Multidisciplinary care coordinator Vitale Battaglini, RN.
Norbert von der Groeben
“Someone newly diagnosed doesn’t know what to expect, and things that seem basic to us are new to them. Our job is to be their first and main point of contact,” Battaglini said. “It’s a reversal of the traditional nurse’s role: We are the patient’s nurse, not the doctor’s nurse. And what the patient needs depends on that particular patient.”
“Cancer care has become so complex because it involves so many subspecialties,” said Julie Kuznetsov, director of the Cancer Patient Experience, who oversees the new program. “The field continues to evolve with new technologies and specialized expertise. While that means more options and better outcomes, for patients it has become more difficult to put the pieces together to coordinate their care.”
The logic behind the multidisciplinary care coordinator program is to take that complexity away from the patient. The coordinators are familiar with the Cancer Center’s clinical and supportive care programs and work directly with the patient’s physicians to organize treatment and follow-up services. They stay with the same patient throughout that person’s care even when multiple specialists and subspecialists are involved.
“Cancer patients are already dealing with all kinds of stress, and coordinating visits can be overwhelming. The coordinators make it their personal responsibility to manage the moving pieces so the focus for patients and families can be on quality of life and healing,” said Kuznetsov.
Setting the groundwork
As the first care coordinators, Birmingham and Battaglini are laying the foundation for an expanded program that eventually will include all new patients at the Stanford Cancer Center.
Part of their role is to help refine the process based on evidence-based practice — tracking what works to identify the most effective processes while keeping each patient’s individual concerns the priority.
“Most patients are in shock when they are first diagnosed, so that initial call we make starts a relationship before they have their first clinic appointment. We are constantly evaluating and assessing different approaches as their needs change,” Birmingham said. “There’s a lot of triage involved — even over the phone. We’re creating guidelines based on patient-centric care. We’re building a whole new system.”
By helping patients prepare for their clinic, diagnostic and treatment visits in advance, the coordinators help reassure patients and families and provide much-needed support to the clinical team. By fully assessing the patient’s physical health, psychosocial well-being and personal needs from the start, they allow clinicians to focus their time on disease management and treatment, Kuznetsov said. And physicians include the coordinators in their discussion of care.
“The concept works especially well in gynecologic oncology because there are so many different aspects of care involved,” said Oliver Dorigo, MD, PhD, director of the gynecologic oncology clinical care program and associate professor of obstetrics and gynecology at the School of Medicine. “It’s a fully comprehensive approach, and it helps to better integrate the full spectrum of ancillary services, such as palliative care, genetic counseling and clinical trials. I trust the coordinator’s judgment as an integral, knowledgeable member of the team.”
For Brockman, having a care coordinator has made it easier to cope with a difficult situation. “It is an incredible program, and I hope that other treatment centers will follow Stanford’s lead. It’s a pleasure to be part of it.”