Tag Archives: patient-centered cancer care

Journeying Beyond the Physical: Addressing a Patient’s Spiritual Concerns

By Susan van der Sommen, MHA, CMPE, FACHE

HC provider cupping patients hand (for web)Based on evidence presented in the Institute of Medicine’s 2008 report, “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs,” the American College of Surgeons Commission on Cancer (CoC) has phased in a new standard – 3.2: Psychosocial Distress Screening. The goal of utilizing a psychosocial distress screening tool is to ensure patients’ emotional and psychological needs are being addressed – in addition to their physical disease and symptoms.  CoC Standard 3.2 includes the following description of the psychosocial assessment:  “This assessment will confirm the presence of physical, psychological, social, spiritual [emphasis added], and financial support needs and identify the appropriate referrals as needed.”

In an article published in the March/April 2017 edition of ACCC’s journal Oncology Issues, the Reverend Lori McKinley outlines how Mercy Health lived up to its promise to “make lives better – mind, body and spirit” by incorporating a rating for various spiritual concerns of a patient or loved one. The Spiritual Care Team at Mercy recognized that just addressing emotional and physical needs of patients is not enough.  After performing an extensive literature review and developing connections with community-based organizations, the Mercy team made significant quality-related, evidence-based changes to their electronic health record (EHR) to accommodate a new and improved distress screening tool. Learn more about their pilot project here.

Indeed, a patient’s spirituality is directly related to their quality of life and has a direct correlation to giving  patients meaning, a sense of purpose and understanding during a critical time in their lives. In “Spirituality in the Cancer Trajectory,”  author C.M. Puchalski writes that “Spirituality is an essential element of person-centered care and a critical factor in the way patients with cancer cope with their illness from diagnosis through treatment, survival, recurrence and dying.” Her article goes on to identify the link between spirituality and “inner peace, gratitude and positivity” when facing a life-changing diagnosis such as cancer. She writes that with proper support, a patient may begin to view their cancer diagnosis as a positive life-changing experience, ultimately paying greater time and attention to higher priorities in their lives. This is not possible if a patient’s spiritual needs are not addressed routinely throughout their care.

Puchalski further points out that religion is but one type of expression of spirituality so non-faith based organizations should not dismiss the concept or its importance. In fact, she writes, a majority of patients want their oncologist or healthcare professional to address their spiritual concerns and integrate their needs and wishes into their care plan.

Not surprisingly, this is what the Spiritual Care Team at Mercy discovered during their pilot program. With the addition of four questions addressing spiritual concerns in their distress screening tool, they were able to more effectively connect patients with their faith, alleviate fears, and assist patients with addressing their trepidation at the end-of-life. Isn’t that what all of us want for our patients?

Reference

Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol. 2012;23(suppl_3):49-55.


Contributing blogger Susan van der Sommen, MHA, CMPE, FACHE, is Executive Director, DSRIP, Bassett Healthcare Network, and Chair of the ACCC Editorial Committee.

 

Bridging the Gap and Improving Outcomes

By Susan van der Sommen, MHA, CMPE, FACHE

ThinkstockPhotos-507273299Healthcare is becoming increasingly complex. With emerging payment models, regulatory initiatives, HCAHPS, and the complexity of electronic health records (many of which don’t communicate with each other), the concept of patient care has changed. How often have patients expressed dismay that their care provider seem more focused on the computer screen than on their needs and concerns? The endless entry of data, best practice alerts, and hard stops that are intended to streamline and improve care have unintentionally added complexity. In fairness to the evolving nature of electronic health records (EHRs), they have added benefits, too. They cannot, however, replace the value of human interaction.

In the November/December 2016 Oncology Issues, Connie Savage shares how Cancer & Hematology Centers of Western Michigan was able to address a complex issue that cannot be effectively resolved through a high-tech initiative—the transition of care from the inpatient to the outpatient setting. In today’s healthcare environment it is challenging to add positions that are not either revenue-generating and/or required by a regulatory agency or credentialing body. Yet the team at Cancer & Hematology Centers of Western Michigan was able to build a case to hire an inpatient coordinator who is charged with improving patient, provider, and family satisfaction and provider efficiency while reducing no-shows, hospital length of stay (LOS), and avoidable readmissions. At this program, the inpatient coordinator serves in a role similar to a patient concierge—gathering and sharing pertinent information, establishing patient and provider expectations, and arranging appointments—ensuring that the patient’s experience and transition to the home and/or outpatient setting is comprehensive and seamless. The return on investment is clear: improved patient and provider satisfaction, a streamlined discharge process, a reduction in length of stay (LOS), and a decline in avoidable admissions and readmissions. These outcomes align well with evolving payment models including, but not limited to, CMMI’s Oncology Care Model. It is likely that Connie and her team rely heavily on their EHR; however, they have proven that a technology-driven solution can never replace a caring human touch.


The story behind the story. ACCC member Connie Savage shared her role as inpatient coordinator at the 2015 ACCC National Oncology Conference New Member Meet & Greet in Portland, Oregon. Our ACCC editorial team heard her story and encouraged her to contribute an article to ACCC’s journal, Oncology Issues. Connie also agreed to share her program’s pioneering approach to patient care by presenting a poster at the recent ACCC 33rd National Oncology Conference in St. Louis. Connie’s story is great example of how our member programs are able to showcase their work on a national scale and share their “how-to’s” with other ACCC-member cancer programs. We are grateful to Connie and all our members who take the time to share their innovative approaches to success and ultimately improve care for our patients.

Contributing blogger Susan van der Sommen, MHA, CMPE, FACHE, is Executive Director, DSRIP, Bassett Healthcare Network, and Chair of the ACCC Editorial Committee.

Radiation Therapists’ Role in Patient-Centered Care

By Bryan M. Schmalhofer, MBA

Hands-creating-circle-of-supportA new ACCC white paper, Empowering Patients, Engaging Providers: The Future of Patient-Centered Care in Oncology explores current challenges and barriers, and what’s needed to make headway in improving patient-centered oncology care. Derived from discussion at the ACCC 2016 Institute for the Future of Oncology forum, the report identifies seven elements required to provide true patient-centered care: patient stories, navigation and coordination, interdisciplinary teams, appropriate reimbursement for services rendered, greater education, information technology connectivity and transparency, and decision-support tools. For this blog post, I’d like to zero in on the first item: knowing the patient’s story. Or put another way, knowing the person, and not just the patient. Our current healthcare environment—with time constraints, data collection and reporting requirements—can make it challenging to know our patients’ stories. That said, we know that members of our multidisciplinary care teams do get to know our patients—one such team member is the radiation therapist.

Radiation Therapists & Patient-Centered Care

Patients undergoing radiation therapy will often interact with radiation therapists on a daily basis for weeks. While our patients and their family members cannot typically discern whether the radiation therapy treatment we are delivering is working, or if it will have a positive benefit in the future—what they do register is a warm greeting and the smiling face and listening ear of the radiation therapist delivering the treatment together with all of the members of the radiation oncology team. This daily contact between radiation therapists and their patients can have a profound impact on the patient experience and the quality of patient-centered care. Therapists have the unique perspective of being able to observe subtle changes in a patient’s demeanor and side effects, both new and ongoing sequelae. Often the skin changes seen by the nurse and physician during the weekly treatment visit can change markedly over the course of the week. Radiation therapists seeing these skin changes can have an important effect on the patient’s experience with radiation oncology by serving as another care touch point or intervention prior to the weekend. Examples include something as simple as changing the type of cream the patient uses to making sure the patient has the proper pain medication before the weekend.

By listening to their patients’ concerns, fears, and questions, radiation therapists not only get to know their patients, but also can help create an environment where the patients feel like they are at the center of their care. For example, given the complex nature of radiation therapies, one of the key drivers to patient satisfaction is the management and explanation of the side effects they will face during treatment and recovery. In fact, this point is specifically measured by the Press Ganey patient satisfaction survey that asks patients to rate the “Explanation of how to manage radiation therapy side effects.”

At WellSpan Health, the Oncology Service Line, has chosen to evaluate this measure and its effect on patient-centered care by adding another “touch point” with the therapists on a weekly basis. Our weekly on-treatment visits (OTVs) are done typically on a Monday. The therapists review the patient’s previous OTV note, and on Thursday the therapists ask specific, pointed questions concerning side effects that were raised and discussed during the OTV. The therapist then documents that these issues were discussed with the patient. I believe this adds to the level of communication, care coordination, and patient-centric care the patient experiences during their radiation therapy treatments and demonstrates a true patient-centered approach to their care and overall well-being.

The Institute of Medicine (IOM) has described patient-centered care delivery as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” On the frontlines of cancer care delivery, radiation therapists are often the “face” of radiation therapy, providing a welcoming presence and connecting with patients to help improve their care experience.


Guest blogger Bryan M. Schmalhofer, MBA, is manager, Radiation Oncology Operations at ACCC Cancer Program Member WellSpan Health, York Cancer Center. He also serves on the ACCC Editorial Committee.

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).