Pulse
Patients' pilotsStage 4 melanoma. After Kathleen Gamblin heard her father's cancer diagnosis in June 2007, she blocked out everything else the doctor said — and she's an oncology nurse.
That's how hard a cancer diagnosis hits. Before patients and their families can adjust to the shock of cancer, they are bombarded with information about tests, specialists, surgery schedules and treatment options.
 Photos by BARRY WILLIAMS/Special |
| Becky Lavender, a licensed clinical social worker at Children's Healthcare of Atlanta, talks with Claudius Angol (right) and his father, Edmund. Claudius has sickle cell disease. |
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| Victoria Alberti, patient coordinator at Kaiser Permanente Breast Care Center in Sandy Springs, looks at the results of a mammogram with Dr. Peter Burns. |
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| Kathleen Gamblin (left), oncology nurse navigator at WellStar Health System's STAT Cancer Clinic in Marietta, discusses a patient's chart with Dr. Sheree Brown. 'I have always had a passion for helping people,' Gamblin said. 'This role allowed me to get more involved with patients and give them that personal touch.' |
Now, in her role as the oncology nurse navigator at WellStar Health System's STAT Cancer Clinic in Marietta, Gamblin, RN, BSN, tells patients: "You are going to hear a lot today [about your disease]. When you don't remember,
call me."
As cancer treatment has gotten more complex, many hospitals have recognized the value of having someone guide patients through the maze of care. The navigator/coordinator role is often filled by a nurse or a social worker.
At the STAT (Specialty Teams and Treatments) Cancer Clinic for patients with melanoma and cancers of the colon, breast, chest see all their doctors and specialists (social workers, dieticians, licensed certified counselors) in one place on the same day.
"Before we had the STAT clinic, patients had to schedule appointments with different doctors' offices. The time from diagnosis to treatment was greater than 54 days," Gamblin said. "Now the average time is 13 days."
As the nurse navigator for lung cancer and melanoma patients, Gamblin guides eight to 12 patients from their initial referrals through treatments and follow-up care. She records patients' health histories, supplies them with Cancer Care Courage Kits, schedules tests and procedures, answers questions and helps them understand what to do next.
"I have always had a passion for helping people," she said. "This role allowed me to get more involved with patients and give them that personal touch."
When Gamblin sends a patient for tests, she writes a synopsis of the results and patient information, so the physician has the most complete picture possible.
"We're available in the clinic and by phone," she said. "Patients have long waits on the day they're here, but we promise them that when, it's their turn, they'll have our full attention.
"We give hope to patients, above and beyond routine care by helping them find resources they didn't know were available."
Gamblin recently found a donor to pay for a flight and the oxygen that a patient needed so that she could spend her final days in California with her family.
"I love being able to make a difference [for] people when they may be at the worst time of their lives," Gamblin said. "Most navigators have had cancer touch their lives, and we're anxious to treat people like we wish our families would be treated."
Coordinating patient care
Victoria Alberti, RN, was an operating room operations manager at Northside Hospital in Atlanta when her sister in Texas was diagnosed with a rare form of cancer two years ago.
Using her medical knowledge, Alberti helped her sister understand the diagnosis and helped steer her through multiple tests, surgeries and treatments. Her sister's latest scan was cancer-free.
So when Kaiser Permanente asked Alberti to help design a patient-coordinator role in its Breast Care Center in Sandy Springs a year ago, she knew she could do the job. Alberti researched breast cancer and developed a booklet of information and resources.
Each year, about 700 patients at the facility on Glenlake Parkway have suspicious mammogram results. About 150 of those have breast cancer.
Before Kaiser Permanente started the program, patients were referred back to their primary-care physicians, who had to schedule biopsies. Now, patients' charts go straight to radiologists and then to surgeons, if necessary.
"With our pilot program, we saw a 70 percent decrease in wait times, from abnormal mammogram to the time of biopsy, which means patients have less anxiety and get faster treatment," Alberti said.
When patients meet with radiologists, they receive Alberti's business card and are told they can call her anytime.
"Some are so upset that they call me as they are walking out the door, and sometimes I'm able to talk with them right then," she said.
Alberti explains the information in her booklet and answers medical and other questions.
"They don't have to research the next step or know the resources available. They can call me," she said. "Some patients call every day."
Alberti sets no time limits on helping patients deal with the medical, emotional and social impact of cancer or on walking them through the process of scheduling visits with oncologists and plastic surgeons. Sometimes she visits patients in the hospital or sits with their families as they wait.
Alberti believes that part of her job is to anticipate obstacles that patients face and to figure out ways to overcome them. By relieving their stress, she helps patients heal.
"You sit with someone whose life has been shattered by the news of cancer, then, a year later, they stop by to say they are done with treatment and are so thankful to be going on with their life. For a nurse, that's a huge reward," she said.
Importance of teamwork
At the blood and bone-marrow transplant unit of the Aflac Cancer Center at Children's Healthcare of Atlanta, patient navigation is a team effort. Supporting a child and his or her family through the grueling, yearlong transplant process requires the efforts of a social worker, a teacher, a chaplain, a child-life specialist and a psychologist.
"It takes all disciplines working together and good communication to meet all the medical, social, emotional and spiritual needs [of patients]," said Becky Lavender, a licensed clinical social worker at the Aflac Cancer Center. "We do a lot of problem-solving."
Lavender's job is to assess how well patients and their families understand transplants and to educate them by providing every resource she can find. She also helps them learn how to communicate with their medical teams.
"We expect a lot of our parents. When a child leaves the hospital, he has multiple lines and IVs. The parent has to function as nurse," said Lavender, LCSW.
She helps families fill out insurance forms and supplies donated gift cards for gas and food if their finances are tight.
"The doctor will talk to them, and afterwards they'll have a million questions they didn't think to ask. That's when I offer them a weekly care conference," Lavender said.
During the conferences, all members of a child's medical and support team meet to give the family undivided attention, explain procedures and address concerns. Getting them all together to form an integrated care plan saves time and is better for patients, Lavender said.
The connection that Lavendar makes with parents is key to her role.
"The patient's room becomes the parents' world," she said. "[Parents] have to be good actors in the child's room, but they know they can cry in my office."
If a child develops an infection and ends up in the intensive care unit, Lavender is there to sit with his or her parents.
"That's when parents start to second-guess themselves and feel guilty. I tell them [that] they have made the best possible choice for their child and they can't look back," Lavender said.
A roommate's cancer diagnosis when she was in college led to Lavender's career decision.
"It opened my eyes to the psycho/social aspects of the disease, and I knew I wanted to be an oncology social worker. And I have been for 27 years," she said.
Lavender is no stranger to stress and sadness, but some stories have happy endings.
"The best reward is when a patient comes back a few years down the road — maybe you sat with her parents in ICU — and you think, 'Oh, my; just look at her now!' " she said.