New Patient Care Coordinators Humanize Cancer Care
(Left to right) Julie Kuznetsov, director of the Cancer Patient Experience, with Stanford's first Multidisciplinary Care Coordinator Laura Birmingham, RN. Kuznetsov and Birmingham are bringing a new care model to patients at the Cancer Center, which pairs new patients with a dedicated nurse coordinator to guide them through their entire span of care.
December 2014
As Chris Bowers, a cancer survivor and member of the Patient and Family Advisory Council describes it, receiving a cancer diagnosis is like entering an alien world—there are terms and treatments you don't understand, you're in a place you've never been before, you don't speak the language and there's a chance you might die. Now imagine that scenario with an interstellar guide, a person who meets you even before you arrive and lets you know everything about the new world you've just entered. That's the premise behind the Multidisciplinary Care Coordinator (MCC) role at the Stanford Cancer Center.
Piloted in June in Gynecologic Oncology, this new program assigns a dedicated nurse to serve as a one-on-one point of contact for cancer patients new to Stanford Health Care. In conjunction with the attending physicians, the MCC serves to advise, guide, understand and support patient's interests and desires throughout their cancer journey. The MCC follows patients from their first point of contact through their entire span of care. They assess patients' needs, triage symptoms and questions, make referrals, coordinate logistics and explain terminology.
"Over the past few decades, we've gotten very specialized in cancer care," says Julie Kuznetsov, director of the Cancer Patient Experience. "All of that specialization has benefited patients so much, but it has made the system very complex. The MCC clinical care service model evolved as a way to meet that complexity."
Laura Birmingham, RN, an oncology nurse who transitioned to this new role in June, is the Multidisciplinary Care Coordinator for about 70 patients to date in gynecologic oncology. Birmingham contacts new patients via telephone before they are seen in clinic, and then meets with them in person at their first appointment. Her primary goal in that first call, she says, is to gather information, get to know them as a person and let them know they have a primary point of contact for their entire journey. Then throughout their treatment, she proactively reaches out to patients at specified transitions of care such as starting chemotherapy or radiation, undergoing surgery, being hospitalized or dealing with a change in their health. These transitions are when most patients have questions and when decisions need to be made.
"Rather than being reactive, there are key moments in a patient's care that cause us to proactively check on them to make sure all their needs are being met," says Birmingham. "From a medical perspective, this proactive outreach is improving patient outcomes."
This new model for the Cancer Center also includes a clinical administrative assistant who handles most of the administrative work, freeing up the MCC to spend more time in a nursing role providing patient care and support.
"For the first time, the nurse is partnered with the patient, not the doctor," says Birmingham, "and that has been transformative. We are here to improve outcomes and reduce stress on patients and families. But mostly we're here to create a relationship that says, "We're here with you. We can help you with whatever you need."
The more we can be proactive and anticipate psychosocial and clinical challenges that are likely to come up for our patients and address those problems before they become crises, the better we do in managing the patient's care.
The first MCCs were hired in March, and Kuznetsov, who is charged with developing the program, included them in developing the standard work for the program. Using a rapid deployment design thinking approach, the MCCs are testing the model as the team continues to refine it. The team has developed standard work around every point of contact. How do you conduct the first call? How do you manage the advanced directive? How do you do a screening for financial counseling?
"The more we can be proactive and anticipate psychosocial and clinical challenges that are likely to come up for our patients and address those problems before they become crises, the better we do in managing the patient's care," says Kuznetsov.
Currently, Oliver Dorigo, MD, is the only physician working in this new model of care. "The MCC provides the patient with a single point of contact and acts as a guide, which is really unique and unprecedented," says Dorigo, Associate Professor of Gynecologic Oncology. "The MCC is taking care of every single step of the diagnostic and treatment process to make sure patients get to their appointments on time, that their records are in place and that the patient knows the facility and what to expect before they even come here."
Even before Dorigo meets a patient for the first time, Birmingham has spoken to the patient, has evaluated his or her primary concerns about the disease, treatment, symptoms and quality of life issues, and has started the clinic notes. "This gives me a much more comprehensive picture of the patient's needs," Dorigo adds. "It's truly an asset to our patients."
In January, the program will be rolled out to the entire Gynecologic Oncology area as well as to Hematology. The goal, says Kuznetsov, is to have every patient assigned an MCC over the next few years.