Purpose: Describe a shared medical visit approach used to orient Veterans and their caregivers to a new cancer diagnosis and cancer care processes.
Background: Veterans are referred to the Cancer Care Navigation Team (CCNT) by a health care provider when they have suspicion of cancer or new cancer diagnosis, as there is no onsite oncologist. Veterans indicate high levels of distress in this initial phase due to lack of information, uncertainty of next steps, lack of support system and other psychosocial issues.
Methods: A Cancer Orientation Clinic using a shared medical visit was developed for Veterans and their caregivers. The objectives of the visit are to decrease distress, increase understanding of the cancer journey, increase coping and self-care skills, proactively identify barriers to care and improve coordination of care. Veterans with a high suspicion of cancer or new cancer diagnosis are consulted to CCNT and scheduled into the Cancer Orientation Clinic. Visits are face-to-face and one hour in length, Veterans attend the appointment as a group of 3-5. Veterans are encouraged to bring a caregiver to their appointment. The CCNT multidisciplinary team including a registered nurse, social worker and nurse practitioner facilitate the visit. Educational information and cancer resources are presented in a group format to encourage sharing and support. Participants are introduced to the role of the CCNT and what to expect when traveling to VA tertiary centers for cancer care. There is educational content and discussion about cancer, their fears, and how they can improve/maintain their health to enhance cancer treatment outcomes. Veterans are assessed for distress and potential barriers; advance directives and release of information forms are completed. Each participant is given an individualized care plan by the nurse practitioner. Evaluation forms are completed by participants at the end of the visit.
Results: There were 10 Cancer Orientation Clinic visits completed for Veterans within the Spokane catchment areas between 3/14/18 and 5/30/18, for a total of 38 Veterans. The average level of distress reported at the visit was 6 (on a 1-10 scale). Evaluation forms have shown Veteran and caregiver satisfaction with the visit content and presentation.
