Tag Archives: supportive care

Oncology Social Workers’ Role in Patient-Centered Care

By Fran Becker, LCSW, OSW-C

JPG-2017SWM-LogoWebMarch is National Social Work Month.  This year, the National Association of Social Workers’ theme is “Social Workers Stand Up.”  This is a time to acknowledge the contributions of all social workers.  Some social workers are part of a team, others work independently—all are patient centered in their approach to care.  Oncology social workers are part of this proud group—but our work differs in several ways.  While master’s degree prepared social workers are trained in assessing the psychosocial needs of their clients and in provision of a range of services, oncology social workers often have additional expertise and specialized clinical training in the meaning and impact of a cancer diagnosis on patients and their families.

Oncology social workers must have a working knowledge of cancer treatments, the side effects of treatment, and the psychosocial impact on the patient and family.  This skill set is a broad one, especially for those working in community cancer centers who are called on to help patients and families at all stages of illness and diagnoses. Oncology social workers may assist patients with a wide range of concerns, including issues faced by patients at high risk of cancer, those newly diagnosed, patients in active treatment, as well as helping with survivorship, palliative care, and end-of-life issues.

Oncology social workers need to be knowledgeable about individual and family coping styles, resources, clinical interventions, and employ a myriad of other skills to help patients and families manage the multidimensional (emotional, financial, and physical) impact of a cancer diagnosis through their long journey. This management can range from distress and depression screening to assisting with transportation issues. It can encompass educating patients (and their caregivers) about stress management and self-care. It can entail working with parents on how to talk about cancer in an age-appropriate way with their children or with employees on how to discuss their needs with their employers, and extend to finding community resources to assist with a number of problems.  And, at times, it is sitting with a family facing the loss of a beloved family member.

Key to success as an oncology social worker is the ability to be present, to engage open-heartedly with empathy and compassion, to start where the patient is, focus on hearing the patient and/or family needs, and helping them to meet those needs, which may range from a simple referral to managing complex multidimensional issues.

I often hear—“Your job must be very hard, I don’t know how you do it.” In my career as an oncology social worker, one of the most important things that I’ve learned after 30 years of working with cancer patients and their families is that it is a privilege to walk alongside them during their journey, whatever the outcome.  There are fears and tears, but laughter and warmth, too. To me, oncology patients and their families are role models of courage and grace in the face of an often traumatic and life-changing experience.

As we join in marking National Social Work Month, I would like to acknowledge my fellow oncology social workers and say “thank you” for your contributions as part of the multidisciplinary cancer care team.


Guest blogger Fran Becker, LCSW, OSW-C, is manager of Cancer Support Services, Carl & Dorothy Bennett Cancer Center, Stamford Hospital, and a past member of the ACCC Board of Trustees.

ACCC thanks all oncology social workers for their efforts as part of the multidisciplinary team delivering patient-centered care in cancer programs across the country.

Navigators: Communicating Your Role

By Tricia Strusowski, RN, MS

Patient Navigation Healthcare CompassAlthough patient navigation services are becoming more common at cancer programs nationwide, physicians and administrators still frequently ask, “What are the responsibilities of the navigator?” Navigators coordinate care and remove barriers across the care continuum, which can potentially include many responsibilities. It is very important for navigators to be able to articulate their role concisely so that there is no room for misinterpretation. It is also important to share the Commission on Cancer Standards, Chapter 3: Continuum of Care Services, and navigator competencies/position statements from national organizations such as the Association of Oncology Social Work (AOSW), the Academy of Oncology Nurse & Patient Navigators (AONN+), and the Oncology Nursing Society (ONS), just to name a few.

Over the past year I’ve had several cancer programs request a tool to educate their physicians, office staff, and other departments on the role of the navigator and oncology support staff.  For programs looking for a similar tool, here are two sample questions and suggested answers. These can be customized to reflect your cancer program’s structure and its navigation and support staff responsibilities.

Example 1:

What is a navigator and what are the Commission on Cancer (CoC) Standards for Navigation?

Navigation Definition:
C-Change defines navigation as “individualized assistance offered to patients, families, and caregivers to help overcome health care system barriers and facilitate timely access to quality medical and psychosocial care from pre-diagnosis through all phases of the cancer experience.”

Commission on Cancer Standards, Chapter 3: Continuum of Care Services

Standard 3.1: Patient Navigation Process
A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations. The navigation process is evaluated, documented, and reported to the Cancer Committee annually. The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment.

Standard 3.2: Psychosocial Distress Screening
The Cancer Committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care.

The psychosocial representative on the cancer committee (oncology social worker, clinical psychologist or other mental health professional trained in the psychosocial aspects of cancer care) is required to oversee this activity and report to the cancer committee annually.

Timing of screening: Patients with cancer are offered screening for distress a minimum of 1 time per patient at a pivotal medical visit to be determined by the program. Some examples of a “pivotal medical visit” include time of diagnosis, presurgical and postsurgical visits, and first visit with the medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or a post-chemotherapy follow-up visit. Preference is given to pivotal medical visits at times of greatest risk for distress such as at time of diagnosis, transitions during treatment (such as from chemotherapy to radiation therapy) and transitions off treatment.

Standard 3.3: Survivorship Care Plan

The cancer committee develops and implements a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment. The process is monitored, evaluated, and presented at least annually to the cancer committee and documented in the minutes.

Include navigation position statements based on your navigation model. Use the following organizations:

Oncology Nursing Society Nurse Navigation Core Competencies

Academy of Oncology Nurse and Patient Navigators, Definition of Models of Navigation

Oncology Nursing Society, Association of Oncology Social Work, and National Association of Social Workers joint Position Statement on Navigation

Example 2:

How can the Navigator and Support Staff help your office?
Call us at _______________________________________

Nurse Navigator:
A nurse navigator provides patients and their families with education and assistance to overcome healthcare barriers and assist with timely access to quality medical and psychosocial care across the continuum of care.

 How can the nurse navigator help? 

  • Provide a comprehensive assessment/psychosocial distress screening of the patient/family needs, introduction of appropriate support services.
  • Reinforce education with patient patients/families regarding disease, treatments, side effects, and adverse reactions.
  • Link patients with community agencies and resources.
  • Make follow-up calls to patients/families at home.
  • Review support groups and educational programs for patients/families.
  • Educate patients on reportable signs/symptoms, based on physician’s plan of care.
  • Follow-up with patients’/families’ status post (s/p) discharge to ensure services are set up as planned. Coordinate with inpatient staff.
  • Conduct performance improvement (PI) projects.
  • Participate in Tumor Site Team and tumor conferences.

Social Worker:
A social worker can assist patients and their families with information on internal and external resources, financial, practical, and emotional concerns during their cancer journey.

 How can the social worker help? 

  • Provide counseling for patients and families.
  • Perform psychosocial assessments.
  • Offer and facilitate Support Groups.
  • Assist with completion of charitable application/patient assistance applications.
  • Assist with medication applications.
  • Evaluate patient for Medicaid/Medicare eligibility.
  • Provide transportation resources.
  • Identify community resources.
  • Coordinate Community Assistance Program.
  • Educate on Hospice.
  • Assist with end-of-life decision making.
  • Provide bereavement follow-up.

Registered Dietitian:
A registered dietitian is an expert in dietetics; that is, human nutrition and the regulation of diet. A dietitian advises oncology patients on what to eat in order to lead a healthy lifestyle or to achieve a specific health-related goal.

 How can a registered dietitian help?

  • Screen high-risk patients.
  • Provide group and individual nutrition counseling.
  • Connect patients with community and national resources.

 Genetic Counselor:
A genetic counselor can offer education, testing and counseling for patients (and families) with a history of cancer. Cancers may or may not be inherited.

How can a genetic counselor help? 

  • Provide risk assessment.
  • Provide genetic testing.
  • Provide genetic counseling.
  • Discuss strategies for risk reduction.

These are just two examples of how to create a tool to clearly and concisely explain the roles and responsibilities of navigators and support staff at a cancer program. These can be modified to describe the specific responsibilities for these roles at your cancer program. I encourage navigators to go forth and educate about your role.


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

Five Tips to Help Your Patients “Savor the Flavor” of Eating Well

In this follow-up National Nutrition Month post, guest blogger Colleen Gill, MS, RD, CSO, shares some tips for helping patients with cancer rediscover pleasure in eating. Ms. Gill is a clinical dietitian with the University of Colorado Cancer Center. She is also serves on the ACCC Board of Trustees.

Red appleBy Colleen Gill, MS, RD, CSO

National Nutrition Month is an opportunity for all of us to refresh our commitment to considering how we can help our patients with cancer rediscover joy in eating.   Even the 2016 National Nutrition Month theme, “Savor the Flavor of Eating Right,” reminds us of the obstacles faced by many patients, limiting their ability to experience the flavors and social experiences that food adds to our lives.

Five Strategies That Can Make a Difference

Here are some suggestions that can help patients eat well during and after treatment:

  1. Maintain traditions and social outings where food often plays an important role. During treatment, some patients choose to isolate themselves from such gatherings, adding to the sense of loss that accompanies diagnosis. Actually, most of us eat better in a social setting, enjoying the company around us. Accept the invitations that come your way and consider hosting your own events with a simplified potluck, or take out menu!
  2. It is OK to go slow. Eating slowly is not a bad thing, but rather a goal we all can adopt. It allows you to appreciate the flavors of the food, while giving your stomach time to signal when you are full. Don’t beat yourself up for being the last one done. If you are eating alone, or at home, consider pacing your meal/snack/drink with commercials on the television. Take a couple bites, or drink a couple ounces, with each commercial “reminder.”
  3. Go for flavor! When treatments affect taste buds, consider ethnic foods that have more spices and flavoring. As long as it doesn’t aggravate mouth sores or your stomach, there is no harm and a big upside.
  4. Make it easy and let others help! Coming up with ideas for meals and snacks can create stress for the whole family. Drafting a list of options that are “tolerable” for breakfast, lunch, dinner, and snacks saves everyone a lot of stress, guides shopping lists, and ensures enough variety so that no one burns out on eating the same thing over and over again. You can also add the extras that pack on calories, if you can’t eat a lot at one time. Softer, moist foods are often favorites. When people ask if they can help, provide them with a recipe. This saves you time and energy, and ensures that you will like what arrives.
  5. Don’t be afraid to eat out of fear of “feeding the cancer.” There is so much misinformation out there, and losing weight rapidly leaves you at risk of malnutrition, affecting your immune function and ability to heal, or even stay on treatment. Ask for a referral to a dietitian that works with cancer patients. He or she can give you individualized recommendations based on your cancer, treatments, weight and labs, as well as many other factors.

Some good resources are AICR’s H.E.A.L. Health Eating and Activity for Living Well: A Cancer Nutrition Guide and the Academy of Nutrition and Dietetics Oncology Dietetic Practice Group FAQs page here.

 

From Distress Screening to Solutions: Patient-Centered Support

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By Don Jewler, Guest Blogger

The Edward and Marie Matthews Center for Cancer Care at the University Medical Center of Princeton at Plainsboro is a New Jersey cancer program with a tall vision to identify distress among their patients, no matter where they are within the organization, and refer them quickly to the help they need. The institution will be honored with a 2014 ACCC Innovator Award for the development of a distress tool that guides clinical staff in making timely and appropriate referrals.

“It’s been amazing how many different issues we have been able to solve for patients with the distress tool,” said Lori McMullen, RN, MSN, OCN, senior oncology nurse navigator. “One patient, for example, was having a really difficult time emotionally coping with cancer. With the distress tool, we could see that he was struggling with his diagnosis. Conversations were started. We were able to make sure he received the psychological help he needed, and that’s a beautiful thing.”

McMullen along with representatives from both outpatient and inpatient nursing staff developed the user-friendly distress tool, which uses a six-point Likert scale scoring system. Patients rank a number of concerns, including weight loss and nutrition, finances, sadness, anxiety, family, and, of course, coping with the disease. A line for “other” allows patients to write in whatever else is bothering them.

“In the outpatient setting, the distress tool is done on paper and entered electronically into each cancer patient’s electronic medical record. For our inpatients, we have worked with our IT department so that the tool is totally electronic” said McMullen.

Commission on Cancer Standard 3.2 (a 2012 standard that must be phased in for 2015) mandates that patients with cancer are offered screening for distress a minimum of one time per patient at a pivotal medical visit to be determined by the program. Some examples of a “pivotal medical visit” include time of diagnosis, pre-surgical and post-surgical visits, first visit with a medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or a post-chemotherapy follow-up visit.

“Here, the patient might take the distress tool three or four times during the treatment cycle,” said McMullen. “As clinicians we were worried that our patients would get tired, or even annoyed, that we keep asking them about their distress level, but we have found our patients are happy that we are concerned.” At the University Medical Center of Princeton at Plainsboro, patients are screened for distress in radiation oncology at the first nursing visit after simulation, in the outpatient infusion room at the first chemotherapy visit, at the physician’s office at week five or six if on treatment, at the breast health center after a treatment plan is developed, and at the end of radiation treatment.

McMullen makes sure that referrals to support services are made. She has been the champion for implementing the distress screening tool system-wide.

“It took time to put the new process into the daily routine,” she noted. “Inviting patients to share their problems may not fit into every physician’s time frame. Although it may not yet be second nature for everyone to work the distress tool into their schedule, with gentle reminding we are getting close to 100 percent compliance.”

McMullen will speak at ACCC’s 31st National Oncology Conference in San Diego, Calif. On Friday morning, October 10, 2014, she will discuss techniques and barriers for building and implementing a system-wide distress screening tool. Come listen.

ACCC members will recognize the byline of guest blogger, Don Jewler, former ACCC Communications Director. We coaxed Don out of retirement to contribute to ACCCBuzz.