Joey Wahler (Host): This is Health Matters, insights from WCH Medical experts. Our guest, Sara Hackler. She's Nurse Navigator for Wood County Hospital's, Maurer Family Cancer Care Center. Thanks for joining us. I'm Joey Wahler. Hi there, Sara. Welcome.

Sara Hackler: Good morning. Thank you for having me.

Host: Great to have you aboard. We appreciate the time. So first, for those unfamiliar, in a nutshell, what exactly does a cancer nurse navigator, like yourself, do?

Sara Hackler: So basically as the word navigation says, I help direct patients from the moment they get their first abnormal test all the way through their cancer treatment to the end and then beyond if they feel like they still need that.

Host: So we'll get into some specifics in a moment or two, but generally speaking, how did patient navigation at Wood County Hospital start in the first place, and why would you say overall it's so important in cancer care there?

Sara Hackler: So about a year ago, Dr. Parikh, who's our Medical Director, started looking at numbers of cancer care here in Wood County. And we are a rural community, so a lot of our patients live out in the country or in these small towns and getting care sometimes for them can be difficult, whether it's transportation or anything like that.

So we started running numbers and the time from their first abnormal test to their first definitive treatment was staggering. So that's kind of where the Wood County Navigation program started is our goal is to decrease that number. So when you decrease the amount of time between those two things, the patient's anxiety goes down and it makes their treatments a lot more smooth.

Host: I'm sure and when you talk about travel, Sara, this comes up a lot in people I talk to in healthcare where it's often overlooked, right? The burden of travel for people that aren't well, may have mobility issues, may have financial issues that limit how they get to and from where they need to go to be treated. Right?

Sara Hackler: Correct. So a lot of patients, if they don't have the transportation, let's say they are older and they don't have any family left to bring them, they never had kids or their kids live out of state or not close, they still work. We never want to just count them out because they don't have the transportation.

Host: You certainly don't want to have them having to make that choice. So transportation aside, what other barriers do patients in this situation often face dealing with cancer and having to get through the things that come along with it. How does navigation, you and yours, help remove some of those roadblocks?

Sara Hackler: So some of the other big barriers we come up against with these patients is little to no healthcare whatsoever, or maybe their healthcare only allows them to go to certain centers. So we want to make sure that no matter what that barrier is with healthcare, that we're helping them there as well. Do we need to get them on some type of financial assistance with the hospital or Toledo clinic, which is who our physician is through?

Do we need to see if they have different plans that they can choose from, if they're on marketplace or if they're getting supplemental plans for Medicare, anything like that. So we do have, again, a social worker here who can help with that. The social worker's in our outlying offices here at Wood County, and we have financial navigators here at Wood County as well.

Some patients come across childcare issues. We don't always treat older patients. We have younger patients who have younger kids. So childcare issues can be a thing. Do they need to come in after their kids are dropped off at school? Do they need to come in during the lunch hour for them? Things like that, or adult daycare. A lot of our patients are still taking care of their parents or even older children who need their help. So the same thing, what can we do for those patients to make sure that they have a limited amount of time to come in for their stuff, but also still make sure that they have somebody secure and safe at home to take care of the people that they normally do.

So having navigation gives that patient one good source to be able to contact for all of that, and then know that they're going to get the response back, or at least get the referral to whoever it is could help them with that.

Host: Gotcha. And some of the things you just mentioned that can provide some of those roadblocks for patients, that can lead to stress and the need for stress management, right. Along with financial issues, debt, it's a lot to juggle. And again, hence the word navigator because you are trying to basically be the point people to help with all those things, right?

Sara Hackler: Exactly. Exactly.

Host: So what if there is such a thing, Sara, is a typical day like for a cancer navigator? I would imagine it's many things and many different cases for various different people, right?

Sara Hackler: Exactly. So nobody ever wakes up in the morning and says, you know what? Wow. I think today's going to be the day that I'm diagnosed with cancer. Right? So when you hear those words, it's life altering. It changes everything. Everything kind of comes to a halt. Nothing looks clear anymore. You're not sure where to go.

So a lot of my days I will spend working with maybe just one patient, figuring out their situation, their family involvement. Do they want family involved? Do they want family to know anything at this point? What are their fears? Who do they want to tell? What are the treatment beliefs? Do they believe in having treatment at all or do they just kind of want to go on about their life and maybe act like they never even heard the word cancer because it does happen. Sometimes I will get ahold of a patient who doesn't feel like they need my assistance right now, and that's perfectly okay. I just make it very clear to that patient that if they should change their minds, I am still here as a reference for them and a source.

 This is a very vulnerable time for patients and they need somebody to confide in, somebody that they can talk to. Maybe somebody, they just need to come in and sit while they vent. Maybe they need to cry, maybe they need to scream, anything like that. So to be able to be that confidant for them is amazing.

Almost surreal sometimes. They come in at their weakest. And when people are weak, as long as you can make them feel like they're heard, they become empowered and they get to write their own cancer story. They get to decide how it goes, how it ends, and how everything in between looks. I can relate to these patients.

I've been family to patients who've had cancer and have lost that battle. I'm a nurse by trade. I am a patient advocate, and I'm a fellow survivor, so I have walked in some of these people's shoes, maybe not as far as others, but I have walked in the shoes. I have sat there and listened to that. So I can empathize with these patients in many, many ways.

And when you, again, start to empower them, it's liberating to them. They need to know how they want their story to look, and that is just a blessing on my side to be able to help them with that.

Host: Thank you for sharing that part of your background, and of course, I'm sure that gives you increased credibility with these people when they know that you have walked in their shoes. How about the way in which Sara, navigation has shown to actually improve outcomes for these cancer patients? What impact does it have?

Sara Hackler: So patients who start with navigation right from that first abnormal test have shown to get to the actual diagnosis faster, and then that leads to getting their treatment faster. So again, you're cutting back on all of that anxiety in between. And when somebody has somebody on their side, as they will call it, a lot of times, it increases their adherence to treatments, increases their quality of life.

Just one person to be able to assist them. Somebody they can call in the morning, they can look forward to that once a week phone call if that's what they want to get. Psychosocial and logistical challenges. Again, all of those barriers, all of the feelings of fear, anxiety, the fear of the unknown, all of that.

So it just makes them want to keep going, they want to start, they want to keep going and then the navigator can help them make sure they're getting to all follow ups, future screenings. Because we don't want anything else popping up that we may not be aware that's coming.

Host: So something you touched on earlier that I wanted to have you expand on, please. Namely families, loved ones here. How does navigation extend beyond the patient to also support their caregivers and their families? Because often an experience like this can be just as daunting, literally for them as it is for the one with cancer, right?

Sara Hackler: Correct. So again, with the diagnosis of cancer comes anxiety and fear, and it's not just for the patient, like you said, it's the family as well. The fear of what could be, what if it does come back cancer? What if it doesn't? Yay. On that side. Correct. Family members who are closest to the patient will most likely be the ones who feel the brunt of the patient anger.

So we tell patients all the time and their families when they come in for consult, don't be surprised if that patient starts to lash out a little bit. They're going to have good days, they're going to have bad days, and unfortunately, that person who's closest to them feels those bad days a lot because that person knows they can lash out at that person and they're not going to leave them, right.

They're not just going to say, I'm not going to take that anymore, and they walk out. So they continue to do that, not out of anger towards that person, but just because they need to get those feelings out. And unfortunately, that person is the one who's right there.

They make contacts during this. They come in for treatment and they meet other people who are going through the same process. Maybe some of them a little bit more extensive, maybe some of them not as extensive, but they start to make those bonds and you'll hear the patients in the waiting rooms talking back and forth. Oh, it's so good to see you this morning.

How was your weekend? How was your day? What are your plans? So they make those connections and they keep going. So even when those patients who are unfortunate and lose their battle with cancer, those bonds that are made between caregivers, nurses, doctors, and these patients and their families, they go on for a long time.

These families will come back six months to a year later and bring cookies or a card or something and say, thank you so much for all the care that you gave my loved one. And they just want to check up. They just want to make sure that you're still doing okay. So it's just as much a resource for them as it is for the patient themselves.

And it's a sweet and endearing relationship and not a lot of people get to experience that. So when you do, it is truly something remarkable.

Host: And speaking of which, what's that like for you when you see that kind of giving back, that kind of comraderie and that bond that's formed as you put it?

Sara Hackler: It's fantastic. So I have seen patients in the past who have wanted to quit treatments, just after a couple of treatments in, and there was people in our waiting room who rallied behind them, and that was over two years ago. And those patients still to this day go to lunch together and everything because they made that bond.

They have that special pact and they've gone through something that not everybody goes through. So until you've had to walk that walk and experience all of that, you really don't know what all of that entails. So it is amazing to see them be able to get that.

Host: You talked earlier about empowering patients, giving them options. Speaking of which, what unique choices does Wood County Hospital's navigation program give patients regarding where they receive treatment?

Sara Hackler: So when we were doing all of this research into navigation, you know, you watch a lot of webinars and you hear a lot of things, and one thing I came across was the fact that if these patients are going to larger tertiary centers, even the ones local, that if they are hooked up with one of their navigators and then somewhere down the line the patient says, you know, I live in Bowling Green, or I work in Bowling Green, or whatever location it may be, and I really want to get my treatment there.

Those bigger centers will drop that patient from survivorship right then and there, no questions asked. So then that patient right then and there is left to figure out what comes next. Where do I go? Who do I call? Is my insurance going to cover? So one of the main things we're going to do at this program at Wood County is, we're not going to do that.

So if the patient comes here and they consult, but yet they decide they want to go somewhere else for treatment, that's okay. I will continue to follow them through those centers, make sure that they are moving through the system, that things are happening in a timely manner. And not only that, getting that information back to the family practice.

So I worked family practice for many years and patients would come in who had had something catastrophic going on in their life and maybe we haven't seen them in six months, and now they're frustrated because their family doctor, who they think is over everything doesn't know anything about what's been happening with them, so as long as I can follow them, I can get that information back to the family doctor so that when the patient goes in, that line of communication remains open and the family doctor is aware of everything that's been going on.

Cuts down on frustration with the patient, cuts down on frustration with the doctor, and everybody tends to leave happier that way.

Host: I would imagine so. And finally, Sara, in summary here, particularly as a cancer survivor yourself, I'm sure there are many answers to this question, but most of all, what would you say is most rewarding about what you do on a daily basis?

Sara Hackler: Most rewarding for sure is watching these patients walk out of here on their last day of treatment and they may be smiling, they may have tears and smiling. Their families are celebrating with them. Some of the families come in and meet them by surprise. They bring them flowers, gifts, they take them places.

Things like that. Husbands take their wives on trips. And even just watching them come out and give the treatment team the hugs and say, you know, thank you. Just thank you because you are there in their weakest moment. And to have eyes on them all the time and watch them go from, again, being very meek, a lot of times, and then writing their story and coming out and they just feel a lot better, empowered, stronger knowing what they went through and that they got through this portion of it. It's unbelievable.

Host: I'm sure, and it sounds like on a daily basis for you and yours, it's very emotionally charged and very gratifying work. You should be proud of what you do.

Sara Hackler: Thank you. We are.

Host: Absolutely. And folks, we trust you now more familiar with Cancer Nurse Navigation at Wood County Hospital. Sara, keep up all your great work and thanks so much again.

Sara Hackler: Thank you for having me.

Host: Absolutely. And for more information you can call Sara, 419-728-0676. Now, if you found this podcast helpful, please do share it on your social media. And thanks so much again for being part of Health Matters, insights from WCH medical experts.