Stay Up
to Date
Stay Up
to Date
Breaking News,
Updates, & More
Breaking News,
Updates, & More
Click Here to
Subscribe
Click Here to
Subscribe

Group Visit Proves Highly Satisfying to Breast Cancer Survivors

TON - October 2012 Vol 5 No 9 - Best Practices
Caroline Helwick

A “group visit” model, led by nurse practitioners, is a feasible and highly satisfactory means of following breast cancer survivors, according to 2 oncology nurse re­searchers from the Duke Cancer Cen­ter’s program.

Kathy J. Trotter, DNP, CNM, FNP-C, and Susan M. Schneider, PhD, RN, AOCN, FAAN, described their breast cancer survivorship clinic at the American Society of Clinical Oncolo­gy 2012 Breast Cancer Symposium held in San Francisco, California, in September.1

“The group visit replaces the follow-up medical appointment. The idea was to offload the medical oncologists so they could see more newly diagnosed and sicker patients,” said Trotter. “This is a billable service that I as a nurse practitioner provide, though oncologists could do this as well.”

“We love it, the patients like it, it works,” she said.

Follow-up Clinic Begins 3 Years Postdiagnosis
The group medical appointment for breast cancer survivors was initiated at Duke Cancer Center in 2008, adapted from the Centering Healthcare In­sti­tute model. Patients who are at least 3 years postdiagnosis attend the clinic together in groups of 6 or 7.

An interdisciplinary group visit format in the front-end of the appointment provides education and support. The first hour includes a review of the patients’ personal care plans and a 45-minute facilitated group discussion. After this, half the patients leave for mammography and laboratory testing, while half remain with the nurse practitioner and have access as well to a dietitian, social worker, or physical therapist.

“It is important to make this visit multidisciplinary,” she said. “They are most interested, at this point, in talking with a dietitian,” she added.

Very Satisfied Patients
The researchers evaluated the level of patient satisfaction with the model and also determined if there might be a cost benefit to the group visit model.

A 22-item Likert-type questionnaire sought opinions from 122 patients regarding logistics and the style and function of care delivered. Second, a retrospective analysis of clinical fi-nan­cial data on 300 patients was performed. For this, revenues from the group medical visit by the nurse practitioner were compared with those ob­tained from traditional physician visits. A review of time to the third avail­able appointment for each clinician was also recorded.

Overall, 98% of the 122 respondents felt the program provided quality care, and 97% were likely to recommend the clinic to other breast cancer survivors. More than 80% of respondents added comments, with the vast majority being positive. From these comments, several qualitative themes emerged, most strikingly that patients appreciated the opportunity to share with other survivors and to receive nursing care with such a high level of attention and professionalism.

“At first I was wary about this program, but only one visit converted me,” one patient wrote. “It felt warm and friendly, versus clinical, which is exactly what I needed.”

Program Is Cost-Effective
The cost-benefit analysis revealed that revenues and direct costs were nearly equal between the 2 delivery models. A review of time to the third available appointment for the primary referring oncologist dropped from 29.4 days to 26.7 days, while the nurse practitioner’s time remained stable at 8.7 days.

“Our financial manager told me that for each new patient that the oncologist is free to see, that is $8400 [revenue] for our budget,” Trotter said.

But what is immeasurable is the community value of a center that takes care of its patients. Even though we are not actually making money from this, patients are spreading the word that we are a center that will take care of you.”

William Sikov, MD, of University Medicine in Providence, Rhode Island, led a “poster discussion walk” at the meeting, where he commented on the potential value of this format. He said the patient volume at large medical centers “threatens to swamp the ability of physicians to see patients for follow-up, to the detriment of seeing new patients. This is an interesting approach.”

Sikov suggested one of the greatest benefits is the group sharing experience in which patients feel the commonality of their condition. “I may have a difficult time convincing the stage I patient with a twinge in her knee that she doesn’t need a bone scan. It is meaningful for patients to hear from around the room that other patients have these symptoms too. They see that certain things really are common.”

Trotter responded that such peer support is part of what the group visit offers. “But my job is to see that we get the correct information out,” she said, “and that patients understand when they don’t need to worry, and when they need to see us right away.”

Reference

  1. Trotter KJ, Schneider SM. Evaluation of a breast cancer survivorship clinic that uses a group medical appointment model: patient program evaluation and financial analysis. Presented at: American Society of Clinical Oncology 2012 Breast Cancer Symposium; September 13-15, 2012; San Francisco, CA. Abstract 90.
Related Items
Palliative Care Improves Pain Control with Less Opioids in Advanced Cancer
Corbin Davis
TON - February 2020, Vol 13, No 1 published on February 5, 2020 in Best Practices
Greater Social Support May Help Alleviate Pain in Patients with Cancer
Corbin Davis
TON - February 2020, Vol 13, No 1 published on February 5, 2020 in Best Practices
Navigating Hematologic Malignancies
Peg Rummel, RN, MHA, OCN, NE-BC
Best Practices in Patient Navigation – Navigating Hematologic Malignancies published on April 11, 2019 in Best Practices
Addressing Financial Toxicity Through Systematic Change
Meg Barbor, MPH
TON - February 2019, Vol 12, No 1 published on March 1, 2019 in Best Practices
Discussing Costs with Your Patient Can Reduce Financial Toxicity
Chase Doyle
TON - September 2018, Vol 11, No 4 published on September 19, 2018 in Best Practices
The Patient Voice Is Key to Value-Based Care
Gail Thompson
TON - September 2018, Vol 11, No 4 published on September 19, 2018 in Best Practices
Is Your Healthcare Organization Addressing Nurse Fatigue?
TON - March 2018, Vol 11, No 1 published on March 9, 2018 in Best Practices, Nursing
Addressing Usability Concerns in Oncology Electronic Health Records
Meg Barbor, MPH
TON - September 2017, Vol 10, No 5 published on September 10, 2017 in Best Practices
Nurse Navigation Program Improves Access and Satisfaction with Cancer Care
Alice Goodman
TON - July 2017, Vol 10, No 4 published on July 6, 2017 in Best Practices
Streamlining Project at Infusion Center Improves Efficiency
Alice Goodman
TON - July 2017, Vol 10, No 4 published on July 6, 2017 in Best Practices
Last modified: April 27, 2020