4 Policy
Pharmacy Practice News • August 2015
ASHP Summer Meetings
Caregiver couple experiences the best—and worst—of cancer therapy
A Tale of Two Treatments Denver—There is an irony in the twoyear journey of the late Jerod Loeb, PhD, as a cancer patient: After serving as a senior executive at the Joint Commission for 19 years, he was subject to the vagaries of safety and quality that he had been working to eliminate. Dr. Loeb died in 2013 after a series of briefly effective treatments for advanced, metastatic prostate cancer, but his wife, Sherri Loeb, RN, has since been speaking about the “broken health care system” they encountered and the importance of greater patient engagement. “We saw the best and the worst of health care,” Ms. Loeb, who serves on the Person- and Family-Centered Care steering committee of the National Quality Forum, told attendees of the American Society of Health-System Pharmacists 2015 Summer Meetings. Among her laments was that “patients need a map, a guide and an extraordinary amount of skill and stamina” to navigate the health care system. “And this is coming from two people who’ve worked in it for a long time,” said Ms. Loeb, who is also a research coordinator at Advocate Lutheran General Memory Care Center in Park Ridge, Ill. Dr. Loeb received his first treatment for stage IV prostate cancer in 2011 at a hospital near their home in Buffalo Grove, Ill. The treatment was effective for three months, but Dr. Loeb’s disease returned aggressively. Ms. Loeb and her husband considered their options after the treatment failed and traveled to the University of Texas MD Anderson Cancer Center in Houston. Dr. Loeb enrolled in a clinical trial and was treated with abiraterone (Zytiga, Janssen Biotech), sunitinib malate (Sutent, Pfizer) and dasatanib (Sprycel, Bristol-Myers Squibb/Otsuka America Pharmaceutical Inc.). Those drugs slowed the disease’s progression until January 2013, when Dr. Loeb’s condition worsened. He was subsequently treated at MD Anderson with IV vincristine and cytoxan, cabazitaxel (Jevtana, sanofi-aventis), enzalutamide (Xtandi, Astellas) and docetaxel (Taxotere, Sanofi-aventis). Dr. Loeb died on Oct. 9, 2013, after receiving hospice care in his home.
A Study in Contrast The care that the Loebs received at their local hospital and at MD Anderson is a study in contrast. According to Ms. Loeb, providers at the local hospital were dismissive and did not communicate well with the couple as well as among themselves. She recalled the only time her hus-
band required emergency hospitalization near their hometown. “He was hospitalized over the weekend, and unfortunately, we picked the wrong weekend because Jerod’s oncologist and internist were off,” she lamented. “The covering internist wasn’t talking with the covering oncologist, and when we left the hospital on Monday, they still hadn’t communicated with each other—or with his regular physicians. We also couldn’t get answers from the nurses, who hadn’t communicated with the physicians either.”
which point Jerod said, ‘over my dead body,’” Ms. Loeb commented. The Loebs left their local hospital feeling excluded from their own care decisions, but moved on to receive higher quality treatment at MD Anderson. She said the providers there had a much better regard for patients, and institutionalized practices, such as bedside shift reports, provided opportunities for direct patient engagement. “Both the incoming and the outgoing nurse stood at the bedside and provided a verbal shift report that Jerod and I
by the
numbers The Loebs had a mixed bag of cance er care. But when clinics focus on boossting patient satisfaction, dramatic ga ains can be achieved, a new study sugge ests:
97% |
Patient satisfactions scores after QI project (up from 56th percentile at baseline)
92% |
New patient scores (up from 27th percentile at baseline)
98% |
Care provider scores (up from 29% percentile)
Source: J Oncol Practt 2015;30. JOP.2015.004911. [Epub ahead of print]
‘If you engage patients and their families, you not only make them feel more involved, empowered and satisfied with their care; you also will improve the safety, efficacy and overall quality of care.’ —Kay Swint, MSN, RN Ms. Loeb said the brief stay was also characterized by subpar clinical practices, such as poor hand hygiene, failure of hospital staff to perform a full assessment of Dr. Loeb and an attempt to ignore a computerized medication alert that sounded when a nurse tried to administer an IV medication. Her husband knew he was about to be given the wrong medication and pointed this out to his nurse, Ms. Loeb recalled. Rather than taking his input seriously, she said the nurse insisted on proceeding with the drug administration. After the nurse scanned Dr. Loeb’s wristband and the agent, indeed, an alert sounded. “Even after all of the warnings that this was clearly the wrong medication, the nurse attempted to hang the IV, at
could hear,” Ms. Loeb explained. “The process gave us a sense that we could hold our providers accountable, and we were able to ask questions and add our own comments.”
A Question of Engagement Health care leaders across the country are familiar with patient- and family-centered best practices, such as bedside shift reports, but for providers to implement the practices, they need to understand that there is a direct link to improved patient outcomes, commented Kay Swint, MSN, RN, who is a director of patient experience at MD Anderson, and was not involved in Ms. Loeb’s presentation. “Practitioners need to understand that if you engage
Jerod Loeb, PhD, and Sherri Loeb, RN. At the recent ASHP Summer Meetings, Ms. Leob recounted the pain of navigating “a broken” health care system when seeking treatment for her husband, who eventually died from pancreatic cancer.
patients and their families, you not only make them feel more involved, empowered and satisfied with their care; you also will improve the safety, efficacy and overall quality of care,” Ms. Swint said. For example, patients who are prescribed opioids for pain may have concerns about addiction, but if they do not share these concerns, they may not use the medication as prescribed, or they may not fill the prescription. This can result in poor pain control or adverse events, Ms. Swint said. “On the other hand, if you involve the patient in the treatment decisionmaking process and actively ask about their concerns, you can address issues like addiction by providing additional patient education about addiction and by assessing their risk for addiction,” she explained. “Alternatively, your collaboration may result in choosing a different treatment that better incorporates their individual needs and preferences.” The most common objection to patient-centered care that Ms. Swint hears from providers is that satisfying patients will lead to clinically inappropriate care, such as agreeing to prescribe antibiotics when they are not indicated. “We are very clear that tailoring care to an individual’s needs and preferences involves treatment choices within clinically appropriate options,” Ms. Swint emphasized. From Ms. Loeb’s experience, resistance to greater patient engagement is more common among older generations of providers. “The way they were taught, you just developed a plan and expected the patient to accept it, which patients used to do,” she said, referring to a “hierarchy of care and communication.” “But I think there’s a revolution coming,” she said. “Patients are tired of being obedient.” —David Wild Ms. Swint and Ms. Loeb reported no relevant financial conflicts of interest.