Learning to manage change has become an essential skill during the COVID-19 pandemic
Amid the stress and chaos of the early months of the COVID-19 pandemic, oncology pharmacists have become essential team members in managing change, according to a session of the 38th National Oncology Conference of the United States. Association of Community Cancer Centers.
In the presentation, Debra Patt, MD, PhD, MBA, FASCO, Executive Vice President of Texas Oncology in Austin, discussed the effects of rapid changes in the field of oncology as well as lessons learned and potential challenges in years to come. Implementing guidelines, dealing with staffing shortages and creating new solutions were 3 major hurdles at the start of 2021, and Patt said the repercussions of those changes still resonate today.
In March and April 2020, Patt said oncology assessment and management visits had dropped significantly. Although there was some recovery later in the year, rates continued to decline and remain low, and are still sub-optimal today. Patt said this decrease in screenings could have a powerful impact on cancer rates and outcomes in the decade to come.
“Screening is what finds cancer, and early detection saves lives,” Patt said during the presentation.
Patt estimated that about 30% of cancers may have gone undiagnosed during the pandemic due to the sharp drop in screenings. Because of this decrease, she predicted stage migration, with patients presenting with more advanced cancers. This migration is likely to result in worsening morbidity and mortality rates.
“It’s really concerning for cancer care providers, and I think a lot of us are already seeing it in our clinics,” Patt said.
In addition to delayed and missed screening appointments, Patt noted significant delays in routine care. Many patients have missed routine care due to fear, unavailability of appointments, competing priorities, insurance issues, financial issues, or transportation issues. Notably, Patt said many of these concerns are disproportionately impacting communities of color during the pandemic.
“If you’ve had obstacles in your life to navigate, those have been further exacerbated by the pandemic,” Patt explained.
Healthcare systems and oncology clinicians have also faced a myriad of hurdles, Patt said, including the rapid implementation of guidelines, unprecedented stress on the healthcare system and the development of new solutions. . Many new guidelines, such as social distancing, masking protocols and vaccination mandates, had to be implemented very quickly, straining the already overwhelmed healthcare system. Additionally, staffing shortages have impacted an already stressed workforce, and the need for new home staffing models has led to confusion and chaos for many healthcare systems.
Patt noted several important takeaways from dealing with these competing obstacles. First, communication is key when dealing with rapid change in a stressed workforce, although she said there is no perfect way to manage communication. At Texas Oncology, Patt said he has set up periodic town halls for staff to ask questions, in addition to emails, newsletters and signs posted throughout the clinic about new policies and procedures.
Another important point to remember is the importance of being agile, both in identifying resources for staff and in reviewing staffing solutions. Thinking differently about how to support the workforce will be a requirement for healthcare systems going forward, Patt said, including new staffing models to help accommodate employees facing unique challenges.
“I think working from home and digital healthcare solutions are part of managing that change going forward,” she said.
Finally, Patt discussed the implementation of vaccination mandates and the challenges that accompany these mandates in health systems. Texas Oncology has a vaccine mandate, and they were in the middle of the implementation process at the time of Patt’s presentation. Reviewing vaccination mandates from other organizations, Patt pointed to encouraging results. For example, Florida Cancer Specialists had a 94% compliance rate with over 4,000 employees. Key to this success is the creation of a streamlined process for religious and medical exemptions, as well as a clear timeline for firing employees who do not comply.
“I don’t think anyone likes the idea of developing a mandate for healthcare workers,” Patt said in the presentation. “But imperfect vaccination rates made us feel compelled that a vaccination mandate was needed for us to improve our compliance numbers.”
The Florida Cancer Specialists mandate was announced on August 3, 2021. At the time of Patt’s presentation, 84% of employees were vaccinated and 99% of physicians were vaccinated. Employees with approved exemptions began weekly testing from October 4, 2021 and the vaccination deadline was September 30, 2021 for those without an exemption.
Despite all the challenges of the past 2 years, Patt noted some upsides and opportunities to learn from the pandemic. First, telemedicine has evolved extremely rapidly and acute care visits can now be well managed virtually, allowing for alternate staffing models as needed to manage ongoing staffing issues. Virtual staffing can also enable the delivery of care in many communities that would otherwise not have access to oncology experts, such as rural and underserved communities.
“In my mind, it’s the silver lining of the pandemic,” Patt said. “It’s the change emerging from the crisis that really blossoms into an opportunity to provide cancer care.”
Patt D. Cancer care’s road to recovery from the global pandemic. Presented at: Association of Community Cancer Centers 38th National Oncology Conference; November 9-10, 2021; virtual. Accessed December 8, 2021. https://www.accc-cancer.org/home/attend/national-oncology-conference/keynote-speakers