The JADPRO Podcast

Gabrielle Zecha, PA-C, MHA, Director of Advanced Practice Providers at Seattle Cancer Care Alliance, talks about her team's preparations for COVID-19.

The COVID-19 outbreak has necessitated cancer centers to rapidly develop screening protocols and explore telemedicine strategies to prevent infections. Advanced practitioners have been on the front lines of patient care and education, and we talk with two of them to see what their processes are and what other health-care providers can learn from their experiences.

Show Notes

What are the preparations you've been involved in?

• Created two teams to preserve provider capacity
• Working with Head of Infectious Diseases
• Actively screening all persons entering building
• Work pool created with NPs and MDs for offsite participation in screening
• Identified PPE stocks, using masks in initial screening

What is your screening procedure?

• Algorithms updated every morning
• Have to have different colored stickers to enter the building every day
• If screen failure, we direct them to a separate triage and treatment area
• Testing in cars unless patients need to come in for life-saving treatment
• We have assigned a COVID-19 provider of the day at the institution and one in home-based team
• Daily meeting to count swabs for patient testing, and priority testing of providers

If a patient needs to enter the building, what do you do?

• Escort them to a designated area, with full droplet protection
• Aggressive debulking of clinic, calling and rescheduling patients. If patients are not on active treatment, don't have treatment-related toxicities, and don't require frequent supportive care, we set up telephone visits with own billing code.

What are you instructing patients who aren't sure whether they should come in or not?

• Triage them into secure area of building
• Having serious conversations about being mindful of danger of going into the hospital, but also of staying out
• Created criteria for admission
• For regimens considered inpatient, figuring out how to do in clinic by modifying regimen
• People getting admitted are getting treatment for curative intent and are on regimens requires inpatient admission

Where are your sources for education?

• Virtual huddles through skype
• Home-based huddling with in-based team
• Meeting with screening staff to tell them what's new in screening and testing process
• Constant communication
• Dispelling myths - managers round regularly
• Central command set up in clinic - only this group will communicate, email sent every morning with update on who infield provider is, who home-based provider is, so staff know who to contact
• Chair of medicine, APP manager, Infectous disease, medical team, nurse managers, central supply

What is your biggest tip to give to APs facing preparation?

• Take it seriously
• Get your center or clinic to take it seriously
• If you don't have anything in place now, start now
• There are models, algorithms, criteria for admission available
• Share information
• Assume everyone is infected and practice accordingly
• Sensible use of PPE

Victoria Reiser, RN, BSN, BMTCN, OCN, author of the JADPRO article Beyond CAR T-Cell Therapy: Continued Monitoring and Management of Complications speaks with co-host Wendy Vogel, MSN, FNP, AOCNP, on caring for patients who have received CAR T-cell therapy.

2:07 Introductions 3:42 If you had a billboard about your article, what would the headline be? 4:25 Why is this topic important for APs? 5:27 How would you explain CAR T-cell therapy to family members? 6:35 Infusion process 7:52 Monitoring for cytokine release syndrome 8:26 Immune effector cell-associated neurotoxicity syndrome (ICANS) 11:05 Inpatient vs. outpatient 11:35 Caregiver involvement 14:02 Hemophagocytic lymphohistiocytosis (HLH) 15:48 Recovery period 16:28 Long-term toxicities 17:34 Assessing response 18:18 Prophylaxis after therapy 19:30 COVID-19 advice for patients 20:52 Geriatric patients 22:15 Myths 23:42 What's the hardest thing about CAR T-cell therapy?

What's the quickest way to ruin a dinner party? Talking about death might be one, but Debra Jarvis, former chaplain with Seattle Cancer Care Alliance, TEDMED speaker, podcaster, author, and writer-in-residence at University Congregational United Church of Christ doesn't shy from talking about taboo topics. After her keynote at JADPRO Live, Debra sat down with freelance medical writer and editor, Kate MacDougall, on her journey on the Camino de Santiago, similarities she recognized between her hike and the practice of oncology, and fine-tuning attitudes and perspectives on death.

In early 2020, the Trump administration rolled out a Medicaid block grant program, where states apply to received capped federal funding and have new flexibility to dictate coverage and benefits. Tennessee's application is a telling example of how health benefits for the most vulnerable populations have the potential to change drastically.

References:

Kaiser Family Foundation estimates based on 2017 National Health Expenditure Accounts data from CMS, Office of the Actuary; The Kaiser Family Foundation, Medicaid in the United States Fact Sheet, October 2019. http://files.kff.org/attachment/fact-sheet-medicaid-state-US

The Facts on Medicare Spending and Financing https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/

Trump Administration Announces Transformative Medicaid Healthy Adult Opportunity https://www.cms.gov/newsroom/press-releases/trump-administration-announces-transformative-medicaid-healthy-adult-opportunity

Trump Administration Clears The Way For Medicaid Block Grants https://www.npr.org/sections/health-shots/2020/01/30/800841612/trump-administration-offers-states-a-way-to-block-grant-medicaid

In this episode, we're sharing the acceptance speech of the first recipient of the annual Mary Pazdur Award for Excellence in Advanced Practice in Oncology, Jeannine Brant, PhD, APRN, AOCN®, FAAN, Billings Clinic, Billings, Montana. If you have an advanced practitioner in your life who's mentored you and inspired you, you can nominate that person for the 2020 award at marypazduraward.com. The winner will receive $5,000, a trip to the 2020 conference in Minneapolis, and recognition at the conference and in the journal.

In this episode, we're sharing the acceptance speech of the second recipient of the annual Mary Pazdur Award for Excellence in Advanced Practice in Oncology, Jody Pelusi, PhD, FNP, AOCNP®, of HonorHealth Research Institute, Scottsdale, Arizona. If you have an advanced practitioner in your life who's mentored you and inspired you, you can nominate that person for the 2020 award at marypazduraward.com. The winner will receive $5,000, a trip to the 2020 conference in Minneapolis, and recognition at the conference and in the journal.

Are you curious about what goes on in the FDA? Natasha Kormanik, MSN, RN, OCN, Senior Regulatory Health Project Manager at the FDA describes her day-to-day job and debunks myths about the expanded access program. Reporting by A. Kate MacDougall, editor and writer.

Brianna Hoffner, Director of Clinical Outreach and Development here at Harborside, talks with guest Cindy Murray of Princess Margaret Cancer Centre in Toronto on the nuances between practicing oncology in the US and Canada.

A. Kate MacDougall, editor and writer, speaks with Beth Eaby-Sandy, MSN, CRNP, OCN, of the Abramson Cancer Center on data showing that women still lag behind men in areas like pay and leadership positions, and the particular challenges in oncology for women.

Articles referenced in this episode:

Women in Healthcare Leadership 2019, Oliver Wyman.

Still a Man's Labor Market: The Slowly Narrowing Gender Wage Gap, Institute for Women's Policy Research, November 26, 2018.

2017 National Nurse Practitioner Sample Survey, American Association of Nurse Practitioners, August 8, 2018.

How Medicine Became the Stealth Family-Friendly Profession, Claire Cain Miller, The New York Times, August 21, 2019.

Female Physicians Reject Good Enough Miriam A. Knoll, MD, Forbes, 2019.

The Business of Health Care Depends on Exploiting Doctors and Nurses, Danielle Ofri, The New York Times, June 8, 2019.

What's Holding Women in Medicine Back from Leadership, Harvard Business Review, June 19, 2018.