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FAQs - Fast Facts (Community Care)

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Since hospital stays are short, how can I find home health services for the patient diagnosed with CRC?

Home health care is a physician-ordered nurse-coordinated and -administered service that brings patient-specific care into the home. Home health nurses care for patients with multiple health care issues. They are expected to follow evidence-based practice guidelines for each specialty and supportive-care issue. Home health nurses are a resource in providing information at the patient’s or caregiver’s learning level and adapting practice guidelines to the patient’s needs in the home environment. Discharge planners in the inpatient setting may serve as their collaborative partners to individualize home care.

Many factors are considered in choosing a home health service.

  • Some home care providers have nurses with an oncology background; however, one must consider the insurance coverage or payor source
  • Insurance and managed care plans require the use of a provider in the plan’s network. Use of an “out of network” provider usually increases cost to the patient
  • Some health care plans include home care providers. To reduce the chance of creating additional financial burden for the patient, it is important to verify the preferred provider for the patient’s insurance carrier
  • A case manager is another option
    • This professional assists the patient and health care provider through the transition of care from hospital to home
    • The case manager is usually employed by the insurance company and available throughout the continuum of care
    • The nurse can request a consultation with a case manager with coverage determined by the patient’s insurance The case manager acts as the “go to” person for
      • Information sharing
      • Interpretation of billing
      • Resource management
      • Education of the patient
      • Encouragement to adhere to the treatment regimen
      • Involvement of patients in their own care
      • Coordination of care with all parties
    • If case management services are not offered through the insurance company, the patient may privately hire an individual with this expertise
    • Case management services are often available through home health services

What materials are available to help patients learn about CRC? How do you know if the information is reliable?

A variety of patient materials is desirable, since we all learn through different formats and at different rates. Print, audio, CDs, and online resources allow the patient and family to review information at their own pace. Patients feel stressed when coping with the diagnosis of CRC, treatment, and side effects, and they may not understand information when offered—especially immediately following surgery or treatment. Family members may be equally stressed and unable to absorb spoken information.

Home health nurses and case managers are familiar with print materials appropriate for different learning levels, because their practice arena is wide and diverse. Videotapes and CDs can be useful instructional tools, and most patients have access to video and CD players. The Health Literacy: A Manual for Clinicians offers excellent suggestions for assessing and designing patient resources appropriate for different learning levels.1

Online resources are another option to encourage patients to be involved in their own care. There are many useful Web sites, and it is difficult to know which ones might benefit each patient. It is beyond the scope of this question to suggest specific Web sites for CRC. However, searching Google using the key phrase “colorectal cancer” will provide patient-specific Web sites. Although the World Wide Web is becoming the place to find health care information, not all patients have access to the Internet.

Other suggestions:

The reliability of information is a complex issue. Materials produced by the American Cancer Society (ACS), National Institutes of Health (NIH), professional oncology organizations, the patient’s treatment center, and comprehensive cancer centers, to name a few, are considered to offer reliable current information. Assessing the credibility of online resources can be a challenge, and there is no easy way to determine reliability. Again, note the sponsor or the group who developed the materials. Always note when the information was updated, usually stated at the bottom of the Web page.

Some online health care Web sites carry the designation . Health on the Net Foundation (HON) http://www.hon.ch/ is a nonprofit organization that certifies health care–related Web sites that meet the HON ethical standards. Seeking this designation is a voluntary process. Web sites that display the HONCode symbol are considered reliable. However, many health care sites do not seek this or any designation but remain reliable and credible in the information they provide.

The Utilization Review Accreditation Commission (URAC) Web site at www.URAC.org is the largest accrediting body for health care. URAC accredits many types of health care organizations. Some accreditation programs review the entire organization and some focus on quality within a single functional area in an organization (eg, case management). Web sites also display awards noting review by an external body.

Don’t forget the sharing of information in the waiting room, in support groups, and with well-meaning relatives and friends who often prefer to emphasize side effects and use the opportunity to recall their own cancer experience. A good rule of thumb is to ask patients to confirm what they learned about the CRC since the last visit. Where did they find the information? This is especially important for information coming from the Internet. The health care provider should check out these Web sites to confirm the reliability of the information.

How do I know when my patient is ready to learn?

The Institute of Medicine (IOM) report states that problems with the ability to read, understand, and act on health information affects 90 million people in the United States and, by some estimates, costs the health care system more than $58 billion annually.2

  • The average adult reads at an 8th grade level1
  • Most patients learn at a 5th and 6th grade level1
  • Patients with low literacy levels read materials written at a 3rd to 5th grade level1,2
  • Yet the IOM study showed that current patient consent forms are written at an 8th grade to graduate education level.3
  • Yet the IOM study showed that current patient consent forms are written at an 8th grade to graduate education level.3

The challenge in patient education is multifactorial:

  • Short hospital stays often fund instruction to patients and family given during crisis periods in their care
  • Individuals with high literacy levels may not understand health care information because of either the vocabulary or the manner of presentation
  • Comprehending information involves many components; it is difficult to assess readiness to learn because of either time or limited resources, such as people qualified to assess health literacy
  • Materials often take form of a brochure for patients leaving an office or health care setting, because it is the most expedient way to give information
  • There is much discussion about the psychosocial aspect of educating the patient, involving them in their care and partnering with them to maximize their learning experience2,3

It is critical that our initial patient assessment included health literacy. Is the patient able to process information in written or oral form? Are there cultural or language barriers to address before the patient is ready to receive instruction?

The Web site Partnership for Clear Health Communication (www.askme3.org)4 provides solutions to assist clinicians and patients with health literacy issues. Patient information on this site can promote self-efficacy while assisting the provider in education preparedness.

When patients do not meet the guidelines for hospice care but need support at home, are home health staff sufficiently knowledgeable to care for cancer patients?

Nationally, home health agencies provide skilled services (nursing, physical, occupational, or speech therapies) to cancer patients. In addition to those with a primary cancer diagnosis, they also provide supportive care to those with long-term nutritional issues, such as enteral or parental therapies as well as ostomy, tracheostomy, and wound care. Private duty is also available; however, private duty may be a patient-paid expense. Assessment of the burden of patient care on the family and the potential need for respite care is important.

When do I refer a patient to hospice, and what services are provided?

When a patient has a terminal diagnosis with an anticipated life expectancy of less than 6 months, it may be time to discuss hospice care.5 The patient and family must be ready to accept palliative versus curative care and be willing to assist in the care, support, and management of the patient.

Hospice provides comprehensive medical, psychological, and spiritual care for terminally ill patients and support for their families, including bereavement care following the death of the loved one. Hospice care includes the provision of related medications, medical supplies, and equipment. Services are provided by nurses, therapists, aides, social workers, clergy, and volunteers. Hospice care enables families to care for their loved ones in their home. Short-term respite and inpatient hospice facilities may be available to complement the hospice home care service.

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References

  1. Weiss B. Health literacy: a manual for clinicians. The American Medical Association Foundation and American Medical Association. Available at: http://www.ama-assn.org/ama/pub/category/9913.html. Accessed May 17, 2007.
  2. Kindig D, Affonso D, Chudler E, et al. Report brief. Health literacy: a prescription to end confusion. Institute of Medicine of the National Academies. Available at: http://www.iom.edu/CMS/3775/3827/19723/19726.aspx. Accessed May 17, 2007.
  3. Berkman BD, DeWalt DA, Pignone MP, et al. Literacy and health outcomes. Evidence Report/Technology assessment No. 87 (prepared by RTI International–University of North Carolina Evidence-Based Practice Center under Contract No. 290-02-0016). AHRQ Publication No. 04-E007-2. Rockville, MD: Agency for Healthcare Research and Quality. January 2004. Available at: http://www.ahrq.gov/clinic/epcsums/litsum.html. Accessed May 17, 2007.
  4. Ask Me 3. The Partnership for Clear Health Communication. Available at: http://www.askme3.org/. Accessed May 21, 2007.
  5. The American Cancer Society. Available at: http://www.cancer.org/docroot/ETO/content/ETO_2_5X_What_Is_Hospice_Care.asp?sitearea=ETO. Accessed May 22, 2007.

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This page was last modified on 6/19/2007, at 8:52:46 am ET.