By ELLEN FUTTERMAN
Ronda Buffington has seen how a cancer diagnosis first brings total fear to a patient, then dread, and eventually, a quagmire of worries.
She says once the initial shock wears off, a patient's concerns often turn to more pragmatic matters such as "Will my insurance pay for this?" "Will there be side effects to my medications?" and "How do I talk to my children?"
In an effort to reduce barriers and gaps in care and to facilitate timely access to medical treatment, St. Joseph's Hospital in Tampa, Fla., began a navigation process late last year to assist cancer patients through all phases of their experience and to establish a "no wrong door" approach to answering patients' questions.
Need to know
Key to this program is a "navigation team," that is educated to have a much broader knowledge of national, community and hospital resources, as well as a cancer orientation class for patients, to address their physical, emotional and practical concerns.
"We want to give cancer patients the information they need upfront so that they can be active participants in their own care," says Buffington, community outreach coordinator at St. Joseph's Hospital.
The free, two-hour class entitled "Cancer Orientation: Resources and Financial Information to Assist You" started in December 2013. It now takes place every other month and is offered in both English and Spanish because of a large Hispanic population in the Tampa area.
The class covers a variety of topics, including the various treatments a patient may undergo; insurance and financial concerns; how best to communicate with the medical team; how to manage side effects; nutrition and psychosocial issues.
"We're not necessarily telling them something they don't already know or something that isn't already available out there," says Buffington, who teaches the orientation class given in English. "But this class lays all the information out in one place. They get a copy of the PowerPoint we go through and receive a booklet with all the information.
"The class is empowering because it gives patients a chance to ask a lot of questions, and underscores how much support there is for them at the hospital and in the community."
Buffington says family members are encouraged to attend the class, too. Often, they have lots of questions and anxieties but aren't always given a forum to have them addressed.
"We explain that there is no right or wrong way to feel about the diagnosis," says Buffington. "What we do emphasize is that (the cancer) can be managed, that there is support out there."
In 2012, St Joseph's diagnosed and treated 1,300 patients for all types of cancer. Buffington said the orientation class began after a survey revealed cancer patients felt they weren't getting the information they needed in a timely manner. Part of the problem, she explains, is that often hospital professionals work in a silo, "and only know what's available resource-wise in their own department, or area of expertise."
That's why, she says, the multi-disciplinary navigation team was created. Made up of 20 people drawn from every department at the hospital that assists cancer patients, the team meets monthly to cross-train and educate one another so that each member has knowledge of every resource available at the hospital, as well as in the community and elsewhere. Then members go back to their department to share what they've learned with coworkers.
"So now, if a nutritionist is asked by a patient where she can get a good wig, (the nutritionist) knows the answer and has the resources available to assist a patient without having to pass her off to someone else or make her wait for the answer," says Buffington.
Michelle Moore, manager of breast cancer services at St. Joseph's, gives both the orientation class and navigation team approach high marks because they are so comprehensive.
"Now, we all have access to one another and know what each other is doing," Moore says. "More and more cancer accreditation bodies are looking to make sure cancer centers provide comprehensive care because it makes for better outcomes and patient services."
That, says Lorraine Lutton, president of St. Joseph's Hospital, is at the core of the hospital's mission.
Informed, proactive patients
"The cancer orientation class goes hand in hand with our mission to improve the health of all we serve through community-owned health care services that set the standard for high-quality, compassionate care," says Lutton. "We empower patients as active participants in their care by going over different treatment options and explaining side effects, but there are other factors involved. Things such as financial worries, managing employment, dealing with insurance companies, transportation to and from appointments and child care issues are often overwhelming for a patient that's just been diagnosed with cancer. We let patients know there are resources out there and point them in the right direction to get the assistance they need during their time of need."
Patient evaluation forms indicate the orientation class is making a difference. "The length of the class was such that anyone with questions had the opportunity to ask them at that time instead of at the end when they might have been forgotten," said one newly diagnosed woman in her 50s.
Buffington explains both the class and the navigation program are still in their infancy, and will continue to be tweaked. For example, in June, instructors added videos about chemotherapy and radiation. The orientation class size is limited to 20 people, but to date the largest attendance at any one class has been 10.
"We've been holding the classes at night but it may be that we need to do some during the day," says Buffington. "Although the class size has been small, it's been good because the people who came really wanted more detailed information.
"Sometimes cancer patients are a little intimidated to ask questions of their doctor," she adds. "We discussed how it's OK to ask questions, it's what they're paying for, and to even get a second opinion.
"We don't make decisions for them or tell them what they should do, but we are there to guide them."
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