healthypeople.gov/2020/default.aspx

Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA: Cancer J Clin, 2009; 59;225-249. doi: 10.3322/caac.20006

Lawsin, C.R., Borrayo, E.A., Edwards, R. & Belloso, C. (2006). Using a Community Readiness Model to Help Overcome Breast Health Disparities Among U.S. Latinas. Substance Abuse & Misuse.
42(4). 603-619

Lesko, S.M. (2011). Cancer in Northeastern Pennsylvania: Incidence, Mortality and Survival for
Common Cancers. Retrieved from: Northeast Regional Cancer Institute website.
http://www.cancernepa.org/PDF/Cancer%20in%20NEPA%20May%202011.pdf

Lichtenfeld, J.L. (2010). The 2010 Statistics are Out, and 767,000 People Have Celebrated More
Birthdays. Retrieved from: http://www.cancer.org

Reynolds, D. (2009). Yoga Benefits Cancer Patients. Yoga Journal. Retrieved from:
http://www.emaxhealth.com/1506/51/34310/yoga-benefits-cancer-patients.html

SEER (2011). SEER Cancer Statistics Review: 1975-2008. National Cancer Institute. Retrieved from:
http://seer.cancer.gov/csr/1975_2008/index.html

Ware, J.E., Kosiniski, M., & Keller, S.D. (1996). A 12-item short form health survey: Construction of
scales and preliminary tests of reliability and validity. Medical Care. 34: 220-233
Rachel T. Francis, M.A.
March 20, 2015
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