Commission on Cancer Standard 8.1: Addressing Barriers to Care

What Would Lillie Do? published on December 19, 2019

Name: Mariellen
Position: Nurse Navigator
Subject: Standard 8.1

In Standard 8.1: Addressing Barriers to Care, please explain “Metrics related to outcomes of reducing the chosen barrier” with an example. Thank you.

The CoC wants to know what specific barrier to care you are focusing on in any given year, and how you decided to choose that specific barrier. It also wants to learn how you are measuring your ability to reduce the barrier, as well as what outcomes it has produced. Here is an example: Patients are missing radiation appointments due to lack of transportation. This results in patients with “XYZ” cancers not receiving radiation treatment in accord with NCCN treatment guidelines. The incidence of missing appointments is 27%. Your solution was to get a grant from a local advocacy organization to provide free taxi vouchers. You tracked compliance with usage of the taxi vouchers and also calculated the percentage of missed radiation appointments after the taxi voucher process was implemented. The new percentage for missing appointments was 9%.

Name: Joe
Position: Nurse Navigator
Subject: Suggestions for multidisciplinary appointments

Hi Lillie! Trying to get all initial consults (surgical, medical, radiology) scheduled for the same day for my patients with esophageal cancer is very challenging. Is this a reasonable expectation or, in your experience, is it just too much information in one day (even with my navigator services)? Thanks Lillie!

We actually do the consultation process as you described, but primarily for determining which treatment will go first, second, then third. Sometimes, however, it can be determined before the day of the appointment, if all scans, pathology, etc, are provided as requested in advance. It is a lot of information for a patient to deal with. What usually works best is to tell the patient what types of treatments they will have and in what order, then focus a more detailed discussion on that first treatment. Plan for discussions about the other treatments soon before they start (what I call “just-in-time treatments”).

Be sure to ask the patient how much information they currently know about their cancer so that you can confirm their information is accurate.

Then ask how much information they WANT to know about their cancer, because some patients want to know everything, and others want less.

Ask what they are hoping for, and what they are most worried about at this time.

And ask the patient to tell you 3 things that bring them joy. These joys help you to learn what is important to them and how they measure quality of life. These joys need to be preserved whenever possible.

Find out if there are any significant milestones coming up while he/she will be getting treatment, such as a wedding or graduation. Work the treatments around these events so they are preserved. Don’t cause the patient to sacrifice these happy moments to his/her cancer.

Also, discuss what his/her life goals are for the future. Depending on the stage of the disease, some may need to be fulfilled in alternative ways if the patient is dealing with stage IV disease. Let me know how it goes!

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