In 2008, the Institute of Medicine (now the National Academies of Science, Medicine, and Engineering) released its influential report, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, which called attention to the importance of the psychosocial needs of cancer patients and the consequences of these needs remaining unmet. The IOM report concludes:
Attending to psychosocial needs should be an integral part of quality cancer care. All components of the health care system that are involved in cancer care should explicitly incorporate attention to psychosocial needs.
Today, there is an increasing body of knowledge around this area, and organizations like the Commission on Cancer (CoC) and others are including distress screening as part of their guidelines and accreditation standards.
ACCC, along with its project partner APOS, identified three ACCC member programs that are serving as model sites for the “Psychosocial Distress Screening” project.
A new ACCC white paper, Empowering Patients, Engaging Providers: The Future of Patient-Centered Care in Oncology explores current challenges and barriers, and what’s needed to make headway in improving patient-centered oncology care. Derived from discussion at the ACCC 2016 Institute for the Future of Oncology forum, the report identifies seven elements required to provide true patient-centered care: patient stories, navigation and coordination, interdisciplinary teams, appropriate reimbursement for services rendered, greater education, information technology connectivity and transparency, and decision-support tools. For this blog post, I’d like to zero in on the first item: knowing the patient’s story. Or put another way, knowing the person, and not just the patient. Our current healthcare environment—with time constraints, data collection and reporting requirements—can make it challenging to know our patients’ stories. That said, we know that members of our multidisciplinary care teams do get to know our patients—one such team member is the radiation therapist.
Radiation Therapists & Patient-Centered Care
Patients undergoing radiation therapy will often interact with radiation therapists on a daily basis for weeks. While our patients and their family members cannot typically discern whether the radiation therapy treatment we are delivering is working, or if it will have a positive benefit in the future—what they do register is a warm greeting and the smiling face and listening ear of the radiation therapist delivering the treatment together with all of the members of the radiation oncology team. This daily contact between radiation therapists and their patients can have a profound impact on the patient experience and the quality of patient-centered care. Therapists have the unique perspective of being able to observe subtle changes in a patient’s demeanor and side effects, both new and ongoing sequelae. Often the skin changes seen by the nurse and physician during the weekly treatment visit can change markedly over the course of the week. Radiation therapists seeing these skin changes can have an important effect on the patient’s experience with radiation oncology by serving as another care touch point or intervention prior to the weekend. Examples include something as simple as changing the type of cream the patient uses to making sure the patient has the proper pain medication before the weekend.
By listening to their patients’ concerns, fears, and questions, radiation therapists not only get to know their patients, but also can help create an environment where the patients feel like they are at the center of their care. For example, given the complex nature of radiation therapies, one of the key drivers to patient satisfaction is the management and explanation of the side effects they will face during treatment and recovery. In fact, this point is specifically measured by the Press Ganey patient satisfaction survey that asks patients to rate the “Explanation of how to manage radiation therapy side effects.”
At WellSpan Health, the Oncology Service Line, has chosen to evaluate this measure and its effect on patient-centered care by adding another “touch point” with the therapists on a weekly basis. Our weekly on-treatment visits (OTVs) are done typically on a Monday. The therapists review the patient’s previous OTV note, and on Thursday the therapists ask specific, pointed questions concerning side effects that were raised and discussed during the OTV. The therapist then documents that these issues were discussed with the patient. I believe this adds to the level of communication, care coordination, and patient-centric care the patient experiences during their radiation therapy treatments and demonstrates a true patient-centered approach to their care and overall well-being.
The Institute of Medicine (IOM) has described patient-centered care delivery as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” On the frontlines of cancer care delivery, radiation therapists are often the “face” of radiation therapy, providing a welcoming presence and connecting with patients to help improve their care experience.
Guest blogger Bryan M. Schmalhofer, MBA, is manager, Radiation Oncology Operations at ACCC Cancer Program Member WellSpan Health, York Cancer Center. He also serves on the ACCC Editorial Committee.