9/26/2016. Call or Today. Presenters. Diane Jones Larson, RN, BSED Rita Sanem, RN, CDP Jordan Fiegen, MSW

Transcription

1 Call or Today Presenters Diane Jones Larson, RN, BSED Rita Sanem, RN, CDP Jordan Fiegen, MSW 1

2 Cancer Navigation: The History Founded in 1990 s at Harlem Hospital by Dr. Harold Freeman Recognized low socioeconomic status prevented timely diagnosis and access to care Developed longitudinal model of navigation where lay navigators shepherd patents through each phase of care, ensuring care happened timely, involving lots of community outreach Patients with late stage diagnosis were reduced by half and 5 year survival rates nearly doubled! Cancer Navigation Across the US Many cancer programs starting to implement some navigation Nurses or lay navigators Disease specific navigators, specific population such as indigent, or navigate a specific piece of the cancer journey like initial referral Should be designed based on the needs of your population But, none like the Avera Cancer Institute Navigation Center! Cancer: Affecting Lives Right Here at Home Per American Cancer Society (ACS) In 2016 in the U.S., there will be an estimated 1,685,210 new cancer cases and 595,690 cancer deaths. In South Dakota an estimated 4,690 new cases and 1,640 deaths. 2

3 Rural America: A Healthcare Disparity One quarter of Americans live in rural areas Americans living in rural areas consistently report higher cancer mortality rates Complex causes for this disparity: Nationally, only 10% of physicians practice in rural areas (Only 3% of Oncologists per ASCO s state of Cancer in America report 2014) Nationally, 4 out of 10 cancer patients live at least one hour from an urban area. Standard barriers for quality cancer care include: Time Transportation Financial Resources We Are Rural America South Dakota covers 75,885 square miles. Prairie, grassland and farmland cover 90% of the state estimated population was 853,175 people 446,157 living in rural South Dakota A majority of SD is designated as a health professional shortage area and most of the rural areas are considered medically underserved. SD ranked 30 th nationally for women 45 and older getting mammograms and 35 th in colon cancer screening for 50 and older per ACS. Avera Cancer Institute Navigation Center Steering Committee Community Partners affected by Cancer Survivors/caregivers/those who had lost a spouse to cancer Avera Cancer Institute Leadership Avera Call Center Leadership Foundation Leadership Marketing Leadership Supportive Services Staff Assisting to design and implement the navigation center to meet the needs of those who will be served 3

4 Avera Rural Cancer Advisory Board Respected Professionals in Farmer Rancher Industry Physically live and work across the Avera footprint Established to assist cancer services in keeping a rural focus because Avera s footprint is primarily rural Providing resources, barriers or contacts in the counties around where they live that are beneficial to know to better serve our callers Will be having a presence at community events and organizations and spreading the word about ACINC Avera Rural Cancer Advisory Board "I am proud to be a small part of this very proactive effort. Thank you to Avera and the Bush Foundation on behalf of those of us involved in SD Agriculture" Walt Bones, Advisory Board Member Jim Wooster, Advisory Board Member Community Needs Assessments State cancer statistics and existing cancer control plans Research via literature review of best practices around navigation Focus Groups of existing navigators Utilization of existing community needs assessments done across service area (all had very consistent needs) 4

5 Access as a Barrier Rural Populations are often underrepresented in clinical trials Palliative and End of Life Care services and facilities 6 million U.S. individuals reside more than 60 minutes from a hospice facility Screening, treatment, follow up care farther away 5

6 Burdens and Complexities of the Cancer Journey Very Distressing Affects job, family, finances, body image, physical ability, emotions Many physicians involved Primary care, oncologist, surgeon, radiation oncologist, pathologists, radiologists, Lots to coordinate Scans, labs, MD appointments, chemotherapy, radiation, when to take what medications, where to go for what services Burdens and Barriers Affect Outcomes The odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. Depressive symptomology was a consistent psychological predictor of shortened survival time. Increased travel burden was associated with a decreased likelihood of receiving adjuvant chemotherapy, regardless of insurance status. Patients with non private insurance who resided in low density oncologist areas were less likely to receive adjuvant chemotherapy. Avera Cancer Institute Navigation Center What did we develop? Bringing a free and trusted cancer resource to anyone in the greater region affected by cancer and address the barriers, burdens and needs Collaborating with individuals, organizations, and communities We want to become embedded in these communities across SD and into surrounding states. We are developing and sharing a resource data base with organizations to maximize efficiencies for cancer patients Navigation services for the six Avera regional cancer centers with services for people from their regions We work as extensions of staff at these ACI s, thus providing one part of COC requirements as well as support for staff and patients Increase access to navigation services to help more people Provide 24 hour/7 days a week support regardless of location M F 8 8pm with nurses at Avera Call Center weekends and overnights 6

7 Avera s Navigation What Makes Us Unique? Our Mission: Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. Avera Cancer Institutes were implementing disease specific navigators and saw benefits and we knew we needed to offer navigation to everyone We decided to think outside the box and create what will work for all, right here in South Dakota, a rural >72,000 square mile service area continued Master s prepared Social Workers and Registered Nurse Navigators The SW services added a needed dimension to our model Only 7% of navigation services have Social Workers RN and SW work in tandem for the benefit of our clientele RN navigators will be certified through the Association of Oncology Nurse and Patient Navigator Program. SW navigator will be certified through the Association of Oncology Social Workers. A hub to connect people to what/who they need when they need it, close to home Phone based service with a walk in option so all can access Philanthropically funded Continuously working on Grants, assessing for the needs of the community The Avera Cancer Institute Footprint 7

8 Removing Barriers, Reducing Burdens, Providing Support What ACINC can do for you and your patients Timely access to quality care Referrals to oncologists, primary care, wellness and rehabilitation experts, mental health services, etc. Knowledge Educating patients, families, providers on specific Ca diagnosis, from diagnostic tests to treatments, what to expect, and questions to ask their providers Continued Connecting to Resources Connecting people to what they need close to home such as transportation services, insurance and financial experts Symptom Management Cancer doesn t stop after clinic hours: 24/7 access to clinical support, assist with understanding what is normal, when to call the doctor, and when to seek immediate help Support throughout the journey for patient, loved ones, caregivers, or spiritual care providers with coping strategies, trusted online support networks *NO CALL OR QUESTION IS INSIGNIFICANT Serving All Affected by Cancer Anyone affected by cancer Healthy individuals, the individual with cancer, cancer survivors, loved ones, caregivers or healthcare professionals Regardless of where they receive care Any healthcare system, clinic, hospital Focus is on the entire state of SD into the surrounding states 8

9 Nurse Navigator Role Details Rita Sanem, Nurse Navigator Registered nurses help navigate patients, families, and other healthcare professionals through a cancer diagnosis by: Support and guidance on new or existing cancer dx s and treatments for patient or caregivers. Education on disease, disease process, and types of treatments to fight their cancer. Educate on new and expanding targeted therapies and clinical trials Assist with questions that can help patients during their visits with physicians. Assist with initiating new cancer referrals to the closest ACI, or facility of preference, and needed diagnostic tests. Serve as an extension of the care team for Primary Care Providers or other specialty providers. Educate and help patient and families after treatment from survivorship to hospice care. Follow up calls to survivors after completing care approx. 2 weeks after. Find answers to any question or concern the calls request Social Work Navigator Role Details MSW helps navigate patients through the healthcare system by providing services including: Ongoing psychosocial support Identify needs of patients, caregivers and loved ones Education and information Community resources Referrals Advocacy Coping skills Counseling services Social work navigation role assists in complimenting the medical team by providing that complex addition to care that may have been hindered or overlooked. This may be directed towards a patient, caregiver, loved one and/or professional. Jordan Fiegen, MSW Avera Cancer Institute Navigation Center Avera Cancer Institute Support Services Avera Cancer Institute Navigation Services, RN & SW Avera Cancer Institute Providers and Resources Those Affected by Cancer Cancer Diagnosis, Symptom Management and Support National, Regional and Local Resources National, Regional and Local Services 9

10 Navigation Case Studies 54 yr old woman from Eastern SD area. Calls navigation center and speaks with SW navigator. Pt informs navigator that she has chemo on Sept 6 but lives over 3hrs away and needs assistance with lodging. Pt attempted to reach ACS liaison but was unable to make contact. Pt s primary SW also out of the office for the time being. Contacted ACS liaison at national contact number and placed a request for lodging Sept 5. Navigator reconnected with pt to inform her that she would be getting a call with lodging information. QCL sent to pt s social worker for continuum of care. On 8/29/16, sw navigator spoke with ACS Liaison to see what progress had been made. Pt was placed at local hotel. Navigation Case Studies Call transferred to RN navigator. Client had just talked to her sister, having just told her of her new cancer diagnosis. Client s sister upset her, telling her that she had to have treatment right away before the cancer spread! RN assured client of the progress in cancer care, even from just 2 years ago, the nature of her specific cancer diagnosis, and treatments available for her type of cancer. Client was confused on why her physician would want another visit for further testing. RN explained what the tests that were ordered for her consisted of, and what information they could tell the physician. Information was also given on the surgery her physician had previously suggested. RN gave client suggested questions to ask her provider at her next visit and arranged to have information sent to her on her cancer, treatments, and future questions to explore with her provider. Client asked if she could call RN back and writer encouraged her to do so, also encouraged her to have her sister call us. Navigation Case Studies Client called ACINC to ask how much a donation to the lodging facility, Walsh Family Village usually was and then had some clinical questions she didn t want to bother the team with. Asked about how her treatment would be given, where, and how; also possible effects that could happen during and afterwards, possible lasting ones; concerns about not wanting to be in pain. RN gave general information on her treatments and reassured her that the care team knew about these things and had plans in place to prevent or alleviate any potential adverse effects as much as possible. Client had concerns regarding billing, and at this juncture RN referred her to her SW on her team. I suggested she tour the facilities where her treatments would be given to reduce her anxiety. RN notified her SW of our discussion as well as the rest of her health care team. 10

11 Contact Us Navigation Line: or For a nurse or social work navigator Or navigation@avera.org Jamie Arens, MSW Director at Jamie.Arens@Avera.org or For more information or collaboration opportunity Dorinda, Admin Assistant at Dorinda.Martin@Avera.Org or For more business cards or brochures for your facility To request our presence at a meeting, community event, health fair etc Thank you! For more information about the ACI Navigation Center and our services, go to: medical group/servicelines/oncology/aci navigation center/ References Maximizing the Value of Patient Navigation, Oncology Roundtable Challenges of Rural Cancer Care in the United States By Carlton, Schlichting, Chioreso, Ward and Vikas Depression Is a Risk Factor for Noncompliance With Medical Treatment Meta analysis of the Effects of Anxiety and Depression on Patient Adherence M. Robin DiMatteo, PhD; Heidi S. Lepper, PhD; Thomas W. Croghan, MD Psychological Distress and Cancer Survival: A Follow Up 10 Years After Diagnosis KIRK W. BROWN, ADRIAN R. LEVY, ZEEV ROSBERGER, AND LINDA EDGAR Association Between Geographic Access to Cancer Care,Insurance, and Receipt of Chemotherapy: GeographicDistribution of Oncologists and Travel DistanceChun Chieh Lin, Suanna S. Bruinooge, M. Kelsey KirkwoodChristine Olsen, Ahmedin Jemal, Dean Bajorin,Sharon H. Giordano, Michael Goldstein, B. Ashleigh Guadagnolo, Michael Kosty, Shane Hopkins, James B. Yu,Anna Arnone, Amy Hanley, Stephanie Stevens, and Dawn L. Hershman Cancer statistics report by Stacy Simon, ACS 1/7/16. Cancer Facts & Figures 2016 from website below by American Cancer Society pdf products/state fact sheets/statedata.aspx?statefips=46&statename=south%20dakota SD Cancer Control Plan