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Program can cut costs, improve satisfaction
A program of telephone counseling and education by nurses has the potential to save money, improve patient satisfaction, and improve outcomes in cancer patients, says Merle Mishel, PhD, a University of North Carolina at Chapel Hill (UNC-CH) researcher who is conducting three psycho-educational intervention studies with cancer patients.
During the eight-week program, trained nurses call cancer patients once a week to answer questions, educate them about their disease and the potential side effects of treatment, and give them resources. The phone calls typically last 15 to 20 minutes.
"Managed care has decreased the amount of time health care providers spend with their patients by placing a premium on seeing more patients in less time," says Mishel, who is Kenan Distinguished Professor of Nursing at UNC-CH and a member of the UNC Lineberger Compre hensive Cancer Center.
The result is that patients are discharged from the hospital without enough information. Cancer patients frequently complain about the difficulty of getting questions answered, she adds.
"This is a service that patients want that isn’t readily available. This gives them a tie to help them over the most difficult periods," Mishel says.
The study, funded by the National Cancer Institute and the National Institute of Nursing Research, involves three groups of cancer patients: African-American and white men with localized prostate cancer and their family members; older white, Mexican-American, and African-American women with breast cancer; and younger African-American women with breast cancer.
Preliminary results of the study have shown that the telephone intervention can cut down on the frequency with which cancer patients call their physician’s office, identify serious complications early on, improve compliance, and increase the patients’ quality of life, Mishel says.
The program saves costs by identifying complications early on before they become severe and costly to treat, she notes. For instance, the nurses were able to identify symptoms of spinal cord compression in prostate cancer patients who didn’t realize the condition was life-threatening.
"Physicians may not emphasize the result of complications because they don’t want to scare the patients, but if no one follows up, the patients may not realize how severe the problem is," Mishel says.
The follow-up program has "great potential" for cost savings in managed care and capitated systems, Mishel says. Her team is working with several HMOs on implementing a similar program for them and is willing to work with physician practices to help them set up a similar program, she adds.
The UNC-CH study employs practicing nurses who take on the project as a part-time job. The nurses went through a 30-hour training program to teach them the follow-up protocol and to educate them on cancer treatments and side effects.
When a patient enters the program, the nurse and patient agree on a time for the nurse to call the patient. The same nurse calls each patient throughout the follow-up program.
The nurse addresses a list of problems specific to each diagnosis category. Treatment decisions, side effects, uncertainties, social relations, and financial concerns are among the topics addressed.
The nurses use telephone counseling and supplementary materials to teach patients how to manage the uncertainty they may be experiencing because of the cancer diagnosis and treatment.
Patients are asked to monitor themselves for symptoms and side effects and to generate a list of questions before the weekly call. The nurses teach patients how to phrase their questions to get the attention of their health care provider.
"We teach them the words to use to get the health care patient’s provider, how to phrase the problem to avoid being triaged out by the office nurse," Mishel says.
The follow-up calls have reduced the number of patient problems, helped patients manage the side effects of their treatment, and increased compliance, Mishel says.
For instance, the prostate cancer patients report improved control over urine flow, increased satisfaction with sexual relationships, and better family relationships.
The nurse always asks prostate cancer patients if they are practicing their Kegel exercises.
"The doctor may teach them Kegel exercises, but if no one checks up on the patients, they may do them incorrectly or sporadically, neither of which is effective," she adds.
If your practice is considering a similar program, Mishel recommends hiring a part-time nurse whose sole responsibility is making the follow-up calls.
"If a nurse has multiple responsibilities, she may not have a chance to make the phone calls on schedule. Then the program doesn’t work as well. Follow-through is very important," she says.