Immunotherapy has changed the landscape of oncology, particularly in advanced metastatic disease, where the chance of prolonged remission is now measured in years or even into the early decades in [ Read More ]
February 2018 VOL 9, NO 2
Creating Partnerships Between Navigators and Physician Practices
Value-based cancer care is about better care, smarter spending, and healthier people, whereas the goal of the recently developed Academy of Oncology Nurse & Patient Navigators (AONN+) Standardized Navigation Metrics is to provide more coordinated care for patients and their families across the continuum. According to Tricia Strusowski, RN, MS, Manager at Oncology Solutions, Inc, “The AONN+ metrics fit beautifully with what’s going on with value-based cancer care, and providers and administrators are taking notice of what we’re doing with our metrics.”
To advance quality patient care and ensure all parties are working toward a common goal, navigators must integrate with oncology/hematology physician practices. At the AONN+ 8th Annual Navigation & Survivorship Conference, Ms Strusowski discussed approaches to doing just that.
How Can We Help Our Practitioners?
When a cancer center is having a difficult time coordinating care, the navigator can step in with certain practices designed to facilitate success and enhance the patient experience.
To create partnerships with physician practices, navigators should incorporate performance improvement based on both the AONN+ metrics and the value-based cancer care metrics those practices are working to meet. These partnerships should increase efficiency and timely access to services by providing comprehensive assessments and referrals to appropriate disciplines and should reinforce patient education and empowerment through decision aids and patient appointment checklists (used to help the patients understand why they are being referred to different services).
Initiate proactive identification of support service needs and create standing order sets, she advised. “We know what our patients need by disease site, so let’s write it down.” Increase support for providers by teaching members of the care team how to initiate critical conversations—about palliative care, goals of care, advanced care planning and prehabilitation—earlier in the continuum.
“We need to have these discussions early on, before the patient is in an acute medical crisis,” she said. “That is not the time to be talking about goals of care.” Additionally, introduce the concept of the survivorship care plan early on in the continuum and review this information with patients and their families throughout.
Increase contact with “frequent flyers” to decrease avoidable admissions. “Let’s call our patients,” she said. “Let’s keep them out of the ER and hospital; that’s what value-based cancer care is all about.”
She recommends drafting a welcome letter to patients complete with frequently asked questions. The letter should be simple, and the questions can prompt the patient when they don’t know what to ask. “Start from where the patient is, not where we are,” she said.
Aim to provide the same standard of care in both the inpatient and outpatient settings, create multidisciplinary teams (including all support staff) to meet about each patient on a regular basis, make sure patients meet their team and know their support services as early as possible, and create guidelines for automatic referral to financial counseling (ie, self-pay = automatic referral).
A palliative care “tip sheet” can also be a useful tool. Set staff up to succeed by distributing this at the beginning of the continuum. The tip sheet should address such topics as the importance of discussing palliative care with patients, frequently asked questions for newly diagnosed patients, and communication pearls for palliative care discussion. “When we’re all saying the same thing, we can set our conversations up to succeed in terms of palliative care,” she noted. According to Ms Strusowski, actually scripting out the initial palliative care discussion can be very powerful.
Use the “Ask-Tell-Ask” methodology, she advised. Ask the patient “what do you know about palliative care?” Avoid reviewing more than 3 points at one time, then ask the patient to repeat back what they’ve been taught. “Keep going over it until the patient has it right and understands what palliative care actually is,” she said.
Finally, keep a dashboard to measure the provision of various aspects of patient care, and report back to the cancer care team to create benchmarks.
“We need to be extremely aware of what’s going on in value-based cancer care,” she added. “And we need to participate and make partnerships with our providers and administrators, so they understand and appreciate the value we bring to the team.”
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