- AONN+ 2022 Midyear Conference Kicked Off a Brand-New Meeting Format in Austin, Texas
- Preconference Sessions Offered Opportunities for In-Depth Exploration of Selected Topics
- AYA Oncology Navigation
AONN+ 2022 Midyear Conference Kicked Off a Brand-New Meeting Format in Austin, Texas
While we were delighted to welcome back so many of our members and attendees to the live meeting venue, we remain committed to accommodating the needs of our members, and we therefore made the decision to offer the conference in our first-ever hybrid event. Combining an onsite meeting in Austin, Texas, and the same virtual platform that we have used since the start of the pandemic, the meeting offered the best of both worlds. In this way, many more members and other colleagues were able to attend, and, in addition, all attendees were able to join in the group chat and other interactive features only available on the digital platform. Attendees tell us that they appreciated having this choice. They also valued the chance to chat with navigators from across the country well as with AONN+ leadership and subject matter experts through the interactive virtual platform.
Preconference Sessions Offered Opportunities for In-Depth Exploration of Selected Topics
Understanding the Needs of the LGBTQI Community
In this workshop, presented by Mandi L. Pratt-Chapman, PhD, Associate Professor, Medicine, The George Washington University, Washington, DC; and Asa Radix, MD, PhD, Senior Director of Research and Education, Callen-Lorde Community Health Center, New York, NY, facilitators and attendees explored best practices and issues of bias, sensitivity, and awareness when working with patients in the LGBTQI community.
The presenters stated the learning objectives for the workshop were to:
- Describe basic terms that healthcare professionals should be familiar with when working with LGBTQI people
- Identify lived experiences and social structures that influence health outcomes
- Describe unique cancer risk reduction and screening considerations for LGBTQI people
- Apply learning through case vignette discussion in small groups
- Become aware of resources for continued learning.
The presenters began with what they described as “burning questions” involving understanding terminology and pronouns used among the LGBTQI community. The facilitators then discussed intersectionality and diversity and an explanation of the types of discrimination LGBTQI people face in the healthcare system, including homophobia, ageism, transphobia, classism, etc. The ways in which exclusion is related and reinforced by other social structures was also explored.
As part of a workshop, participants were asked to reflect on their own bias, and those of the larger care community, by first answering a series of true/false questions that spanned from ideas about health outcomes, tobacco and alcohol use and cancer risk, mental health issues such as depression and anxiety, and social stigma including denial of care.
The role of the navigator, and how to remove barriers to care for members of the LGBTQI community were further explored in a series of group exercises. Some of the barriers LGBTQI patients encounter include heteronormative or cis-normative assumptions; microaggressions, such as trivializing patient concerns; explicit aggression, such as rudeness and condescension; discrimination; and denial of care. The facilitators said that while insufficient training and knowledge contribute to these biases, they can be addressed and corrected.
Additional exercises and discussion examined how the role of social determinants of health manifest and evaluated their impact on health outcomes among sexual and gender minorities. Navigators were introduced to diagnostic tools that are useful in screening for and identifying biases and barriers experienced by their LGBTQI patients, and provided with strategies and resources useful in helping patients who face these barriers.
Navigators considered the power of language, and how language use can affect the patient experience using chosen names, appropriate pronouns and descriptions of experience, and awareness of patients’ previous negative experiences when in the healthcare system.
Clinical issues were also discussed, particularly as they relate to anatomy-driven cancer screening and diagnosis. Navigators and other HCPs should be aware of issues such as gender dysphoria and the likelihood of false positives on some tests due to hormonal changes.
Trauma experienced by LGBTQI patients in the healthcare system was another topic that navigators investigated. Ways that trauma can be avoided or reinforced were part of a series of exercises that also looked at ways of creating a welcoming environment. Finally, participants reviewed key takeaways and were encouraged to create an action plan for their workplace and provided additional resources.
What are “powerful conversations” and why are they important? This was the focus of the second preconference offering. In this hands-on workshop facilitated by Ann Moenke and Ryan Soisson of Soisson & Associates, participants embarked on a guided exploration of different modes of communication, their own communication style and assumptions, and how they might improve their ability to negotiate and manage difficult or sensitive topics at home or in the workplace.
The facilitators explained that having good communication skills can lead to better relationships with family and friends, and are especially useful in the workplace, where communication problems occur regularly.
Some numbers show how crucial it is to have good portable communication skills. According to the presenters, employers in the United States spend $359 billion of company time managing unresolved conflict; that is 2.8 hours a week for every employee (CPP GlobalHuman Capital Report 20). All of this unresolved conflict takes its toll in employee relations and morale, and can spill over into tensions with clients as well as patients.
When “strong disagreements, conflicts, and hard feedback” occur, powerful conversations are necessary to resolve emotionally charged problems in a way that is satisfactory to all involved.
These are some examples of the types of conflicts that frequently can arise:
- Mom and teenage son disagree about his smoking
- A married couple disagree about the amount of money to save for retirement
- Supervisor and employee disagree on what constitutes quality work
- Business partners disagree on which core customer group to serve
- One friend routinely feels slighted by another friend
- Supervisor wants employee to change employee’s workflow, but the employee is resistant.
Often, when these crises come up, we often avoid handling the situation for fear of making the problem worse, causing hurt feelings, harming the relationship, damaging one’s reputation, or saying the wrong thing in the wrong way. We can also be stopped by fear of displaying strong emotions, managing the negative reaction of others, or of “losing” the argument.
It is exactly such situations that can benefit from employing a technique of powerful conversations, one that is centered on resolving conflicts, finding solutions, and negotiating for optimal outcomes. The goal in these conversations should be to accomplish what is important rather than being right or winning an argument.
The facilitators demonstrated how to approach such conversations and avoid unproductive behaviors, and offered help with 3 critical points in a conversation: Preparing–Opening–Discovering. Importantly, they also advised on how not to prepare as well. Avoiding common pitfalls such as rehearsing statements, compiling arguments, or mapping rebuttals, among others, can go a long way. They also discussed using a self-assessment tool to get at what you really want from the conversation. Workshop attendees participated in several guided exercises to acquire new ways of communicating and broke into groups to practice putting those skills to use.
AYA Oncology Navigation
Megan Solinger, MHS, MA, OPN-CG, Director, Service & Care Delivery, Ulman Foundation, Baltimore, MD, and Paula Sanborn, MS, APRN, FNP-C, CPHON, ONN-CG, Sarcoma Nurse Practitioner, Nationwide Children’s Hospital, Columbus, OH, presented this general session on navigating Adolescent and Young Adult (AYA) patients with cancer. While the AYA population faces some of the same issues as other patients with cancer, in other ways, the AYA population is unique because of their particular psychosocial needs, including financial, social, mental health, and family planning issues, and related barriers to care.
The learning objectives for this session were to:
- Define the Adolescent and Young Adult (AYA) cancer population and their unique needs and challenges
- Present in tumor board format 3 case presentations of AYA diagnosis
- Describe treatment options for the AYA diagnoses in a pediatric versus adult setting
- Describe age-related developmental challenges of the AYA patient
- Understand the psychosocial support needs of the AYA patient.
More than 89,000 cancer diagnoses occur in people aged 15 to 39 every year. The most common cancer type among AYAs is female breast cancer, with an age-adjusted rate of 22.9 new cases per 100,000 female AYAs, followed by thyroid cancer (11.9 per 100,000 AYAs), and testicular cancer (11.5 per 100,000 male AYAs). The 10 most common cancers among AYAs represent about 75% of new cancers among AYAs.
For most AYA patients, this period of life is a time of transition, change, and instability. They are beginning to become more independent from their parents and other caregivers and are putting an emphasis on establishing peer and romantic relationships. In addition, they are forming their own world view and cementing a personal and sexual identity. It is also a time when education and career goals are crystalizing.
AYA patients differ from both the adult and the pediatric patient with cancer. For example, they are less likely to be treated at pediatric cancer centers and they will make more of their own decisions independently of their parents or guardians. Like the adult patient, they have more treatment options available, such as radiation, and they also have more career, fertility, and peer pressures than the pediatric patient. Finding a balance and establishing a relationship of trust is an important goal for the navigator working with these patients.
As this group is in their peak reproductive years, fertility preservation is of high concern. The cancer survival rate is increasing, and more patients will want to start or enlarge a family after their treatment. Navigators should be able to discuss frankly the need for fertility preservation and the available options.
In addition to the desire to preserve fertility, AYA patients with cancer also experience more social isolation. It is likely that they don’t know anyone in their age group with cancer and may not have the emotional vocabulary or life experience to discuss their situation. They also are more likely than children or other adults to have problems with transportation, unstable social and sexual relationships, and feelings of invincibility. Therefore, navigators who work among this population must be aware of different communication styles and use age-appropriate language. It may require involving parents and other family members in the conversation and should focus on building trust and creating for the patient a sense of empowerment.
The pressures of paying for treatment at a time when they may be transitioning off of their parents’ insurance or other types of health insurance, and when their own earning potential may be, as yet, nonexistent, suspended, or thwarted, is also a very real consideration.
Cancer Trends in the AYA Population
Clinical trial enrollment improves outcomes, and the Children’s Oncology Group has increased the age limit to 39 years for many of their clinical trials to improve AYA access to clinical trials.
“Navigators are at the forefront to help patients understand clinical trials and access to enrollment,” said Ms Sanborn.
The panel then presented detailed case histories of 3 AYA patients and discussed how their treatment was navigated. They also gave details about available resources for the AYA oncology population.