Cheryl Martin (Host): It can be overwhelming and challenging when you get a cancer diagnosis, so support from skilled and compassionate professionals, can make all the difference along the journey of cancer care and recovery. We learn about patient navigation with Paula Paez, an Oncology Social Worker, and Oncology Patient Navigator, and Tina Unsworth, a Registered Nurse and also an Oncology Patient Navigator.

This is DocTalk presented by Montefiore St. Luke's Cornwall. I'm Cheryl Martin. Paula and Tina, so glad you're on to tell us about patient navigation and how it works. So, Paula, let me begin with you. What is patient navigation?

Paula Paez LMSW: Sure, so patient navigation is pretty much just a support to any cancer patient. The way that I like to describe patient navigation to patients who sometimes get confused when they're in the hospital, between the role of a case manager in the hospital and us, I say we're a point of contact in the community.

Sometimes it's hard for patients to navigate the system. So Tina and I say, you know, if you have any questions at all, give us a call. If we can't directly help you, then we'll direct you to the right person. So we're really just a support in the community, in our radiation oncology office, in our infusion center, and like I said, inpatient to our cancer patients.

Host: So, Tina, when someone has been diagnosed with cancer, will a navigator reach out first along with the doctors, or is it left up to the patient to learn about a patient navigator and say, yes, I am interested in being involved in this?

Tina Unsworth, MSN, RN, CMSRN: So we have a lot of different ways that we get referrals to us. We do visit the hospital at St. Luke's and we do visit patients that have a cancer diagnosis. We also have oncologists that refer to us and then we reach out to the patient and try to remove any barriers they would have to care. And then we also have, um, marketing.

So, we have in the community, we reach out to patients at events. We go to health fairs and churches, and we try to get our name out there to everyone. This way we have a point of contact, they have a point of contact in the community, whether they come to Montefiore or they're just in the community and they have a cancer diagnosis. So there's a lot of different ways we reach out to patients.

Host: So this is great to know. So it's not just a program for those who have been diagnosed with cancer or either going through treatment, but even if someone is in the community that has been diagnosed, they can take advantage of your services?

Tina Unsworth, MSN, RN, CMSRN: Correct. We do a support group every week and that's anyone with a cancer diagnosis or family members that want to be on our support group, whether they come to this hospital or they're just in the community. And we also do community events with just not cancer diagnosis. We do community events and we do screenings. And we get them the resources for them to get cancer screenings as well.

Host: Now, how long does a patient navigator walk alongside a patient?

Tina Unsworth, MSN, RN, CMSRN: There's really no end to when we stop our services. We are a point of contact whenever they need us.

Paula Paez LMSW: I would just like to add when we first talk to a patient, we kind of tell them like, we're here to help you, as you need us to. So if you go, you know, a few months without needing us, that's totally fine. They can feel free to pick up the phone, give us a call if an issue comes up. And we do have a lot of patients that kind of come in and out of our program.

Host: Run through a list of the services that you provide, what that looks like.

Paula Paez LMSW: Sure, so Tina and I actually do something that's called a distress screening, which asks questions to see if the patient has any issues with financial, insurance. Tina and I can help connect patients to insurance carriers, and also we help connect patients to grants. There's a lot of grants that are diagnosis specific, so that we know, like, for example, a patient has breast cancer. We know to refer them specifically to a breast cancer grant. Leukemia and Lymphoma is also a great resource for patients with blood cancers, and they actually cover a wide spectrum of diseases. We also ask about transportation. Unfortunately, we don't have a transportation grant, but we can help set up Medicaid transportation and we also work with the local taxi in the community that will provide our cancer patients with a discount. We ask about their supports in the community. We ask about any mental health that a patient may need help getting connected to such as like therapy or medication management.

We also ask about any need for assistive devices to get around the home. We have ordered wheelchairs for patients. So that's just kind of like our, our assessment that we do to see what we need to connect a patient to.

Host: Is there a cost involved in these services? Your services?

Paula Paez LMSW: Nope, our services are completely free.

Host: That's great. Now, what kind of feedback from patients have you received?

Tina Unsworth, MSN, RN, CMSRN: We've received very, very grateful, positive feedback from our patients because when you're diagnosed with cancer, you just don't even know where to begin. And there's just so many things you don't even think about. There's resources like having food delivered to patients that are in treatment that have children and things like that.

And we've gotten just so many positive things when they realize that we're here. The main thing is getting our name out there that we are here, and we are here to help them.

Paula Paez LMSW: So we've actually also had patients, where we've reached them like in the middle of, of their treatment where they're like, Oh my gosh, I wish I would have known about you guys, in the beginning of treatment or when I was first diagnosed. So we're definitely a big, a big support to our patients.

Host: So, you provide a lot of emotional support then. And how vital is that?

Paula Paez LMSW: It's very important. A lot of patients also have trouble, I don't want to say have like trouble, but are sometimes don't feel comfortable really sharing with their family members how they're feeling. So we're kind of that like unbiased person that they can, you know, just be raw with us and just tell us exactly how they feel, if they're upset, a lot of patients don't like to cry in front of their family members. So we, we see a lot of that.

Tina Unsworth, MSN, RN, CMSRN: And to add to that, we also do a lot of supportive care to the uh, caregivers. We do the counseling with the caregivers. We also rate their distress, because a lot of these caregivers take on a role they weren't expecting, and, and it's a lot. So we give them resources as well.

Host: And are you finding that a lot of times the caregivers are indeed family members?

Paula Paez LMSW: Yes.

Host: And a sense of maybe being overwhelmed, feeling overwhelmed?

Tina Unsworth, MSN, RN, CMSRN: Yes.

Paula Paez LMSW: We also see a lot of patients who don't have a caregiver or do not have family members, so our support, you know, is even more crucial to those patients because they really just have no one to kind of express their feelings to.

Host: Now, in terms of cancer diagnosis, are you open to being a patient navigator, let's say for someone who's on the lower end of the spectrum, let's say, stage one, or is it really those who are much further along? Does it matter?

Paula Paez LMSW: So we see all patients in all stages. So we have breast patients who are stage zero, and we have colorectal patients who are stage four. So we really just, we cover everyone.

Host: And, did you say that these services, your services, are also available to those who have not been diagnosed with cancer?

Tina Unsworth, MSN, RN, CMSRN: Correct. We do screenings and we have a lot of community events to bring education and screening to the community members.

Host: Can community members reach out to you and say, I want you to come, or do you find out about these programs and ask if you can be a part of them? How does that work?

Tina Unsworth, MSN, RN, CMSRN: We've actually done both. We've reached out to places and asked if we can come and, they've reached out to us as well.

Host: Anything else you'd like to add about your program? I would think this is such a benefit to patients and their families.

Paula Paez LMSW: I think we covered it all. I think we're definitely a huge support to our patients. And the fact that we, Tina and I are actually housed in the radiation oncology office, but every Friday we actually do rounds in the hospital. That way we, um, we see inpatients and they can have that face to face interaction with us rather than just a phone call.

We also cover the community, and like I said, our infusion center. We do round the medical oncology offices, not too often, but just to kind of introduce ourselves to the staff at the offices so that they know about us and if they see that a patient is in need of our services, they know to refer them to us.

Host: Do you get involved at all with suggesting clinical trials or giving them directions in that or is that more for the physician?

Tina Unsworth, MSN, RN, CMSRN: We do work with the physicians and refer to clinical trials. There's a few things we do here at the cancer center, that patient navigation assists with. We do the lung screening program, so for smokers that fit the criteria, they can get a low dose CT lung screen. We do genetic counseling here, so if any doctors want to refer us or if the patient calls and wants genetic counseling, we do that here too.

And we have a smoking cessation program that Paula and I run, and we've had a lot of success with that too.

Host: Just one other question that came to mind. How involved are you with each patient? Does it depend on the patient? For example, will the patient have your number so they can call anytime they want? Or do you have a system that says, I'll check in with each person on my list once a month? How individualized is it?

Paula Paez LMSW: So that distress screening that I mentioned before, we ask about their level of distress based off a thermometer. And we do that on initial encounter with the patient. So any patient that scores a four or higher, we meet with them after a week. And then it really is patient by patient basis.

Like there's patients that I see weekly. There's patients that I see multiple times in a week. It all just depends on their needs. The patients also do have both of our direct lines in case anything comes up.

Host: Great. Thank you so much Paula Paez and Tina Unsworth. Thanks for educating us about patient navigation and also just for the positive difference that you're making at a critical time in the lives of so many patients. Thank you.

Paula Paez LMSW: Thank you.

Tina Unsworth, MSN, RN, CMSRN: Thank you for having us.

Host: For more information about our Littman Cancer Center, visit MontefioreSLC.org. That's montefioreSLC.org. And please remember to subscribe, rate, and review this podcast and share it on your social media. You can also check out our entire podcast library for other topics of interest to you. Thanks for listening to DocTalk, presented by Montefiore St. Luke's Cornwall.