Streamlining cancer care

STANFORD MEDICINE NEWSLETTER
FALL 2014

Sharron Brockman has become all too familiar with cancer. Diagnosed 18 months ago with stage-3 ovarian cancer, Brockman has gone through two rounds of chemotherapy and had to drop out of a clinical trial because of a reaction to one of the medications. But when she decided to continue her treatment this spring at the Stanford Cancer Center, the Sacramento resident came across something new: her own multidisciplinary care coordinator.

"Before I even showed up for my first appointment, we spent more than 40 minutes on the phone going over everything from my medical history to my personal background," she said. "And once I showed up for my first appointment, she made it a point to come by to see me. I was flabbergasted. I never had anyone spend that level of dedicated time with me before."

Brockman is part of a new program that assigns special nurses to serve as one-on-one advocates and liaisons for cancer patients new to Stanford Health Care. The first two multidisciplinary care coordinators, who were selected for their in-depth knowledge and personal initiative, follow their patients from the first point of contact through the entire span of care. They assess patients' needs, triage symptoms and questions, make referrals, coordinate logistics and explain terminology, putting a friendly face on the often confusing process of cancer diagnosis and treatment.

"Our role is to act as an agent of change in terms of the patient experience," said Laura Birmingham, RN, the coordinator working with Brockman and 17 other new patients in gynecologic oncology, a number that is expected to increase rapidly as the program progresses. "We're here to help improve outcomes and reduce stress on patients and families. But mostly we're here to create a relationship that says, 'We're here with you. We can help you with whatever you need.'"

Pioneer program

Birmingham and Vitale Battaglini, RN, who works with patients diagnosed with head and neck cancers, handle all questions and concerns, from possible side effects of treatment to what a hospital resident does. They keep in contact through calls, texts or emails, and follow up after clinic visits and before and after any transitions in care. Their inquiries are designed to ensure that personal and social needs are being met as well as to help improve the patient's physical well-being. They provide a single point of contact for resources and support, tailoring information to suit patients' needs and explaining it in a way that patients understand.

"Someone newly diagnosed doesn't know what to expect, and things that seem basic to us are new to them. Our job is to be their first and main point of contact," Battaglini said. "It's a reversal of the traditional nurse's role: We are the patient's nurse, not the doctor's nurse. And what the patient needs depends on that particular patient."

"Cancer care has become so complex because it involves so many subspecialties," said Julie Kuznetsov, director of the Cancer Patient Experience, who oversees the new program. "The field continues to evolve with new technologies and specialized expertise. While that means more options and better outcomes, for patients it has become more difficult to put the pieces together to coordinate their care."

The logic behind the multidisciplinary care coordinator program is to take that complexity away from the patient. The coordinators are familiar with the Cancer Center's clinical and supportive care programs and work directly with the patient's physicians to organize treatment and follow-up services. They stay with the same patient throughout that person's care even when multiple specialists and subspecialists are involved.

"Cancer patients are already dealing with all kinds of stress, and coordinating visits can be overwhelming. The coordinators make it their personal responsibility to manage the moving pieces so the focus for patients and families can be on quality of life and healing," said Kuznetsov.

Setting the groundwork

As the first care coordinators, Birmingham and Battaglini are laying the foundation for an expanded program that eventually will include all new patients at the Stanford Cancer Center. The next phase, set to start next year, will include patients in the breast oncology and hematology programs.

Part of their role is to help refine the process based on evidence-based practice—tracking what works to identify the most effective processes while keeping each patient's individual concerns the priority.

"Most patients are in shock when they are first diagnosed, so that initial call we make starts a relationship before they have their first clinic appointment. We are constantly evaluating and assessing different approaches as their needs change," Birmingham said. "There's a lot of triage involved — even over the phone. We're creating guidelines based on patient-centric care. We're building a whole new system."

Team effort

By helping patients prepare for their clinic, diagnostic and treatment visits in advance, the coordinators help reassure patients and families and provide much-needed support to the clinical team. By fully assessing the patient's physical health, psychosocial well-being and personal needs from the start, they allow clinicians to focus their time on disease management and treatment, Kuznetsov said. And physicians include the coordinators in their discussion of care.

"The concept works especially well in gynecologic oncology because there are so many different aspects of care involved," said Oliver Dorigo, MD, PhD, director of the gynecologic oncology clinical care program and associate professor of obstetrics and gynecology (oncology) at Stanford School of Medicine. "It's a fully comprehensive approach, and it helps to better integrate the full spectrum of ancillary services, such as palliative care, genetic counseling and clinical trials. I trust the coordinator's judgment as an integral, knowledgeable member of the team."

For Brockman, having a care coordinator has made it easier to cope with a difficult situation. "It is an incredible program, and I hope that other treatment centers will follow Stanford's lead. It's a pleasure to be part of it."

Original article appeared here.

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