After three decades as an oncology nurse, Janet Soboleski, BSN, RN, OCN, knows that while different cancers have different symptoms and prognoses, virtually all cancer patients experience a sense of isolation.
“Cancer is a very scary word. And when people receive that diagnosis, they can often feel alone,” said Soboleski, who serves as a practice administrator for the West Hartford, Conn., and Manchester, Conn., practices of Regional Cancer Care Associates, LLC (RCCA), one of the nation’s largest networks of oncology specialists.
The infusion rooms in both the West Hartford and Manchester locations are large spaces with a nursing station in the center and infusion chairs located around the perimeter. “The nurse can see everyone, and everyone can see the nurse,” Soboleski said, explaining that curtains can be drawn and individual areas’ lights dimmed, if patients wish. Each location has areas designed to provide privacy for people who are feeling physically or emotionally unwell. “While we always accommodate a desire for privacy, we want patients to know they are not alone, that the nurses are nearby. I’m amazed at how social the patients are. Of course, they quickly get to know our nurses and other staff very well, but they also develop a great rapport with other patients who are on the same treatment schedule.”
Soboleski said that patients are encouraged to have one or two family members or friends stay with them during the treatment sessions, and that the presence of spouses, close friends and children age 12 or older makes for a comfortable and comforting environment. “What happens in an infusion room is very serious, but serious doesn’t have to mean grim. When patients can laugh, we want them to, and it’s wonderful to be in that room and hear nurses and patient joking and talking about one another’s families, and what plans they have for the weekend.”
A key reason that patients can feel relaxed in the infusion room is the in-depth, one-on-one education session they have with a nurse before starting treatment, Soboleski said, “We want to take away the fear of the unknown, so the nurse focuses on the treatment they will be receiving – why it was prescribed, how it works, what side effects it may cause and what to expect generally – as well as any questions or concerns. But our nurses go beyond the purely medical to understand what is happening with the patient overall. We ask about the situation at home and the support available there, any child care and transportation needs, and how the treatment schedule may affect the person’s work. We’re here to take care of the whole patient.”
The nurse adds that this focus on sharing information is a key feature of the community-based oncology care RCCA offers at its 30 locations in Connecticut, New Jersey and the Maryland/Washington, D.C. area. “Our oncologists know our patients’ internists, family physicians, Ob/Gyns, urologists, cardiologists and other physicians, so they are able to communicate with them easily and frequently about the care we’re providing here and to make treatment decisions that take into consideration the patient’s other conditions and medications.”
For Amita Patel, BSN, MSN, NP-C, AOCNP, sharing information to enhance cancer care involves not only talking with her patients at the East Brunswick, N.J., RCCA offices and those patients’ nearby health care providers, but also exchanging best practices and evidence-based approaches with European oncologists and oncology nurses.
In March, Patel was the only nurse practitioner from the United States to participate in an invitation-only, five-day “masterclass” in clinical oncology organized by the European School of Oncology, European Oncology Nursing Society and European Society for Medical Oncology. The event, held in Berlin, Germany, allowed Patel to present information to European colleagues about cutting-edge approaches that RCCA uses in treating breast, lung, colon and prostate cancer.
“This was a great opportunity to compare strategies employed in Europe with the latest treatments we use here, reviewing the evidence for each, and discussing our experiences,” she said.
A past president of the North/Central New Jersey chapter of the Oncology Nursing Society (ONS), Patel said that, “RCCA encourages its nurse clinicians to play leadership roles in professional societies and also incorporates their input into the network’s patient-care protocols. Dr. Fang (Bruno Fang, MD, managing partner for RCCA’s Central Jersey Division) and the other physicians are very supportive when nurses identify ways to enhance care, and it is great to practice in an environment where there is that commitment to acting on the insights nurses obtain from working so closely with patients.”
After earning her bachelor’s degree in nursing, Patel practiced as an oncology nurse in a hospital setting, where she first worked with several RCCA physicians. Upon obtaining her master’s of science in nursing from Rutgers and becoming a nurse practitioner in 2014, she joined RCCA’s Central Jersey Division. “This is an exciting time to be in oncology, and to see how the latest therapies can be provided to patients in community-based settings convenient to their homes,” Patel said. In addition to providing direct clinical care, she also is involved with the division’s patient-education efforts and quality-of-care initiatives. “We’re always looking to refine our processes and integrate the latest findings,” she said.
That pursuit of continuous improvement is taking place amid major changes in health care, as the United States moves from a fee-for-service model to value-based care. As vice president, Clinical Affairs for RCCA, Lani M. Alison, BSN, MS-HCQ, PCMH, CCE, is tasked with ensuring that the physicians, nurses and other staff at Regional Cancer Care Associates’ 30 care sites have the resources, information and processes they need to provide excellent patient care in this rapidly evolving environment.
“The dramatic advances in the diagnosis and treatment of cancer have been accompanied by less-noticed, but very important gains in our ability to analyze data and employ protocols that allow us to tailor care to each patient’s specific needs and to optimize outcomes,” Alison said, who joined RCCA in February 2017. From leading the oncology network’s physician and staff education initiatives to working closely with the government’s Centers for Medicare and Medicaid Services (CMS) on RCCA’s participation in the ground-breaking Oncology Care Model program, Alison plays a leadership role in numerous measures that help clinicians employ the latest therapies and evidence in patient care.
“This truly is a transformational period for cancer care,” Alison said. “The number of new therapies becoming available, and the effectiveness they offer, are enabling us to achieve outcomes that were unimaginable even five years ago, and to do so in the community setting. This presents us with the very welcome challenges of identifying which strategies are best for which patients, and with managing the long-term well-being of cancer survivors. The key to making the most of these opportunities and challenges is to systematically implement care coordination practices. Care coordination, according to the Agency for Healthcare Research and Quality, or AHRQ, is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. We have implemented a care coordination suite of services with a well-organized, comprehensive structure, so that whether we’re providing initial treatment to a newly diagnosed patient, ongoing health surveillance for a cancer survivor, or end-of-life care for a person with very advanced disease, we can draw on the best practices, most relevant information, and latest approaches to meet that patient’s needs.”
In guiding RCCA’s ongoing evolution, Alison draws on extensive and varied experience and education. After receiving her nursing degree from a university in her native Philippines, she practiced as an intensive care unit (ICU) nurse at a hospital in the Bronx and at hospital in New Jersey. There she became involved with quality and accreditation initiatives, which served as her steppingstone to working for health plans. Her service as vice president at a health plan prompted her to obtain her master’s degree in health services, with a focus on health care quality, from George Washington University. This allowed her to naturally move into facilitating practice transformation in patient-centered medical homes in primary care and now in oncology.
“The data analyses and new protocols and other sophisticated tools required to transform practices into patient-centered oncology medical homes represent real advances, as well as a means to have the conversation with payers, including CMS, regarding value, but in the end, it all comes back to using those tools to enhance the patient’s experience,” Alison said.
In seconding that view, Soboleski said that for all that has changed in oncology over the years, she is impressed with one constant: “I received my nursing degree from the University of Pennsylvania and went straight into oncology, starting at Yale-New Haven Hospital before coming to this practice 25 years ago. After 30 years in oncology, I still learn from my patients every day, and continue to be amazed by their strength and courage.”
RCCA includes more than 120 physicians supported by more than 800 employees at 30 care delivery sites, providing care to more than 24,500 new patients annually and more than 245,000 existing patients. – Bio Space