By championing and encouraging advanced practice providers and allied health professionals to work at the top of their licenses, Wilmot Cancer Institute offers comprehensive care close to home through its breast care program that vastly improves the patient experience.
The Pluta Comprehensive Breast Care Program at Wilmot Cancer Institute (WCI) in Rochester, New York, supports advanced practice providers (APPs) and allied health professionals (AHPs) in working at the top of their licenses. APP-run clinics create clear pathways to care and bring services in-house that used to require an outside referral. By championing these professionals, WCI is offering comprehensive care close to home and thus improving the patient experience.
Impact:
Crystal Regis, NP, is Lead APP for the breast surgical group and Clinical Lead of the Breast Health Program, which provides care to patients with benign and undiagnosed disease, patients with known or perceived risk, and patients with noninvasive breast cancer who need surgical follow-up. Many of her patients never see a physician in the breast program, opening those colleagues’ schedules for more complex cases. From first history through diagnosis, imaging, and management, “These are my patients,” Regis says, although she can always pull in a physician colleague for an additional consult, if needed.
Before the APP-run Breast Health Program, these patients had no clear home. They would be referred to the breast surgical group, but the group had limited capacity to care for them. Now, gynecology, primary care, and lactation medicine refer straight to Regis. She also offers e-consults, giving community providers access to her opinion on abnormal imaging results without requiring patients to travel.
WCI’s investment in leadership and professional growth has enabled APPs and AHPs to take on a bigger role. The institution supports and encourages continuing education by providing access to or funding for internal training, professional memberships, outside courses, and certifications. APPs and AHPs also serve on multidisciplinary quality, ethics, and research committees, extending their role beyond the clinic and into how care is shaped in the system.
In addition to breast health, APPs and AHPs play an active role in supporting patient well-being. For example, a sexual wellness clinic was established within the breast survivorship group and has since expanded to accept referrals from all cancer service lines. Carli Kotula, PA-C, who co-leads the clinic, says, “Providers are more likely to ask patients about these issues knowing they have someone on the team who can address them.” Kotula further describes what the clinic has meant to patients: “A lot of these patients come in telling us that they felt like they had nowhere to go, and these are often very emotional, really difficult issues for them. It has been really rewarding to be able to expand and provide this much-needed service.”
Audrey Lawrence, LMSW, is one of two social workers in the Breast Health Program. She sees patients from diagnosis through survivorship, supporting their mental health needs. This includes connecting patients to resources, supporting communication with employers, addressing financial distress, and assisting with health insurance navigation. All patients are screened for distress at the first visit and every six months. They are referred to a social worker automatically if they score above a certain threshold. Nurse navigators, APPs, and medical oncologists also refer patients based on preclinic huddles, which Lawrence is part of, or on conversations that providers have with patients during visits. Laura Eckert-Davis, NP, Lead APP for the breast medical oncology group, describes how this works in practice: “I recently had a patient share something during clinic, so I shot Audrey a message, and it’s just that simple.”
At the end of active treatment, patients with breast cancer move to the APP-run survivorship clinic. Alissa Huston, MD, Professor of Medicine and Co-director of the Breast Survivorship Program, frames this move to patients as “graduating.” Patients meet the survivorship team during the handoff from medical oncology, so when they attend their first survivorship appointment, they see a familiar face. Both Dr. Huston and Eckert-Davis stress that this handoff is shaped by clear workflows and that they work as a team, which means patients receive cohesive care.
All of the providers credit the model’s success to buy-in across the team and backing from leadership. APPs and AHPs feel supported in working to the full scope of their license and patients receive the benefit of well-administered, compassionate care. When Huston has a patient or family member who has concerns, she is able to confidently say, “I’ve got a person for you, I’ve got a place for you.”
Explore additional resources on care coordination at accc-cancer.org/care-coordination.
Acknowledgments
This program is made possible with support from Lilly.
In partnership with the Advanced Practitioner Society for Hematology and Oncology and Association of Oncology Social Work.
