Together We Can -- Newsletter of the Joan Karnell Cancer Center

Fall 2005

Putting Patients Back in the Center of their Care
Message From the Administrator
Understanding Computer Assisted Tomography
Cancer Risk Evaluation
Shiatsu Bodywork
Honors, Awards & Publications
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Putting Patients Back in the Center of their Care

By all appearances, the waiting room in the Joan Karnell Cancer Center at Pennsylvania Hospital is no different than any other, until you notice several patients viewing what look like electronic clipboards. Even before they meet with their doctor or receive therapy, patients at the Karnell Cancer Center are documenting how they feel physically, emotionally and mentally via a revolutionary selfassessment tool called the “e/tablet.”

The e/tablet is part of a new program called AIM Higher. AIM stands for Assessment, Information and Management of cancer related symptoms. Developed and sponsored by Supportive Oncology Services in Memphis, TN, the Joan Karnell Cancer Center is among a select group around the country utilizing the e/table as part of a pilot program.

The e/tablet combines interactive computer technology with a patientcentered, proactive approach toward improving care for patients who are experiencing one or more chemotherapy-related symptoms.

This program has been designed to help doctors and their patients together better assess and manage the side effects of chemotherapy. The Joan Karnell Cancer Center was selected to participate because of its reputation not only for treating cancers, but for providing the highest care possible in managing symptoms and treatmentrelated side effects.

How It Works
Each time a patient comes to the Cancer Center, they are asked to complete the e/tablet questionnaire. The questionnaire elicits information regarding common chemotherapy-related symptoms: anemia, depression or anxiety, diarrhea or constipation, nausea and vomiting or neutropenia, low white blood cell counts which can lead to infection. In place of a keyboard, patients simply touch the response on the screen that most closely matches their impressions. For example, patients are asked to select the level of fatigue or weakness they are experiencing from a rating of “0”, meaning “not a problem” to “10,” which indicates it has been “as bad as possible.”

Information from the questionnaire is sent wirelessly to a database, where it is analyzed and highlights any moderate or severe symptoms for the doctor's review. A report, which becomes part of the patient's confidential medical record, is immediately printed and provided to the doctor even before he or she meets with the patient. The printout not only tells the doctor how the patient is feeling that day, but it tracks a patient's progress before, during and after any treatments they may have received over the course of their Cancer Center visits.

If patients' answers register a certain level of severity having to do with nutrition, anxiety or depression, for example, those responses automatically trigger an e-mail to the relevant health care professional – in those cases, a dietician, social worker or psychologist – who then is able to follow-up with the patient.

“The nurses, doctors and other health care professionals are all receiving the same information from the patient, so they all know if anything about a patient's health has changed,” explains Cathy Fortenbaugh, RN, MSN, AOCN, a clinical nurse specialist, who is coordinating the AIM Higher program at the Cancer Center. “Being able to measure the progress and level of severity of our patients' symptoms based on their perspective helps us to offer them the best care possible.”

Since introducing the e/tablet to their patients, the Cancer Center staff has seen a significant increase in patient referrals to the Cancer Center's nutritionists, psychologists and social workers.

“This increase in referrals was a signal to us that some of our patients were experiencing symptoms that they weren't conveying to their doctor,” says David Henry, MD, a medical oncologist at the Karnell Cancer Center.

The e/tablet is also an effective educational tool. As part of the AIM Higher program, patients and their families have access to an extensive collection of information on cancer through the e/tablet and The Patient Companion, a binder containing brochures and other printed materials corresponding to information on the e/tablet.

Developed by nurses and physicians around the country from AIM Higher sites, topics range from the diagnosis and treatment of cancer to dealing with side effects, descriptions of the Center's supportive care services and the latest cancer research, all of which can be provided to the patient in printed form as well. In addition to text-based information, the e/tablet includes short videos featuring real patients.

Linda*, who was one of the first cancer patients at the Karnell Center to participate in AIM Higher, says that the e/tablet has been particularly helpful in keeping track of changes in her symptoms.

“I don't have to rely on my memory when describing whether my symptomshave deteriorated or improved to any degree since prior visits,” she said. “Arecord from my e/tablet responses is always available and immediately noted by both my doctor and the nurse.

“And,” she adds, “it's a record of my impressions, not someone else's interpretation of how I might feel.”

“This device is a very effective way to begin to gather information from our patients, so that we can zero in on what's bothering them at that particular time and provide better symptom management.”

*Name changed to protect patient privacy.


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