To keep on track, work toward vision methodically

Use patient evaluation to assess effectiveness

As director of the cancer patient education program at Duke University Medical Center in Durham, NC, Kerry Harwood, RN, MSN, coordinates the overall direction, organization, and resources for the education of cancer patients and their families. This includes assessing patient education needs, selecting or developing materials, evaluating what has been put in place, and training staff. She also oversees the coordinator of the patient/family resource center.

While director of cancer patient education is Harwood’s main job title, she also has the title of oncology clinical nurse specialist. In this capacity, she serves as an expert resource to the organization, staff, patients, families, and the community on cancer and education issues.

Harwood has a third role. She is one of six advanced practice nurse team leaders. In this capacity, she supervises 12 advance practice nurses. She reports to the director of the department of advanced practice nursing, who reports to the chief nursing executive.

A separate staff member, who reports to the director for hospital education, coordinates education for noncancer patients. The two areas of education are integrated through the hospitalwide patient and family education committee.

Cancer is one of the top two specialties at Duke University Medical Center. "I think my position is there because of patient need and the leadership in that area has a commitment to it," says Harwood. She has been in the position for nine years.

The requirements according to the job description include a master’s of nursing degree and a minimum of five years of nursing experience with at least two of these in oncology. Harwood has been an oncology nurse for 25 years.

While Harwood’s job focus is cancer patients and their families, there certainly is overlap with patient education in other areas of the medical center. For example, oncology patients were asking for more information about tests and procedures they were scheduled for, so Harwood coordinated the effort to create computer-generated handouts accessible throughout the health care system. Many of the procedures were not cancer-specific.

"I have responsibilities to cancer patients, but the information that they need is not exclusively used by cancer patients," says Harwood.

In a recent interview with Patient Education Management, Harwood discussed her job, her philosophy on patient education, challenges she struggles with, and the skills she has developed that help her to do her job well.

Question: What is your best success story?

Answer: "I have been working on disease-specific notebooks for all the standard oncology diseases. Some of the sections are generic to all cancer patients. For example, in the front section, is a patient’s comprehensive guide to cancer care and the last section is a structured diary called Your Personal Health Log.’ The middle two sections, Your Disease and Treatment’ and Taking Care of Yourself,’ are customized to the specific disease. I thought this would be a good approach but it really has exceeded my expectations in terms of how well that they work."

Patients get lots of different treatments over a long period of time, and although they come to the medical center for treatment they return to their homes, which often are miles away. They need to be able to take care of themselves at home managing symptoms and side effects. In addition, a big part of the stress of cancer is feeling a loss of control and the notebooks give people back some of that control.

In an evaluation conducted with GYN-oncology patients, 77% had a clinical problem at home and were able to go to their notebooks and figure out what to do. For 65% of those patients, the notebook helped them determine that they needed to contact their health care provider.

The notebooks help to empower patients, and they reduce calls into the clinic without compromising safety because patients know when they need to call. Family members use the notebooks to help loved ones manage physical problems at home.

In spite of the fact that there is a lot of text, each section has a table of contents so patients don’t have to read the entire section to find the information they want. Also, the text was written according to readability standards, so patients of all educational levels like it.

Building toward a vision

Question: What is your area of strength?

Answer: "What I think is most helpful is having a clear vision and in a very methodical way building the pieces of that vision. There is so much to do in hospitals and so many wonderful things that many people get pulled in a lot of different directions and don’t end up with much to show for their effort because they are not working toward a vision. We have been working real hard to have a clear vision and build the blocks for it."

The vision for patient education at Duke University Medical Center is to have a comprehensive set of materials, prepared with interdisciplinary involvement that accurately reflect the medical center’s practice available for all patients in a variety of ways that include electronically, verbally, and in writing.

Question: What is your weakest area?

Answer: "In the context of a very large complex organization with a lot of different reporting relationships, there are two things that are related. These are communication and computer technology."

For example, when technicians upgraded a program recently on the computers, they didn’t upgrade the printers. The printers weren’t connected to the computers and some educational handouts would not print.

A few years ago when putting together an education newsletter for staff, the biggest challenge was creating the mailing list, which consisted of clinicians directly involved in the treatment of cancer patients. It did not include researchers or those who sometimes work with cancer patients but mainly treat people with other diseases. The mailing list had more than 700 people.

Now she does more electronic education when working with staff although their comfort level with computers varies widely. Therefore, she tries to use other educational methods such as hanging posters where staff will see them.

Question: What is your vision for patient education for the future?

Answer: "If we are going to take vision into the realm of fantasy, what I think would really make the difference would be very tailored patient education that looks at the needs at the time, the person’s readiness to learn, and his or her preferred learning style. There are methods to quickly assess that and then tailor the education right to the patient. Some of this is being done in a research setting, but I haven’t seen it translated into clinical practice yet."

Question: What have you done differently since your last JCAHO visit?

Answer: "It wasn’t related to the visit; it was related to the feedback I got in focus groups and in our patient satisfaction data about patients wanting more information about tests and procedures."

To meet this need, question-and-answer fact sheets all in the same format were created on all tests and procedures. They are on the intranet so they are available whenever the physician orders a test.

Harwood routinely conducts evaluations in a variety of ways. These include telephone interviews, surveys, and focus groups. They are particularly useful when introducing new materials or a new approach to something. Before creating the disease-specific notebooks for cancer patients, she did a number of focus groups with different types of patients and family members to determine what they thought about the approach, what ideas they had, what type of information they would want in the notebook and what level of information. Members of the focus groups were asked to review information on a certain type of cancer and its treatment written at three different levels of complexity and the group discussed the pros and cons of each one.

Question: When trying to create and implement new forms, patient education material, or program, where do you go to get information/ ideas from which to work?

Answer: "The Internet is great. I do a Google search if I am going to create a new document to see what kind of content others have put into their material. Also, I rely on the cancer patient education network, which is a listserv for the educational representatives of all the National Cancer Institute-designated cancer centers. From there I would draft something up and then get feedback from our staff and some of our patients." 


For more information about the issues discussed in this article, contact:

• Kerry Harwood, RN, MSN, Director, Cancer Patient Education Program, Duke University Medical Center, DUMC Box 3677, Durham, NC 27710. Telephone: (919) 681-5288. Fax: (919) 681-7473. E-mail: