Kaiser Permanente Breast Center offers fresh game plan to patients

In football, it’s the play run on the field that scores a touchdown. But it’s in the huddle where players learn who carries the ball, who blocks which defenders and in what direction the play will go. Without a huddle, players aren’t sure about their roles and the odds of scoring decrease significantly.

A huddle was exactly what Victoria Alberti, manager of the Kaiser Permanente Georgia Breast Center, thought breast cancer patients deserved. It's what they get now, thanks to an innovative team approach by the health care organization.

Advances in care have provided breast cancer patients with more treatment options than ever before, “but that doesn’t make the care process less confusing or overwhelming to people who don’t understand the disease, medical terminology or procedures,” said Alberti, RN.

The legwork involved in getting quality care usually means time spent choosing doctors, picking treatment options, making appointments, undergoing tests and sharing test results with different providers. There’s also a lot of waiting.

“Just coordinating care can become a full-time job for the patient and adds great stress to the treatment process,” Alberti said.

For the last 18 months, Kaiser Permanente has reduced that legwork by bringing a medical team to patients and their families soon after diagnosis. In a large conference room, the patient and family talk individually and together with a breast surgeon, a medical oncologist, a radiation oncologist, a reconstruction surgeon and others who will be part of caregiving team.

“Each patient hears the different treatment options and can talk face-to-face with the specialists involved. A patient navigator is there to act as a patient advocate, to help explain things and suggest questions or concerns that should be addressed,” Alberti said.

Gathering information that would normally take several doctors’ visits over days or even weeks can be completed in one two-hour conference.

“The patient comes in fearful and leaves with a smile on her face, because there’s a game plan,” Alberti said. “Having instant information makes a huge difference.”

Patients start treatment sooner and without the anxiety caused by waiting for recommendations and explaining medical options to family members.

“If we can make the treatment process just a little bit easier, that’s what we need to do for our patients,” she said.

With overwhelmingly positive responses from members, Kaiser Permanente has already implemented the team conference approach for prostate cancer treatment and is working on similar efforts for head and neck, and colon cancers.

Alberti, Kaiser Permanente Georgia’s first breast cancer patient navigator, helped create the new approach. In five years, she has talked with many of the more than 400 Kaiser patients diagnosed with breast cancer annually, so she understands their frustrations and fears.

“It’s never the same conversation, because every case is different, due to age, type of cancer, stage and life circumstances,” she said.

Painful memories

But in each case, Alberti is reminded of her sister, Celeste Warren, who died from cancer in 2008.

“My sister was diagnosed with metastatic thyroid cancer in Texas in 2006, at age 35. There were many good cancer centers in the area, but she was clueless about where to start,” she said.

Alberti spent hours with her sister in person and on the phone, using her nursing skills to ease the process.

“She did get excellent care, but the most difficult part was coordinating it,” Alberti said. “Anytime she got new information, she had to relay that information to several doctors. We knew that doctors were discussing her case at conferences, but they weren’t always talking to each other or to her.

“I hated that in the last years of her life, she spent so much time on hold with doctor’s offices, going to appointments and often hearing conflicting opinions. All that scrambling around — instead of spending time with her family — seemed a waste.”

Warren was grateful to have a knowledgeable advocate and would often call her sister from the waiting room when she met a patient who wasn’t so lucky.

“ ‘Here, talk to my sister, she’d say. She’s a nurse,’ and I would listen and answer questions,” Alberti said. “I’m always shocked by the number of patients who have to go through care without the benefit of knowing someone with a medical background. No wonder they seem lost and discouraged.”