Patient Power
By Melissa M. Thompson
Cancer care has a new paradigm, one focused on making it easier for patients to weather the storm
With a few chirps from her beeper, Raquel Gras hurries to assist her next patient. This time, she’s meeting a regular. When she enters the room, a familiar face, drained
from months of chemotherapy, lights up with reassurance that Gras, a Spanish-language medical interpreter at Shands at the University of Florida, will help her understand what the physicians are saying.
Something as simple as translating prescription instructions seems to reduce the patient’s anxiety and frustration.
In the same way Gras works with physicians to communicate a plan of care one patient at a time, cancer specialists at UF and Shands are developing a system of collaborative care focused on the needs of each patient.
“I think patients expect to go to one place, and they expect their doctors to collaborate with each other,” says Jane Schumaker, senior associate dean and chief executive officer for UF Physicians, the organization managing the College of Medicine’s faculty practice. “Right now, that’s not a reality in a lot of institutions.”
Health officials aim to build on existing strengths to optimize the care of cancer patients in all treatment settings, from UF’s outpatient cancer clinics to the $388-million, 500,000-square-foot cancer hospital now under construction across the street from Shands at UF. Although it likely won’t be a one-stop treatment center for everyone, when the hospital opens next year it will offer patients a more coordinated approach to care. The idea? To allow doctors, patients and families to manage cancer as a chronic condition throughout a patient’s lifetime.
Healing Home
For decades, hospitals have been characterized by the buzz of fluorescent lights, the chime of elevators and the clanking of food carts and gurneys at all hours of the day and night. Thin curtains separate a patient’s most vulnerable moments from their roommate, and armchairs serve as makeshift beds for caregivers spending the night looking after their loved ones.
Following a national trend in hospital design, the Shands at UF Cancer Hospital will emphasize natural light, private rooms and tranquil landscaping to create a more comforting experience for patients and their families.
“Whether we’re renovating an existing space or building a new facility, we strive to create an environment that’s welcoming and healing for our patients and visitors,” says Tim Goldfarb, Shands CEO. “The cancer hospital will serve diverse people with different needs and that’s reflected in the building’s customer-focused design. The private patient rooms, healing garden, chapel, meditation room and community room are just a few of the features that will make this a special facility.”
One of the most noticeable departures from the traditional hospital setting is the cancer hospital’s focus on privacy for patients, translating into a design where private rooms and three independent elevator systems — one for the public, one for patient transport and medical staff and one for service personnel — creates a more dignified experience for patients.
“All of the 192 rooms are private,” says Brad Pollitt, vice president of facilities development for Shands. “There is a pull-out couch in the room that’s actually comfortable to sleep on. It’s an opportunity to make it easier for families to be with their loved ones.”
The private rooms will also have both light and electric blind controls at the patients’ bedside, so they can manage the atmosphere of their room with the touch of a button.
“One of the first things you lose in a hospital is control,” Pollitt says. “They tell you what to eat, when to eat, what to wear — we just wanted to give some control back to the patient in a home-like atmosphere we believe reduces anxiety and makes a patient feel more comfortable.”
These deliberate design elements are also developed with the well-being of caregivers in mind. A healing garden at the heart of the hospital — featuring indigenous plant species, winding walkways and a reflection pond — will serve as a place of refuge for families and medical professionals needing a moment to relax.
The indoor environment is designed to grow with the hospital. The facility is wired for online medical record-keeping and the infrastructure has the capacity to accommodate the next generation of medical equipment, such as more precise and powerful imaging machines. The facility’s operating rooms are flexible enough that almost any procedure can be performed in any room, and decentralized nursing stations bring caregivers closer to patients.
“We spent a lot of time looking at what other facilities did and how we could make ours better,” Pollitt says. “By adding small, quality pieces to different designs, we’ve created a hospital-based, dignified environment for patients.”
Team Approach
Coping with cancer is a way of life in the Sunshine State. More than 98,000 cases of the disease were diagnosed in Florida annually from 2000 to 2004, according to the National Cancer Institute. That’s an average of 60,000 more cases per year than most states in the Southeast.
Recognizing the importance of providing quality cancer treatment for Florida’s residents, UF and Shands HealthCare have teamed up with the H. Lee Moffitt Cancer Center and Research Institute in Tampa.
“We believe there is strength in numbers, and by leveraging the best assets of our three institutions, it will enable Florida to be a leader in scientific discoveries for cancer research, treatment and prevention,” says Moffitt President and CEO William S. Dalton.
UF physicians intend to incorporate many of Moffitt’s Total Cancer Care practices into their treatment regimen to address the growing need for long-term care plans based on cutting-edge research and information technology. This includes increasing patient-centered care by developing a Patient and Family Advisory Council, which provides emotional, educational, economic or spiritual support for patients based on their needs.
The Total Cancer Care model follows patients through each step of their journey — from screening to diagnosis and treatment. Physicians develop multidisciplinary teams, conduct clinical trials and create survivorship plans in an overall effort to, as Moffitt says, focus on the individual, not the disease.
One component of patient-centered care is developing treatments specific to individuals by using information stored in their “molecular fingerprints.”
“This will ultimately lead to a radical new way of practicing medicine,” Dalton says, “one that creates individualized treatments for cancer patients based on cancer biomarkers specific to their tumor types.”
Shands and UF will enroll patients in a TCC clinical study that collects tumor and blood samples that are analyzed for cancer biomarkers of each individual tumor. The program is projected to be the single largest data collection of its kind in the country.
“This marriage of molecular data with clinical outcomes is just the beginning and it’s an ambitious long-term project,” says Timothy Yeatman, executive vice president of translational research at Moffitt. “It is well worth it — eventually leading to improved outcomes, population-based matching of patients with new drugs and the development of targeted, personalized cancer treatments for patients.”
Another goal of the collaboration is to incorporate UF into Moffitt’s National Cancer Institute comprehensive cancer center designation, a distinction held by only 39 cancer centers nationwide.
Patient Power
A cancer diagnosis can mean a jarring shift from managing time around client meetings and Pee Wee football games to scheduling life from chemo treatment to chemo treatment. Traveling and coordinating these visits from one specialist to another can be confusing, time consuming and stressful for cancer patients, who often must travel from one specialist to another during the course of diagnosis, treatment and postsurgical care.
Historically, at Shands and most other hospitals around the country, cancer patients have visited each of a series of specialists individually, often in far-flung locations.
“In the Moffitt world, this coordinated care happens on a more streamlined, patient-focused level,” Schumaker says. “All of those doctors may work in the same office. They bring all of those resources to the patient rather than the patient coming to all of the different doctors, making it easier for patients to access services and get a complete understanding of their course of treatment.”
Another component of patient-centered care is a strong emphasis on multidisciplinary teams of physicians who work together to focus resources and varied expertise on an individual for long-term health care.
In this model, nutritionists might work with oncologists to help boost a patient’s immune system during chemotherapy and surgeons might also share information to form a comprehensive plan for care.
UF’s Department of Neurosurgery — where nearly 600 brain tumor operations are performed each year — has been refining its patient-centered approach for years.
“We’re providing world-class, patient-centered care for patients now,” says department Chair William A. Friedman. “The patient comes to one place and sees three physicians.”
Friedman says the UF and Moffitt physicians are sharing best practices, and “after we gather all of that information, we will have some idea of how we can collaborate.”
Schumaker says sharing is the operative word at both institutions. For example, another planned Shands-Moffitt partnership will involve the formation of teams of physicians and researchers focused on treating and diagnosing cancers specific to women.
“I think as we do that, we can learn a lot about each other and in the end focus more intensely on cancer care,” Schumaker says.