Founded in 1922, Trinity Health was organized by the immigrants who settled Northwest North Dakota. Under the auspices of the newly formed Trinity Hospital Association, ground was broken to build a 30-bed hospital. Over the ensuing decades, Trinity expanded its facilities and increased the quality and scope of care. Trinity Health is now recognized as the region’s leading healthcare provider. As a nonprofit, fully integrated healthcare system, the network of more than 200 healthcare providers, hospitals, nursing homes, clinics, and other facilities serves an estimated 12,000 outpatients and 130,000 inpatients each year.
The Trinity CancerCare Center, located in Minot, North Dakota, is part of Trinity Health. In line with the requirements for American College of Surgeons (ACS) certification as a comprehensive cancer center, Trinity has instituted both a Nurse Navigation Program and a Cancer Survivorship Program. The Oncology Nurse-APN/PA spoke with Jenene Kittleson, RN, MSN, OCN, CBCN, about the Nurse Navigation Program, and Pamela Pearson, RN, MSN, FNP-C, AOCNP about the Cancer Survivorship Program.
How did the navigation and survivorship programs get started? Jenene Kittleson (JK): We started the Nurse Navigation Program for breast cancer patients, funded by a Helmsley Grant. The program blossomed into a navigation program for all new cancer consults at our center. Now I see all new cancer consults, and I focus on patient barriers, including fear of the unknown and transportation, among others. I make sure that patients understand their treatment plan and that we have involved all the resources they will need, including a dietitian, pastoral care, exercise rehabilitation, affordable housing while being treated, and discounts on gasoline. We also provide a distress screening as part of the ACS criteria, and our social worker follows up and identifies other resources that may be necessary in light of the levels of distress that are found. Pamela Pearson (PP): Our Cancer Survivorship Program grew out of the Nurse Navigation Program and is only a few months old. My goal is to assess patients within 1 month of chemotherapy and/or radiation for domains such as physical, social, emotional, functional, sexual, body image, and stress. Upon completion of their treatment, a summary care plan is provided. This also includes long-term side effects to be aware of, for the patients and their primary care provider (PCP). Depending on what the assessment shows, we develop a plan of care that will best help the patients make the trajectory through their treatment. The Survivorship Program offers complementary alternative medicine, including massage and yoga, acupuncture, healthy lifestyle maintenance, and any needed referrals. We offer the following services at no charge, and these are provided by volunteers: yoga, pastoral care, social services, “Look Good, Feel Better,” and cancer rehabilitation exercise.
How many patients will be able to participate in these programs? JK and PP: An estimated 400 to 500 patients per year.
What kind of feedback do you get from patients? PP: In the 3 months that the Survivorship Program has been offered, the feedback so far has been very good. This is a new concept for most patients, and we find that most want to participate. JK: We have had good feedback from surveys. We would actually like to have some negative feedback so we know what areas need to be improved.
How do you think these programs improve quality of care at Trinity CancerCare? PP: The programs help us fulfill the ACS requirements for accreditation as a comprehensive cancer care center. This also helps us to provide a comprehensive holistic approach to living with or beating cancer.
What are some challenges you have faced? PP and JK: The biggest challenge has been integrating these programs into cancer care work flow. Bringing change into an area always requires understanding and education. JK: When navigation was fairly new, a lot of physicians did not understand what a nurse navigator does. My role extends beyond case management; I follow a patient from diagnosis and into the whole trajectory of treatment. PP: The beauty of our program is that patients come back for a recheck after chemotherapy and/or radiation, and we start there to make sure they are comfortable with moving on to a PCP. Eventually with survivorship we connect with the PCP and provide all the patient records to eliminate gaps in care. Patients can request another meeting with us if they want to.
What are your rewards? PP and JK: The biggest reward is getting patients to view themselves from a holistic perspective and feel confident moving forward in their new life after cancer. They are not just cancer patients, but full human beings. It can be particularly gratifying to help head and neck cancer patients who have so many side effects that can compromise quality of life.
If you had the funds, what services would you like to add to the Nurse Navigation and Cancer Survivorship programs? JK: I would like to improve our patient library. We participate in free colorectal cancer screening programs for the area we serve, which includes a large population of Native Americans. This group presents with more advanced breast cancers at younger ages. I would like to have funding to provide education to the general public and promote the need for screening to Native Americans. PP: My “wish list” includes adding more integrative services to the Survivorship Program, including stress management, resiliency training, counseling services for sexual dysfunction and other problems, and acupuncture.
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