- Health Equity – Making Science and Technology Work at the Community Level
- The Science of Compassion – Science-Based Tools for Decreasing Burnout, Increasing Satisfaction, and Improving Communication
Health Equity – Making Science and Technology Work at the Community Level
Robert A. Winn, MD, Director and Lipman Chair in Oncology at the Virginia Commonwealth University Massey Comprehensive Cancer Center, discusses the progress that’s been made in reducing health disparities in the United States and the evolving approach that may eventually erase them altogether.
Just days after the 2024 presidential election, Robert A. Winn, MD, began his presentation by acknowledging the elephant in the room. “Things have changed in a way that I know that, over the last several days, people are wondering, what will happen to navigation? What’s going to happen to the health of our communities?”
He added: “I’m here to talk about equity. I’m not really sure that in the next few years we’ll be able to move it forward. And yet, I stand before you undaunted, unafraid, unapologetic that the work that has to get done will get done.”
Here, Dr Winn, the Director and Lipman Chair in Oncology at the Virginia Commonwealth University (VCU) Massey Comprehensive Cancer Center, the Senior Associate Dean for Cancer Innovation, and a professor of pulmonary disease and critical care disease at the VCU School of Medicine, discusses the progress that’s been made in reducing health disparities in the United States in recent years and the evolving approach that may eventually erase them altogether – even in the face of an indifferent government.
Beyond Biology (and Ignorance)
Despite the widely held belief that numerous health disparities became apparent during the chaotic early days of the COVID pandemic, Dr Winn says that most have been a matter of record since W. E. B. DuBois documented them in a study published in 1899.
“I tell you that because we should not act as if this is new problem, or if this is the first time we’ve been tasked with solving this problem,” he said. “What’s new about it is, like everything else, it’s become a little more nuanced.”
For much of the history of healthcare in the United States, science was divorced from socioeconomic considerations. As a result, knowledgeable, perceptive people like Dr Winn accepted as fact that prostate cancer was more prevalent in Black men because they were simply predisposed to it. But it’s become clear that the exhaustive use of the term “predisposed” was merely covering for a broad ignorance.
More recently, researchers and clinicians have begun to understand the significant impact of socioeconomic factors on a population’s health. In turn, the disparity in cancer deaths between Black and White patients stood at 11.3% in 2020, down from 33% in 1990, according to the American Association for Cancer Research Cancer Disparities Progress Report.
As an example of what this movement looks like at the ground level, Dr Winn pointed to a watershed study published in 2020 that found the disparity in mortality rates from prostate cancer between Black and White male patients narrowed significantly when they were screened and treated in an “equal-access healthcare system.”
But for the most part, these insights remain informative rather than curative. For instance, the lower a household’s income, the more likely that family is to live in an area with a high surface temperature, and a growing body of research supports a correlation between high surface temperatures and chronic diseases and conditions, including cancer. However, recognizing this trend is one thing, reversing it is another.
The Future of Health Equity
The future of health equity, as Dr Winn sees it, is heavily dependent on patient navigation.
The VCU Massey Comprehensive Cancer Center relies on its navigators to ensure patients receive access to the appropriate healthcare. Their role doesn’t end there, though. They’re also counted on as community liaisons, gleaning valuable data from their patients’ environments that can then be used to refine the center’s scientific research.
Dr Winn says the center’s navigators helped bring a cluster of cancer cases to his attention. A landfill was established in the neighborhood – which has a large population of Native Americans – about 30 years prior, and some residents believed there was a connection. Massey engaged with community leaders and helped conduct water tests, among other interventions. While they discovered nothing conclusive, the partnership drew the attention of other tribes across Virginia and led to the establishment of an annual meeting about the health of Native Americans.
“What are we capable of doing?” Dr Winn asked with regard to the next phase of health equity. “For me, I carry hope.
“We are going to be armed with more knowledge and new technologies, and navigation will allow us to be even more precise about how we do things,” he continued. “This concept that the place in space in which a person lives is important, which means that we need to get more and better data. But more importantly, we need to get even more dollars to do the navigation that we need.”
The Science of Compassion – Science-Based Tools for Decreasing Burnout, Increasing Satisfaction, and Improving Communication
In this presentation, Katelyn Carey shares anecdotes from her own 20-year career as an acute care nurse and leader in crisis management to illustrate how and why our brains process information differently when stressed, and she shares evidence-based strategies that allow healthcare providers, including navigators, to become effective in giving and receiving information during stressful times.
Empathy and compassion are often used interchangeably. But in healthcare, at least, they shouldn’t be, argues Katelyn Carey, BSN, RN, a clinical educator, speaker, and author.
Empathy, in this setting, tends to involve an emotional response that can become all-consuming and lead to emotional exhaustion and, eventually, burnout. And when healthcare providers begin experiencing the symptoms of burnout, they are, according to Ms Carey, 45% more likely to make major medical errors and 54% more likely to provide suboptimal care.
Compassionate interactions, on the other hand, have been shown to lead to a 62% increase in the likelihood that patients will adhere to their treatments, a 41% decrease in severe complications, a 50% reduction in the use of pain medication, and 17% faster wound healing, according to Ms Carey.
“Studies have shown repeatedly that when we are compassion-based instead of empathy-based, we are not only more effective with our patients, but it also has protective qualities for us,” she said.
In this presentation, Ms Carey shares anecdotes from her own 20-year career as an acute care nurse and leader in crisis management to illustrate how and why our brains process information differently when stressed, and she shares evidence-based strategies that allow healthcare providers, including navigators, to become effective in giving and receiving information during stressful times.
A Subtle Change in Tactics
Hazel was in respiratory failure when she arrived at the hospice where Ms Carey worked. She “had a lot of pain” and was so weak she struggled to hold the mask up to her face during breathing treatments.
“For us, the problem wasn’t the complexity of her symptoms and her disease,” Ms Carey said. “For us, the problem was Hazel’s son, Tom, who was her medical decision-maker. Because no matter what we said, no matter what education we provided, Tom refused to allow any opioid medications to be given to his mother. And so, we were watching her suffer.”
This continued for weeks, the hospice nurses attempting to educate Tom on the benefits of opioids, particularly morphine, which would relieve her pain and help her feel like she was struggling less for every breath. Family members also lobbied Tom on his mother’s behalf. Still, he held his ground.
Eventually, Ms Carey used a new strategy to communicate with Tom. Fifteen minutes later, she was back with Hazel, administering her first morphine dose. And there was a long-term plan in place to ensure she remained comfortable.
What changed?
Everyone who approached Tom prior to Ms Carey did so seemingly with empathy, which Ms Carey says, “is the wrong tool in situations of high emotion.” That’s because empathy, at its core, involves trying to adopt someone else’s perspective. But Tom was feeling threatened and, as a result, had stopped listening. In turn, those who tried talking with him became more stressed themselves, which affected how they processed their thoughts.
“We’re not thinking complex thoughts anymore,” Ms Carey said. “We’re thinking, where is the danger?”
However, Ms Carey led with compassion and discovered that Tom was also the medical decision-maker for his father. When he agreed to allow the nurses to administer morphine to his father, he died shortly after, and Tom blamed himself. He told Ms Carey he wasn’t going to make the same mistake with his mother.
“That recognition of what his threat was, was enough to move us forward to where we could talk through safety, we could talk through the specific pieces of education that he needed to move past that moment,” she said.
How to Be More Compassionate
What exactly did Ms Carey do to find a way over Tom’s seemingly impenetrable walls?
First, she acknowledged the tension in the room, between Tom and his family and the other hospice nurses. Then she asked thoughtful questions about his experience with hospices and morphine.
These are the 2 hallmarks of Ms Carey’s compassionate care model; observation and reflection, meaning reflecting on the patient or caregiver’s words and energy and meeting them where they are, essentially, and open-ended questions.
“Compassion asks questions,” Ms Carey said. “Is there distress? Do I understand the exact nature of the distress? What skills or knowledge do I possess that can make the situation better? This is what gives us agency.” She added: “’A clever person solves a problem; a wise person avoids it.’ This is to help us do just that. It’s just a shift in our perspective that helps us think about this in a slightly different way.”
