The devil’s usually in the details

What’s on paper isn’t always reality

The plan on paper for the patient and caregiver learning center at City of Hope National Med i cal Center in Duarte, CA, was based on meticulous research by the members of a multidisciplinary committee, but the reality wound up differing from the plan.

The committee gathered information about learning centers across the country and evaluated several models to determine what would work best at their institution. Also, they gathered information about the needs of family caregivers to see what resources and services they should include to meet those needs. Interviews with patient education managers who had already created resource centers were conducted to learn more about budgeting, staffing, and space requirements.

Staff at the medical center were surveyed to determine what they saw as the areas of greatest need for a learning center as well as to ask their opinion about the types of resources a center should have. Family caregivers attending a symposium at City of Hope were given a similar survey.

Once the information was gathered, the committee put together a proposal to give to the administration. What they envisioned and what they settled for were two different things, says Annette Mercurio, MPH, CHES, director of health education services at City of Hope, a national cancer center.

They had hoped to be in an area with heavy patient traffic as well as having enough space to dedicate a room to patient and family caregiver skills training. However, they opened the Patient and Caregiver Learning Center in June 1999 in two rooms in an isolated area of the hospital.

The largest room has bookshelves with books and pamphlets that focus on cancer treatment and three computer terminals with Internet access and Web site bookmarks. The second room has a big-screen TV and a VCR with a collection of videos. The skills training component has been put on hold. (For information on staffing and funding for the center, see article above.)

"You can’t always begin where you want to be. Therefore, we wanted to at least get the center off the ground and begin testing some of our ideas about the services and get together some of the materials we want to have," says Mercurio.

In about two years, the medical center plans to locate several patient service departments in one area, such as health education, pastoral care, clinical social work, and patient advocacy. At that time, the learning center will move to a more prominent location, where it will be located in a general waiting area.

Long before space was allocated for the learning center, Mercurio and the committee members began to work on resources that would make it a success. Their staff and caregiver survey identified a need for information on community resources. Therefore, they decided to create a community resource Web site with information on such resources as hospices, home care services, transportation, and support groups. The administration provided funding to hire a college student to do the research. (The address for the Web site is

"We looked at the Web site as the very foundation of the learning center because the idea for the center was to integrate information about resources available to patients and their family members. In a sense, it was our virtual learning center before we had space allocated for it," says Mercurio.

In addition to the learning center, City of Hope opened a supportive care resource desk in the ambulatory care building in May 1999. The mission for the desk and learning center is to give patient and family members one-stop, easy access to information. The desk provides information about support services, while the learning center focuses on helping people cope with cancer. (For details on the resource desk, see article above.)

The resource desk often refers patients and family members to the learning center, which helps to increase its use. Mercurio has used other methods to increase foot traffic to the center as well. She chairs a number of committees and has taken the members on tours of the center to help familiarize them with its services and therefore generate referrals. For example, the discharge planner who sits on the patient and family education committee has found many opportunities to refer patients.

The learning center research specialist met with the manager of the outpatient village where the bone marrow and stem cell transplant patients stay, and he now refers family members to the center. Patient education staff created a brochure on the center, to be placed in patient education packets and hospital admission packets. Posters advertising the learning center are displayed in the main lobby, the elevators, and the cafeteria.

All these publicity efforts have increased traffic to the center, but they have not been able to overcome the effects of a bad location. "I don’t think we will get a really high volume of use until we move and are closer to patient activity," says Mercurio.