Tag Archives: cancer care

Creating a Navigator Orientation Checklist

By Tricia Strusowski, MS, RN

Compass pointing at answers-SMALLI remember when I first started our oncology navigation program in 1998; there were no national standards or core competencies for navigation. The only model I was aware of that followed the patient through different levels of care was the case management model. The goals of the case management model were to coordinate the patient’s care at the appropriate setting while keeping costs down. We discussed the plan of care with the physician and also spoke with the patient and their family to discuss their specific needs and whether their care could be handled at home or whether they needed an alternative care setting or level of care.  

Fast forward to 2016. Today navigation has support from the Institute of Medicine,  the Commission on Cancer has added a navigation standard to its Cancer Program Standards, the Oncology Nursing Society (ONS) has developed oncology nurse navigator  core competencies, and there is a joint position statement on the role of oncology nursing and oncology social work in patient navigation from ONS,  the Association of Oncology Social Work (AOSW), and the National Association of Social Workers (NASW). (Note: The George Washington University Cancer Center has developed core competencies for non-clinical patient navigators.) Today, our navigation programs follow the patient across the care continuum from the earliest point of entry though survivorship or end-of-life services.

Despite the fact that we now have navigation standards and core competencies in place, I still hear from navigators, “I was hired and told, ‘Go navigate.’ I had no idea what that meant.”

So, how do we teach our new navigators? Typically nurses come to the navigator role from varied backgrounds—the inpatient oncology unit, chemotherapy infusion suite, radiation oncology, and home care, just to name a few.

As with any new job, a robust orientation is key; a full navigation curriculum including an orientation checklist and annual competencies is essential for a solid foundation. Here is one example of the elements a navigator orientation checklist might include:

Navigator Orientation Checklist

  • Hospital-specific policies/procedures and mandatory educational programs
  • Navigation history, definition, and models of navigation
  • Benefits and goals of navigation
  • Job description, roles and responsibilities of navigator, and support staff
  • Commission on Cancer Standards and Cancer Committee responsibilities
  • Institute of Medicine; Delivering High-Quality Cancer Care
  • NCCN, ASCO, and other national guidelines
  • Referrals to the navigation program
  • Internal resources, roles and responsibilities:
    Social workers
    Registered dietitian
    Financial assistant/advocate
    Health psychologist
    Pastoral Care
    Genetic counseling
    Cancer  registry
    Rehabilitation team
    Palliative Care team
    Hospice team
    Other, __________________________________________________
  • Community resources, list_____________________________________________
  • Patient educational materials, i.e., disease–site-specific information, clinical trials, patient journal, etc.
  • Caregiver toolkit and resources
  • Assessment tools, documentation and reporting
  • Communication and managing transitions with the patient, family and/or caregiver
  • Communication among the healthcare team, internal and external resources
  • Patient experience survey process
  • Performance improvement models and initiatives:
    Patient experience
    Clinical outcomes
    Business performance
  • Support groups and educational programs
  • Tumor conference responsibilities
  • Multidisciplinary participation and responsibilities
  • Professional organizations and certification
    AONN, Academy of Oncology Nurse Navigators
    Association of Oncology Social Work
  • Other, list _________________________­­­­­­­­­­­­­­­­­­­­­­­­_____________________________________

This orientation checklist is just a foundation for your new oncology navigator; adjust to your specific needs and navigation model. Remember: a good orientation is key for your new navigator’s success.


Guest blogger ACCC member Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.

A Message to New Oncology Nurses

By Sandy Balentine, MSN, RN,OCN, MBA

Nurse and Patient Holding Hands(small)Although it’s been many years since I was a “new oncology nurse,” I still remember those first few days as a new graduate nurse.

Nurses touch people’s lives in many ways. They usually spend more time with the oncology patient than the patient’s physician or any other professional caregiver, and can develop a very intimate bond with their patients. Patients and families will remember their nurses for the care they provide during a very difficult time of the patient’s life. The public has a high level of respect and trust in the nursing profession. As a new oncology nurse, you are entering one of the most rewarding professions in the world in one of the most challenging specialties in healthcare.

Having completed your training, as a new nurse you are now responsible for everything you do. You try to do everything the right way, just as your clinical instructor taught you, only to find out that the oncology area in which you are working operates a little differently from the way that you learned to do things in nursing school. This sometimes causes your mind (and your stomach) to do a somersault.

A number of stressors make the job of nursing for cancer patients one of the most challenging— as well as rewarding—of all fields. With that in mind, here are some realities to consider so that you can be prepared and manage the stresses that come with this noble profession—especially when you are a new graduate.

Coping with the Challenges of Your New Role

How will you handle some of the stressors of your work environment—fulfilling the high-pressure job demands of nursing, floating to other nursing units, and struggling with the work load, while adjusting to a new role? Here are some tips to help you adjust to your new reality:

  • Build relationships with your colleagues.
  • Never be afraid to ask questions. It is okay to let people know that you do not have all the answers. Nursing is a lifelong learning profession.
  • Know your limitations. Don’t be afraid to express them, in a professional manner, if you feel uncomfortable when asked to do something.
  • Soak up information as much as you can—watch and listen—and you will learn so much more than you learned in school.
  • If your hospital doesn’t assign one, find a personal mentor to be your support person for the first year. You will need someone to talk to about your first days in nursing.
  • Take the time to do things right the first time, even if you think there is no time. Chances are, you won’t have to do it over.
  • Develop good organizational skills.
  • Do not complain about something unless you have a solution. Simply put: be a part of the solution rather than a part of the problem.
  • Always have integrity—you will gain the trust and respect of everyone you come in contact with.
  • Listen to your patients and their families; they know their bodies better than you do.

A Few Words of Advice . . .

So what advice do I have to share with upcoming new graduate nurses?  First, believe in yourself, it is the key to having self-confidence in what you do. Second, everyone has different learning patterns. Know your learning style and seek resources to complement how you learn best. And one last piece of advice: don’t let anyone make you feel discouraged.  As a new nurse, it can be easy to feel discouraged. You are working with other nurses who have more experience than you. You may sometimes feel uncomfortable when talking to a physician about a situation and don’t want to appear as “new.” A patient might even question your ability because they can sense that you are nervous. But always remember that you have been trained for this, and you have others to support you. You care about others and that is why you joined this profession.

Nurse to Nurse Support

We “seasoned” oncology nurses also have a responsibility to the new nurse. We must recognize the difficult transition that a new nurse has to make. Nurse orientation programs need to be personalized to nurses’ individual training and development needs. Such customized development to meet new nurses’ needs creates engaged employees. They will be working with cancer patients who have very specialized needs.  So in addition to teaching our new nurses about these special needs, we must also provide the support they need in their new role. Nurse residency programs are the best programs to help a new nurse through the challenges of their first year of practice. The best mentoring programs guide new nurses through career progression and show them how to be good nurses.

Leadership Training

You also may have heard the saying: “Nurses don’t leave organizations; they leave managers”; thus, leadership training is essential. Investing in leadership training benefits the entire organization. An organization’s leadership must foster a healthy work environment and set clear expectations. They must pay attention to staff’s professional development. The best leaders set realistic expectations, and inspire their nurses through their example.  They coach and nurture new graduates and create a patient care environment to support their staff.

Encourage new nurses to become involved with committees and councils that affect their practice. This can not only help them to feel more a part of their nursing environment, but also encourages them to have a voice in their organization.

Caring and Compassion

The Chief Nursing Officer at The Valley Hospital had a message for our nursing staff recently: Nursing has its roots in caring, and equally important for nurses is their ability to be compassionate with patients, and to use themselves as a therapeutic vehicle for healing.  Nurses’ compassion and their empathy is really just as important as their technical skills. And it is that relationship between the patient and the nurse that really brings healing to the patient. This message should also hopefully touch the hearts of new graduate nurses. Remember why you decided to join this profession. You will make such a difference in the lives of the patients you touch!


ACCCBuzz contributing blogger Sandy Balentine, MSN, RN, OCN, MBA, is the Director of Clinical Oncology at ACCC Member Program, The Valley Hospital. Her article for Oncology Issues (May/June 2016) describes the development of “The Oncology Nursing Fellowship Program” at her institution.

Life, Interrupted: One AYA Patient’s Cancer Journey

From the recent ACCC 33rd National Oncology Conference, this is the second in a two-part blog series highlighting featured speaker sessions focused on adolescent and young adult (AYA) cancer patients.

NOC 2016 Crowd

On Friday morning, October 21, conference attendees heard the AYA patient voice loud and clear in a riveting presentation by Suleika Jaouad, author of the award-winning New York Times column, “Life, Interrupted.”

“My name is Suleika Jaouad, and I am a cancer survivor.” With that Jaouad began the story of her experiences as a young adult with cancer.

“Looking back, the symptoms had been there for awhile,” she said. But getting to a diagnosis turned out to be a lengthy, arduous, and scary process.  Originally told she had “burnout syndrome,” it took months to eventually learn that she had an aggressive form of leukemia. At 22 years of age, Jaouad had no family history of cancer, she always ate organic, and was a straight A student. Lesson learned: “Cancer doesn’t care what your GPA is or how good a person you may be, because cancer doesn’t discriminate.”

Life interrupted is what cancer feels like, Jaouad said. Overnight she lost everything she had worked for as a young adult, having to move back home into her childhood bedroom. “I lost my job, my apartment, and maybe worst of all, I lost my independence.”

Knowledge is Power, But. . .

Where and how to find the “knowledge” about your cancer and treatment “was a bigger challenge than I expected,” she said. With providers, she often felt “lost” in the conversation. “I wanted to understand what lay ahead, but often felt too overwhelmed, intimidated, and sometimes embarrassed to ask them to explain and re-explain.”

While searching the Internet, she came across a list of side effects and “one word stuck out to me—infertility.” No one on her medical team had mentioned this side effect to her. “Lack of information on that felt like a breach of trust early on in my treatment. . . . I wanted to make this decision with my medical team,” she said, not have it be a decision that was made for her. “Preserving my ability to be a mother one day felt like a very important lifeline to a very uncertain future.”

Once she brought the topic up with her team, she was provided with resources. But lesson learned: Clear, open communication between herself and her medical team was not always a given. She would have to take an active role in her treatment.

Echoing Thursday morning’s Helping AYAs Be Loud! session’s call to action, Jaouad emphasized that AYAs face unique medical, professional, and psychological challenges. It’s almost as if AYAs are oncology’s tweens, she said, too old for pediatrics but too young for the adult oncology unit. Young adults are a misunderstood and overlooked part of the cancer patient population.

I Wanted a Cure, Not a Trial

In 2011, at the end of the first round of treatment a biopsy showed that standard treatment hadn’t worked and she was going into bone marrow failure. Because a bone marrow transplant was becoming less likely, Jaouad said, she had to face the possibility that she might not be cured. It was then that she learned about clinical trials. Ultimately, she enrolled in a trial and after 8 months was in enough remission for a bone marrow transplant.

Survivorship: Unknown Terrain

Although she received excellent care, Jaouad did not learn about her cancer program’s survivorship care clinic until after she wrote a column focused on how, as a cancer survivor, she lacked any kind of roadmap for the way ahead. She was then connected to the cancer center’s survivorship program, which provides resources to help patients stay healthy in the long-term both physically and psychologically.

Lesson learned for providers: Make sure patients are connected to the resources that are already in place. After all, “what’s the point of going through all these treatments if it’s not to live a good life and a healthy and meaningful life?”


Stay tuned for more from the ACCC 33rd National Oncology Conference. Read about an innovative program for AYAs at Seattle Children’s Hospital’s Building Hope (Oncology Issues Nov/Dec 2013).

 

 

 

 

 

 

Connecting the Moonshot to Patients

By Amanda Patton, ACCC Communications

ACCC President Jennie R. Crews, MD, MMM, FACP, welcomes conference attendees.

ACCC President Jennie R. Crews, MD, MMM, FACP, welcomes conference attendees.

The Cancer Moonshot framed Thursday’s  sessions at the ACCC 33rd National Oncology Conference in St. Louis. “I’ve been privileged to be part of the conversations around the Moonshot,” ACCC President Jennie R. Crews, MD, MMM, FACP, told attendees in her opening remarks. On Monday Dr. Crews participated in panel discussion at the White House as part of the Moonshot Task Force Report unveiling. With a goal of making a decade’s worth of progress in cancer prevention, diagnosis, treatment, and care in five years—it’s an “audacious” initiative that will bring challenges and significant opportunities to community oncology, she said.

In a heartfelt video message to conference attendees, Vice President Joe Biden, called community cancer centers the “bridge” between the Moonshot and cancer patients. “For the overwhelming majority of those patients who are diagnosed [with cancer], the next step leads to you,” he said. “Community oncologists treat as much as 85 percent of cancer patients . . . .Not only do your patients need you, your country needs you.”

It was a message reiterated at the end of the day by Anabella Aspiras, Director for Patient Engagement, Cancer Moonshot Task Force, in a session exploring how the Cancer Moonshot will affect providers in the community setting. “You truly connect the work of the Cancer Moonshot to cancer patients,” she told attendees. Ms. Aspiras highlighted the three Moonshot reports announced on Monday:

The Vice President’s Executive Report, a summary of work accomplished to date and challenges that must be addressed, which was presented to President Obama on Monday. The report outlines five strategic imperatives:

  • Realign incentives in the research system
  • Enhance prevention efforts
  • Engage patients as partners in research
  • Expand access to care
  • Convene a national conversation about cost.

The Task Force Report, covers the implementation plans for accelerating progress and includes Moonshot efforts underway over the past year.

The Blue Ribbon Panel Report, which integrates feedback into the panels 10 recommendations.

Anabella Aspiras and Jennie R. Crews, MD, MMM, FACP, at the ACCC National Oncology Conference.

Anabella Aspiras  with ACCC President Jennie R. Crews, MD, MMM, FACP, at the Cancer Moonshot Report unveiling earlier this week.

In her remarks, Ms. Aspiras called attention to existing ACCC initiatives that support the Blue Ribbon Panel recommendations, including the Institute for Clinical Immuno-Oncology (ICLIO) and ACCC’s educational work related to integrating biomarker testing in the community setting.

In her role at the Moonshot Task Force, Ms. Aspiras’ primary responsibility is to represent the voice of the patient in four areas: addressing cancer inequities, enhancing community cancer care, improving clinical trial participation (accrual and retention) in particular in terms of under-represented populations; and survivorship. Research must benefit all segments of society, Aspiras said. “We must ensure advances in treatment are distributed equally.”

In closing, Ms. Aspiras thanked ACCC members for the work they do. “You bridge the gap between our efforts on the Cancer Moonshot and the patients we aspire to reach,” she said. “Every day you change the face of cancer as we know it.”

Stay tuned for more from the ACCC 33rd National Oncology Conference. Follow the conferences highlights on Twitter #ACCCNOC.

 

Patient Navigation: How Patient and Family Focus Groups Can Help

By Tricia Strusowski, MS, RN

ThinkstockPhotos-484468581Seeking a great way to enhance your navigation program and best understand the specific needs of your patients and families? Consider conducting a patient and family focus group. I have always gotten the best feedback and ideas for our navigation program from hosting a patient and family focus group.  And I now incorporate focus groups sessions into many of my cancer program site visits. It is easy, fun, and the rewards are tremendous.  The patients and families are so appreciative that their input is sought after and valued.

What is a Patient and Family Focus Group?  

Focus groups are a form of qualitative research, discussions with your patients and families to learn about their healthcare wants, needs, and perceptions.  All great patient experience outcomes begin with listening to the voices of the patients and their families, relying on their perceptions of healthcare to identify priorities and enhance performance improvement initiatives that can yield amazing results.

Some Sample Guidelines for Facilitating a Patient and Family Focus Group

The following guidelines will help foster a robust, information-rich discussion:

  • Invite 8-12 participants of different race, ethnicity, age, gender, and cancer disease site. Invite their family members and/or caregiver, so that you can conduct a separate caregiver group at the same time.
  • Hire or invite an expert facilitator to run the sessions.
  • Choose no more than 10 carefully selected questions that allow for open dialogue.
  • Tape your session as well as invite a scribe to assist with notetaking. (Be sure to inform participants that you will be recording the discussion.)
  • Review focus group participation ground rules with all participants.
  • Provide a light snack and/or small thank you gift for participating in the focus group discussion.

Introduction and Ground Rules for the Focus Group 

Here are tips for getting the conversation started: 

  • Introduce yourself and ask each participant to introduce themselves.
  • Explain that the cancer program wants to know what they like, what they don’t like, and how they feel programs might be improved.
  • Remind the group that the cancer program leadership is interested in both negative and positive comments. 

Next, review the ground rules with your focus group members. Explain that the facilitator/moderator’s role will be to guide the discussion: 

  • Assure participants of complete confidentiality.
  • Emphasize that there are no right or wrong answers, only differing points of view.
  • Ask participants to please speak one at a time so the scribe can accurately capture the conversation.
  • Remind everyone that they don’t need to agree with each other, but it’s important to listen respectfully as others share their views. Everyone should feel free to share openly.
  • Request that everyone please turn all cellular phones to vibrate. If anyone needs to respond to a call, please do so as quietly as possible and rejoin us as quickly as you can.

Some Possible Questions for your Focus Group(s)

  1. What was important to you and your family as a newly diagnosed cancer patient?
  2. What is important to you and your family now that you have started your cancer treatment?
  3. Were you aware of the support services at the cancer center?  What services would you like at the cancer center?
  4. Was the patient journal and/or patient educational materials you received helpful? How could they be better?
  5. Patient- and family-centered care is extremely important, what does this mean to you and your family?
  6. What is important to you and your family in a survivorship program?

Once your focus group is complete, consider keeping the momentum going by creating a Patient Caregiver Advisory Committee.  Learn more in this recent Oncology Issues article that explores how improving patient engagement can help to improve your cancer program.


Guest blogger ACCC member Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.

Will Spending More on Healthcare Result in Better Cancer Outcomes?

by Chad Schaeffer, MS, FACHE

Healthcare costsA recent study published in the Journal of the National Comprehensive Cancer Network finds that spending more on healthcare does not always correlate to better outcomes.  The authors of the article, “Wealth, Health Expenditure, and Cancer: A National Perspective,” studied different areas of the U.S. and looked at the wealth, spending, and cancer outcomes for breast cancer, colorectal cancer, and all cancers.1

The researchers, led by Dr. Jad Chahoud, point out that in 2013 the U.S. spent $2.9 trillion on healthcare—more than any other country—yet ranked 27 in life expectancy compared with the 34 countries that comprise the Organization for Economic Co-operation and Development (OECD).  Their conclusion is that the U.S. healthcare system is flawed by an unequal resource allocation and socioeconomic disparities. This has long been the case when the U.S. is compared to many European countries, which have universal healthcare or a single-payer system and access to healthcare is often more consistently available to all citizens.

However, things get very interesting when the researchers compare different regions within the U.S. and find differences in cancer outcomes. When looking at colorectal cancer and all cancers, the common theme is that wealthier states, such as New York, Illinois, and California, tended to have better outcomes compared to the least wealthy states, such as Mississippi, West Virginia, and Alabama. The wealthier states spent more per capita, but not necessarily for healthcare. For instance, West Virginia spent more on healthcare per capita ($7,667.14) than Illinois ($6,756.36), but the outcomes for colorectal and all cancers are better in Illinois.

 

 

State

Mortality/Incidence Ratio (colorectal cancer) Mortality/Incidence Ratio
(all cancers)
Illinois 0.3652 0.3823
West Virginia 0.3936 0.4306

Yet for breast cancer, the researchers discovered that paying more did correlate with better outcomes.  They surmise that this could be the result of effective breast cancer screenings and an overall high level of breast cancer awareness.

Takeaways

As I read the article and the findings from the study, two or three points come to mind. The first point is that since the extra spending on healthcare was effective for breast cancer, and—if the authors are correct that screening was a major factor—this could be good news for colorectal cancer if we can continue to improve screening rates. The second point is that with the new emphasis from Medicare and other payers on paying for quality, perhaps there will be an improved value in our healthcare system, leading to better outcomes. The last thought is that with the Affordable Care Act in place for several years and more Americans now having health insurance, and with a greater emphasis on screenings, would this potentially change the outcomes?  It is too early to say for certain, but if screenings rates improve, this will likely make a difference in overall outcomes.  We will have to wait and see.

References
Chahoud J, Rieber AG, Semaan A. Wealth, health expenditure, and cancer: A national perspective. J Natl Compr Cancer Netw. 2016;14:972-978.


ACCCBuzz contributing blogger Chad Schaeffer, MS, FACHE, is Executive Director of the Edwards Comprehensive Cancer Center at Cabell Huntington Hospital. He serves on the ACCC Editorial Committee.

Patient Navigation: Reducing Delays in Care

By Tricia Strusowski, MS, RN

Solutions on corkboard-smallOur last navigation blog discussed how process mapping by disease site can help in managing transitions across the continuum of care.  Process mapping helps the cancer care team identify when to initiate patient navigation and support services as well as to identify goals, barriers, and gaps in care.

Removing barriers and gaps in care is a major goal for any navigation program. Many patients have shared with me that delays in care are the most stressful part of their treatment journey; they call it the “waiting game.” While they are waiting, their imagination can get the best of them. They are not only imaging “the worst” but also questioning “who is coordinating my care?” And if these delays occur time after time across the care continuum—they can have significant implications for the patient’s treatment journey. Is this acceptable?  Absolutely not.

So, How Do We Fix This?  

A great solution to eliminating delays is to create a continuum of care spreadsheet in your electronic medical record (EMR).  Use your process map to help identify the different departments and offices with visits that must be coordinated to avoid delays across the continuum.

The first step in creating your continuum of care spreadsheet is to identify the specific appointments and office visits in the correct order.  Each cancer disease site will look a bit different based on the specific needs of the patient.  For example, let’s consider what this might look like for a head and neck cancer patient. We all know that the patient must have dental clearance prior to any chemotherapy or radiation therapy treatment, but what is an acceptable time frame for this step? One week? Two weeks?  To avoid delays in the patient’s treatment journey, an early appointment for dental clearance is a must and should be completed as soon as possible.

Below is an example of the fields for an overly simplified basic continuum of care spreadsheet.  If an EMR is not available, you can use an Excel spreadsheet to create your continuum of care.  You can also add the initiation of navigation, support services, and survivorship care plan into the care continuum. 

  • Diagnostic work up, imaging, tests, and dates
  • Surgical consult, visit and date
  • Surgical biopsy and date
  • Pathology report results and date
  • Surgery and date
  • Medical Oncology consult, visit and date
  • First chemotherapy treatment and date
  • Radiation Oncology consult visits and date
  • CT simulation and date
  • First Radiation Oncology treatment and date.

Next, your multidisciplinary team needs to review the actual or “real” time period for the delays.  An audit will help you identify the true time lapse between each episode of care.

With these steps completed, you’re ready to initiate a performance improvement (PI) project to decrease delays. The team needs to discuss and create new acceptable time frames between the visits. Identify where the delay is occurring: Registration? Insurance verification? Scheduling?  Look for opportunities to meet with the different departments and offices to brainstorm how these delays can be reduced.  Many times you may also identify duplication of services. Eliminating these redundancies will help with staff productivity.

Sustainability is Key

Once you’ve reduced the delays, you will still need to monitor the new process to ensure that it is continuing to be effective—monitor monthly at first and then move to quarterly or bi-annual monitoring as needed. If the new process is not working, revisit the opportunities for improvement.  Finally, remember that the main goal of all of our programs is to work as efficiently as possible while keeping the patient at the center of all we do.

An efficient and timely patient-centered flow will enhance your patient experience!


Guest blogger ACCC member Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.

The Power of Sharing Your Story

One in an occasional blog series on topics from Oncology Issues, the journal of the Association of Community Cancer Centers.

By Susan van der Sommen, MHA, CMPE, FACHE, ACCC Editorial Committee Chair

Talking heads At the upcoming ACCC 33rd National Oncology Conference October 19-21, in St. Louis, Missouri, the 2016 ACCC Innovator Award winners will be showcasing their pioneering efforts aimed at improving the provision of care to cancer patients with initiatives that can be replicated in other community cancer programs.

Spreading the Word

In addition to speaking at the National Oncology Conference, every ACCC Innovator Award winner has the unique opportunity to write a feature article for Oncology Issues, ACCC’s bi-monthly journal.  The just-released July/August 2016 issue presents in-depth, “how we did it” articles from several of the 2015 Innovator Award winning programs. But opportunities for ACCC members to share their cancer program’s initiatives and successes are not limited to Innovator Award winners. Oncology Issues features insightful articles from ACCC member programs throughout the country – large and small. And every issue includes a “Spotlight” article profiling an ACCC Cancer Program member.

For instance, in the January/February 2016 issue, authors from two ACCC Cancer Program member institutions wrote about how to “Unlock the Potential of the Cancer Registrar,” describing the integral role their cancer registrars are playing in their organizations’ lung screening programs. And the May/June 2016 issue featured an article from ACCC Cancer Program Member The Valley Hospital’s Blumenthal Cancer Center on its Oncology Nursing Fellowship Program. In feature articles such as these, ACCC members share their real-world strategies for overcoming challenges and improving oncology care delivery, enriching the oncology community as a whole.

What better way to feature your cancer program’s success than through an article or profile published in a journal with national coverage? Many of our colleagues have used the opportunity to garner local media coverage in their respective markets; others have showcased their work among their peer group – which sometimes includes much larger centers.

In a recent ACCC Communications Survey, ACCC members were polled on the association’s journal, Oncology Issues:

  • 90% said that Oncology Issues is the “primary benefit of ACCC membership.”
  • 98% said that Oncology Issues “contains practical information, insights, ideas, and tools.”
  • 92% said that Oncology Issues “contains information that I do not find in other sources.”
  • 88% said that Oncology Issues “helps my cancer program stay ahead of the competition.”
  • 88% said that Oncology Issues is “must reading for me to stay ahead in my profession.”

What makes the Oncology Issues so successful? Input from ACCC cancer program members like you! To help spread the word to ACCC members about opportunities to contribute to the journal and how Oncology Issues’ content can be leveraged to benefit your program, this year’s National Oncology Conference will feature a new agenda item – “Oncology Issues Live!” hosted by members of ACCC’s Editorial Committee. Interesting in learning more about contributing or having your program featured in Oncology Issues? Want to be part of the Editorial Committee? Come to “Oncology Issues Live!” at the ACCC 33rd National Oncology Conference, October 19-21 in St. Louis, and connect with us.

 

Getting Engaged

One in an occasional blog series on topics from Oncology Issues, the journal of the Association of Community Cancer Centers.

by Susan van der Sommen, MHA, CMPE, FACHE, ACCC Editorial Committee Chair

ThinkstockPhotos-484468581When first hearing of a cancer diagnosis, I imagine a patient’s mind spinning with a cyclone-like ferocity … Am I going to die? How will I tell my family? What about all of my plans? It’s cancer … of course I am going to die … but how soon? Suddenly, life spins out of control.

Engaging patients in their care can dramatically reduce anxiety by giving back some control. Of course they can’t control the diagnosis, but they can control how they face it – on their terms, with their beliefs, wishes, and desires at the forefront of every decision.

In a recent Oncology Issues article, “Talk to Me: Improve Patient Engagement; Improve Your Cancer Program,” author Chad Schaeffer, MS, FACHE, lays the foundation for developing strategies to connect patients and the decision-making process relating to their care. Improved patient engagement can alleviate some of patients’ burden in feeling as if they are hapless victims of heinous misfortune and allow them to regain some semblance of control over their future. Schaeffer is executive director at the Edwards Comprehensive Cancer Center at Cabell Huntington Hospital, Huntington, WV.

Defining patient engagement in simple, broad terms as “the ongoing and mutually beneficial interaction between patient and providers,” he notes that putting the patients’ needs and aspirations first will improve engagement and, ultimately, satisfaction for all.

What are the goals?

Patients’ treatment goals vary and are individualistic. Some desire to extend life at any cost; others prefer quality over quantity. Many want as little disruption to their daily lives as possible. As Schaeffer points out, evening and weekend hours, though not always pleasing to cancer center staff and physicians, will allow some patients and caregivers the flexibility to carry on with their routine (work, childcare, etc.) while receiving treatment and care at a time that is convenient.

Are we meeting your needs?

Cancer center physicians often struggle with the difficult conversations regarding the “end of life,” resulting, as Schaeffer points out, in decisions that may not coincide with a patient’s wishes. According to an end-of-life study at Stanford University, family members whose loved one died in an “institutional setting” reported poor symptom management, lack of physician communication and patient engagement, and a dearth of emotional support for loved ones and caregivers. Conversely, those who passed with home hospice services reported a considerably higher degree of satisfaction with regard to unmet needs and physician engagement.

Is there something you aren’t telling me?

In addition to reviewing Press Ganey and CGCAHPS surveys, the leaders at the Bassett Cancer Institute in upstate New York have instituted a process where they can – in real time – monitor patient satisfaction. Throughout the course of their treatment, patients are offered a tablet on which they answer a few questions about their care. Questions are flagged so that when a patient expresses dissatisfaction, a member of the leadership team can address the patient’s concern during his or her visit. It gives both the patient and staff an opportunity to more effectively understand what drives patient satisfaction while giving patients an active voice in their care.

Engaging patients from the outset of their diagnosis and throughout their care is critical to their satisfaction and ultimately, as Schaeffer points out, a more effective, patient-centered cancer treatment center.

Patient–centered care is a key focus of the upcoming ACCC Annual Meeting, CANCERSCAPE, March 2-4, in Washington, D.C. Learn more here.

Read the current edition of Oncology Issues here.

ACCC member Susan van der Sommen, MHA, CMPE, FACHE, is Executive Director, DSRIP, Bassett Healthcare Network. She currently serves as chair of the ACCC Editorial Committee.

National Oncology Conference—Keep the Conversation Going

dr. peter bach

Featured speaker Peter Bach, MD, MAPP, delivers the opening presentation of the ACCC National Oncology Conference.

By Amanda Patton, ACCC, Communications

From the opening presentation by featured speaker Peter Bach, MD, MAPP, to the final sessions focused on cancer survivors and the workplace and providing survivorship services on a shoestring budget—last week’s ACCC National Oncology Conference covered challenges large and small facing cancer programs and practices across the country.

Macro challenges—occurring at the health system and population health level—are well known to the oncology community. Among these are the high cost of cancer drugs and new therapies, the transformative shift in payment from volume to value, workforce shortages, reimbursement constraints, and the many issues tied to ever-increasing demands for data collection and reporting.

Micro challenges—occurring at the service line and individual provider and patient level—range from adapting delivery infrastructures to meet the evolving treatment landscape, to determining  metrics to track and how to best to communicate these to leadership, to ensuring patient access to supportive care services that remain unreimbursed, to fostering a holistic, patient-centric culture of care.

Common themes across conference sessions and conversations: Collaboration, integration, evidence-based medicine, and value.  Five key takeaways from the conference:

Cancer programs and providers must collaborate outside the box and across the care continuum.
Attendees heard first-hand from programs that are already making this work—from implementing virtual tumor boards, to engaging primary care physicians in survivorship care, to collaborating across disciplines to provide cancer prehabilitation services, and more.

There are formal & informal operational pathways to create integrated delivery networks with stakeholders for quality patient care.
Panelists in the Advancing Quality Care session agreed: to achieve a truly integrated delivery network transparency and trust between all partners is needed.

Oncology programs are increasingly turning to dynamic dashboards to demonstrate value to payers and patients.
Solutions and tools may exist outside the oncology service line. Reach out to the data analytics team or business intelligence team within your organization. Take advantage of or adapt existing resources and tools.

From personalized medicine to immuno-oncology, cancer treatment is undergoing a transformative shift.
For both providers and the patients they serve, the value proposition presented by genomic medicine is that it allows clinicians to make better therapeutic decisions.

Patients are key stakeholders in healthcare integration efforts.
“Successful integration will depend on aligned patient-centered care, patient-focused care, and patient engagement,” said ACCC President Elect Jennie Crews, MD, in the panel discussion on Advancing Quality Care.  Panelists touched on the findings included in a new ACCC white paper released at the National Oncology Conference that outlines forward-looking essential steps to ensure quality patient care in the increasingly integrated healthcare environment.

ACCC encourages members to keep the conversation going by sharing your key conference takeaways in our members-only online community ACCCExchange.

Save the date and join us in Washington, D.C., March 2-4 for the ACCC Annual Meeting: CancerScape 2016.