Kristina N. Michael, APRN, WHNP-BC, Senior Clinical Associate
The first appointment for a new cancer diagnosis can set the tone for the entire trajectory of treatment. This appointment encourages understanding of the diagnosis in addition to active discussion of prognostic implications of cancer. The backbone of an effective treatment team requires guideline-based high quality, safe, patient-centered care. While there can be financial, institutional, or individual obstacles to providing this level of care, attention needs to be drawn to providing the same level of care to each patient.
It is critical during clinic visits that there is an open line of communication between the patient (and/or caregiver) and the provider. Fostering effective communication requires 3 essential components including preparation, execution, and delivery. Preparation and review of clinical information is key for both the patient as well as the caregiver prior to the appointment as this sets the stage for a dynamic conversation. For the clinician, this allows the opportunity for a thorough review of the personalized treatment plan, with less time spent sifting through pertinent clinical data including notes, labs, and imaging. VieCure’s platform currently provides this personalized snapshot view through review of the Interval History and HPI (History of Present Illness) Timeline. With the active transmission of data across the platform, the content is updated in real-time. Notes are also tailored to the providers needs to highlight the subjective and objective data, as well as reference pertinent information for subsequent visits. Patients can report on acute or chronic concerns utilizing the patient mobile application which can be a starting point of discussion during the next phase in the clinic visit of execution.
Execution, or sharing of clinical information, during clinic visits can be the most helpful, yet unpredictable part of the visit. This requires the highest level of conversational engagement, with emphasis on listening for the clinical team. Patient’s will traditionally communicate positive and negative outcomes or concerns with their providers based on the level of trust that is achieved. Asking questions throughout this conversation can address unmet needs, assess compliance to the regimen, and provides an overall understanding of the existing and future care. Utilization of technology including VieCure’s AI based platform to capture discrete data in addition to existing patient mobile and soon-to-come physician mobile applications can supplement existing strategies. During this time, referrals to ancillary support providers for extended management may also be conducted. If there are concerns related to toxicity management including adverse side effects from treatment, these can be mitigated through the visit and subsequently reduce unplanned hospitalization rates.
While delivery can be integrated into the execution of a clinic visit, it focuses more on components such as tone, eye contact, body language, facial expression, active listening, and demonstration of empathy. In a study by Vincente et.al, (2023), it was noted that the most important attributes of a conversation included the physician’s knowledge, honesty, and ability to provide clear information. The optimal solution would support clinicians spending more time with their patients and incorporating more of a holistic approach to their care, as oncology management continues to be complex and dynamic. Due to the following administrative restraints including “data-entry requirements, rapid patient turnover, inadequate reimbursement, lack of administrative support, competing demands, litigious environments, and increased complexity of patients”, the focus of practicing medicine is often lost (Brown-Johnson et. al, 2019). The goal is for improvement of long-term benefits for the patients being managed in the community oncology setting. This highlights the importance of being physically and emotionally present with patients, which is critical to your success as a provider, and the overall health and well-being of your patients. Several recommendations in the literature include incorporation of communication workshops throughout training programs to facilitate enhanced communication.
The elements discussed above can be applied to in-person clinic visits, telephone consults, and even virtual telemedicine appointments. These specific strategies, while focusing on the clinician, are especially important for any member of clinical team that is involved in direct patient care. The communication principles, while most important during the active treatment phase, are also to be acknowledged during the subsequent survivorship phase. In summary, VieCure's platform supports the three pillars of effective communication, including: 1) efficient presentation of patient-specific clinical and other data to prepare for the patient encounter; 2) sharing information with patients and other members of the health care team using fully integrated tools, such as the patient mobile app and soon-to-be-released physician mobile app; and 3) enabling the provider to spend the time needed with patients to convey critically important information already documented in the platform.
References:
Brown-Johnson, C., Schwartz, R., Maitra, A., Haverfield, M. C., Tierney, A., Shaw, J. G., Zionts, D. L., Safaeinili, N., Thadaney Israni, S., Verghese, A., & Zulman, D. M. (2019). What is clinician presence? A qualitative interview study comparing physician and non-physician insights about practices of human connection. BMJ open, 9(11), e030831. https://doi.org/10.1136/bmjopen-2019-030831
Vicente, R. S., Freitas, A. R., Ferreira, R. M., Prada, S. P., Martins, T. S., Martins, T. C., Duarte Mendes, A., Vitorino, M. M., Chaves, A. F., Santos, C. C., Alpuim Costa, D., Custódio, M. P., & Barbosa, M. (2023). Communication preferences and perceptions of cancer patient during their first medical oncology appointment. Psycho-Oncology, 32(11), 1702–1709. https://doi.org/10.1002/pon.6220
Kristina Michael, APRN, WHNP-BC
Senior Clinical Associate, VieCure