Working In Oncology
Working In Oncology

Episode · 1 year ago

The Quest to Standardize Oral Chemotherapy Care with Julianne Darling


“Technology moves too quickly not to use it.” — Julianne Darling

It’s an age-old question in healthcare: How can we standardize a superior quality of care — no matter who’s being treated or where they’re being treated?

In this episode of Working in Oncology, we look at this question through a more granular lens: oral chemotherapy.

We’re joined by Julianne Darling, Manager of Clinical Initiatives at NCODA - National Community Oncology Dispensing Association.

We discuss Julianne’s career transition from impacting patient care on a local level to a national level, and how NCODA works to improve care quality and education for oral oncology patients as well as their providers.

This is a must-watch (or listen!) for anyone in the oral chemotherapy space. It’s loaded with tips, tools, and free resources to help you optimize and streamline care management and patient communication.

Here are the show highlights:

- NCODA’s positive quality intervention (PQI) initiative and first-of-its-kind oral chemotherapy education material (5:03)

- Julianne’s transition from direct patient care to operationalizing on a “bigger picture” level (8:36)

- How you can get your free oral chemotherapy education (OCE) patient handouts and more (14:00)

- Slow down! And more tips and best practices for communicating with patients (18:41)

- How COVID has changed the way Julianne communicates with patients (22:32)

- One thing you can change right now to improve your patient communications (28:56)

And check out these resources we mentioned during the podcast:

- Julianne’s LinkedIn profile

- Julianne’s email address

- NCODA’s website

- BioPlus’ website

- NCODA Positive Quality Interventions

- Oral Chemo Ed Sheets (website)

- HOPA’s website

- ONS’ website

- ASCO’s website

Stay connected with Working in Oncology on Apple Podcasts, Spotify, or our podcast website.

Listening on a desktop and can’t see the links? Just search for Working in Oncology in your favorite podcast player.

You're listening to working in oncology, a podcast and video show that spotlights oncology practice staff and industry influencers who work behind the scenes to shape the future of oncology. The more knowledge the oncology community shares with each other, the more we all grow. Let's get into the show. Welcome to working in oncology. I'm your cohost for the day, Alisaya Evans, and I'm joined here by Juliette Darling, Oncology Pharmacists and manager of clinical initiatives at Ed Cooda. Okay, guys, hi, thank you so much for joining me today. So today we're going to talk a little bit more about how you, as a member of the practice staff, can get in the know about oral chemo therapy treatments. But before we get started, Juliet can you tell me a little bit more about yourself? Sure, of course. First, I just appreciate the opportunity to talk to you guys today. This is it's my first podcast, so this is exciting. I am originally from Rock Hill, South Carolina, which is considered a suburb of Charlotte, North Carolina. I went to Undergrad and pharmacy school at the University of South Carolina, the College of Pharmacy there, which I considered to be the real USC but my California friends would would gets agree. So if I call it USC, just no, I'm talking about the University of South Carolina. During Pharmacy School, I you know, I started out thinking there were no way I would ever do a residency or additional training. You know, I was kind of in it for the short term and thought I would graduate and kind of get started right away. But I kind of decided during my fourth year of Pharmacy School that I really did love ambulatory care and I loved oncology and and that the next best step for me would be to pursue a pharmacy residency. So I did a year of General Pharmacy, or the for a pgo one, at the Greenville Health System in Greenville, South Carolina, which is now considered to be part of PARISMA health, and during that time I kind of drilled down on on what exactly I liked within pharmacy practice and and just decided that I loved the oncology field and that the challenges that presented for the patients and also for the for the provaders and and the role I could potentially play in helping and so I went on to do an oncology PGUATO with the University of Georgia down in Augusta, Georgia, kind of in conjunction with Augusta University health. After that, I I still kind of to this day don't know what possessed me to take the risk to move to Indianapolis where I knew no one, but I kind of interviewed all over and just really liked the people at I you health and and really liked the job opportunity here they were. They were looking for kind of a solely outpatient oncology pharmacists to help with their oral chemotherapy management program and it kind of just checked all the boxes. So I moved to Indianapolis shortly after residency graduation and have been here ever since. It's been about five years now, so about probably three or four years longer than I expected to be in the Midwest, but it's been a great opportunity and recently actually kind of took on a new challenge and a new role within CODA. I'm one of their managers of clinical initiatives and so kind of went from affecting change and impacting patient care on a local level to trying to do it on a national level, and so that's been both exciting and daunting at the same time. I can't imagine that's a big difference. Yeah, yeah, so I understand it. Encoda, you are concentrating or you're focused on clinical initiatives and educating patients and providers on oral chemotherapy treatments. Yeah, so Incoda kind of initially ...

...started with a focus on oral chemotherapy and that's when I got involved with them, probably now, about four years ago, and I really loved what they were doing to try to impact the quality of patient care and sort of the standardization of how we manage oral on Kolitic therapy and and how we kind of ensure that a page shient, you know, in a rural area gets the same care as somebody seeing a specialist, you know, in a more urban area. And so and they do that a number of ways. You know, I got involved early on with their positive quality intervention or Pqi Initiative, and that is just a concise kind of document that goes over each oral ankalitic therapy and what provider you know, the quick and dirty about what providers need to know to share with their patients and also to manage those patients. So I've loved that. They also partner with a couple other organizations, hope OS and a triple C, to produce oral chemotherapy education material, and so this is kind of the the first, I would say the first education material. It's time of its kind where it's kind of an innerdisciplinary approach to what patients need to know. So these documents have input from pharmacists, from nursing, some of them from physician staff, so kind of all across the board. You know, what does someone need to know about this treatment? And we've kind of over the last I would say year to really broadened to include IV therapy as well. You know, the need initially was in oral ankalitic therapy because it's just, I wouldn't call it new anymore, but constantly evolving and definitely not as standardized as IV therapies. But where the education piece and the quality piece is concerned, we need to focus on that for IV therapy to so encode is doing a lot with that. You know, we have some initiatives were focusing on with adherents, with care plan implementation. So how are you streamlining? You know, the Care Plane Requirement specifically to oral chemotherapy management and you know, it's just a constantly evolving role. So it's a good fit for me so far and I've really enjoyed it. Sounds wonderful. So you've taken, it sounds like, input from different stakeholders to create these documents and create these processes to educate providers on these new drugs and then so they can pass on that knowledge to their patients. Yeah, yeah, exactly. The oral chemotherapy education or OCE handouts, those are specifically developed to provide to patients and say that's, you know, it's too kind of a concise and patient friendly document to give to a patient or caregiver. The positive quality interventions or Pek eyes, those are geared towards your providers and your you know, whether that's your physician or your advanced practice provader. It's geared towards making sure that each patient that is started on a certain treatment, you know, fallows the same steps and and and has the same management, whether that's dosaing or labs or adverse event management. Each Pqu as a little bit different in its focus, but the goal is to make sure that that each patient receives, you know, the same the same level of care excellence. So prevatient and provider focused and fashion. Yeah, trying to we're trying to cover education from all from all aspects at which is, of course, that's what we need. And so you've worked on the pharmacy side and also you're providing education materials or create helping to create educational materials. Can you tell me a little bit more about that transition for you? Sure? Yeah, so I might role... I you health was direct patient care. So I was in my office, was in clinic. The providers would kind of grab me, you know, and they had a question about world chemotherapy, whether it was related to access and financial assistance, which we have to give a shout out to our pharmacy technicians. We had an awesome team of pharmacy text that that worked on that. So Kelly's immerment and Kevin Walker, if you guys are listening, you guys are, you know, just the best. But in clinic, you know, if a patient, if a patient showed up and had questions about how they were going to get a drug or, you know, how they were going to pay for a drug or needed, you know, more robust education and surrounding that therapy. You know, that's kind of where where I came in, or where our team came in, and so I did that for four and a half years. Over that time, our oral chemotherapy management process changed drastically. I mean we went from Hey, you know, I'm almost embarrassed to say it, a fully paper system to, you know, fully and integrated electronic process. So our team at I you used cerner and we had a platform called theragy to kind of help us with the patient management piece, and so we kind of implemented that process to meet copy standards and to also meet Urac standards to just again kind of stream on that process and make sure we were checking all the boxes. And we went from managing you know, I would say hundred to two hundred patients to, you know, when I left it was probably somewhere between four hundred and five hundred plus. You know, I'm not sure what they're what they're at today, but you know, we really tried to work on getting that process as thorough and and as patient friendly as possible and once we kind of got to a point where where that process was efficient and kind of a best practice, we felt, you know, I kind of got anty for the next challenge and so I think I'm kind of always looking for those things that can improve and how we improve them. And not to say the process was perfect, but we had gotten to a point that I was comfortable with and that I was proud of and that our providers really appreciated, and so then I kind of started looking for something else and so this transition has been you know, it's very different than what I was doing. Now it's more project management, not any direct patient care. Fortunately I still have patients that that text and call me, so I haven't completely completely lost touch, but you know, it's definitely focusing on larger processes and bigger picture things than the than the sort of granular local level. So I would say I'm still adjusting. You know, I've only been in this role for two months, but so far, you know, it's exciting to see what encode is looking or working on and looking to the future and thinking about yes, it sounds like as we moved towards more standardized care or we're standardized education for patients and providers, it's really going to help our patients get the best outcome, because whether you're in a rule setting or an urban setting, everyone's going to have access to all of the the best practice information. Right, right. Yeah, we would. We would hope that kind of been doing what we're doing between, you know, the OCE handouts for education, the the Pquis for quality practice, and then, you know there's another another arm, that's our treatment support gets where if patients get all three or, you know, the providers are kind of providing all three or following some of those steps, then you know, we know their outcomes are going to be improved because, you know, otherwise it's a little bit disjointed. Every practice is doing things a little bit different, every provider within each practice is doing things a little bit different. You know, every product is different, so what industry is supplying is different for each for each...

...product, the treatment, you know, any sort of education or adverse event management or, you know, initial starter kit is different across the board, depending on the the farm of company and the product itself. And so we're yeah, we're working to just try to stream on that and try to provide as much as we can to ensure that that each patient has what they need from the beginning. So, as a practice staff, as a person in the pack of that. How can they get access to this information? Yeah, so some of it is available without any sort of fire wall or password or anything like that. The oce sheets are available online, complementary, so anybody can access them. It's oral Chemo Ed Sheetscom and it has each oral chemotherapy agent. You can just click on it and download it and print it off and it's even editable. So if you wanted to add in some of your information for the patient, that's kind of what I would do in my practice. US make sure my telephone numbers on there and that kind of thing. Hence the text message is system, which are wonderful. I know I enjoy that. The positive quality interventions, as well as treatment support kits and some other tools and resources are available to encode a members and code of membership is complementary. So if you go to our website and Code Dot Org, you can register. If you are a healthcare provider and somebody involved in in patient care, that accesses is again complementary. So you can find all of that on our website under our initiatives tab and we offer that complementary because it's the right thing to do. You know, we don't want there to be yet another right limiting step to providing quality patient care, another barrier to care. Yeah, so anyone anywhere can access this. I'll be sure to include the website addresses some links in the show descriptions today. Thank you. So we are all overwhelmed with everyday work and don't really have time to hunt down information often. Do you think we should check in, maybe log in to the website and see if there's more information or something new that we should know about? Yeah, I think I think that's a it's a loaded question that all people in oncology struggle with, including myself. When I was in clinical practice I had alert set up from some of the prominent journals and pharmacuit organizations that would send out notifications when something was new. So I found that incredibly valuable. So groups like hope and Os and Encoda all provide some of that information and and usually it's on a on a weekly or maybe bi weekly basis, and so that helped me stay on top of things. I mean, it's largely very dependent on what your role is. So, you know, if you're in a very sub specialized position, you may just need to check in on you know, guideline updates and and that type of thing every month or two, you know, because if you're in a subspecialized role, you're going to be probably pretty privy to whatever new thing comes up pretty quickly, but if you're in a generalized role or kind of a role like mind, where you're looking at all or on politics or all IV therapies across all disease states, it can get overwhelming quickly. So I would yeah, I would highly recommend becoming a member of whatever organization you know fits your needs, because most of them do provide member updates regularly and I find those to be valuable just to skim them and make sure there's nothing that pertains to me or that I need to read further into. Got It. So maybe we can use technology to pitt a take over, that replace that leg work. Sign up for a newsletter is and that set alerts. Yep, I think we have... use technology. I think it moves to too quickly not to absolutely so. From your time in in practice or direct patient care, do you have Eddie tips or best practices around communicating with patients about their medications? Yeah, I mean so, patient education is something I'm very passionate about. I think it's how I ended up in this role with encode. In the first place, we have to slow down. I think that's the first step, really trying to slow down and empathize with what that single patient is is dealing with and going through. I think people that work in oncology can often get, you know, somewhat used to talking about these topics and and that it's just our normal day to day life, but but to this patient it is new and it's something that they're not familiar with, and so I would say the first step to any quality patient education is stopping the other things that you're doing and and stopping, you know, yourself from thinking about, you know, what you need to get done before the day is over, and really focus on what do you need to tell this patient here in the next half hour and really try to to ensure that they aren't perceiving you to be rushed or to be distracted and that you are they are for them and you make that clear, whether that's, you know, a telemedicine visit, whether it's over the phone, or whether it's in person. I think you can always make sure that they know you are focused on them and there for them, and so that's the first step. I mean, otherwise I would make sure you are using a great resource that ensures you cover all the bases from, you know, drug name and dosing all the way to, you know, common adverse events and how they manage them. And again, I would obviously be an advocate for the oosee sheets, but even if you're using something that is, say, homegrown to your institution, you know, just making sure that you have a guideline and mentally know exactly what you need to cover and that it's the same, you know, for every patient. Think if you get if you get into habit, into the habit of winging it, you're going to miss something, no matter how long you've been doing it. So ensuring that you have a good a good resource to utilize. And then I think making sure that they have follow up contact information is one of the most crucial pieces. I mean, because that patient, no matter how bright they are or what their profession is or how many family members they have there with them, it's overwhelming to be educated on some of these things and to hear all of this at once. So making sure that they have all the appropriate contact numbers and emails and whatever method they can reach you, you know, after the fact. I think really allows for better care moving forward. Absolutely, and are there any test practices outlined in the end coode of materials? So maybe a guide to POCKETBOOK OR POCKET GUY? Yeah, yeah, I'm glad you ask that. So there's a couple things I would reference. In CODA partnered with ASCO, the American Society of Corna Oncology, to create a best practice standard for medically integrated dispensing. So I would certainly reference that. If you are in a dispensing pharmacy and if you're somebody that is really involved with oral chemotherapy, whether it's a provider or nurse, a pharmacist, you know social work, I would I would refer you to those standards and on a on a drug specific level, I would I would make sure to refer you to the positive quality interventions. I think whether you are a provider and clinic or whether you're a pharmacy technician calling a patient to follow up on something, I think those documents are a very useful kind of quick reference for whatever drug...'re you're looking at. God at all of these are provided complimentary on the website. Is that included? And yes, Yep. Yeah, and the Encoda and ask O godlins. I believe those are on our website and not exactly positive. We're on our website. They are, but you can just google those. They are. Are on the ASCO website as well. God, I will research that. I'll make sure. We have all make things easy. Awesome, deerful. So we have talked quite a bit about patient education and that has changed a little bit due to covid. We're communicating with our patients a little bit differently. Can you speak to any changes that you have experience in the last year? I see you're working from home. Yeah, yeah, I mean I so much change in the last year, I mean both personally and professionally. I would say from a patient education and management standpoint. We, you know, unfortunately did have to change some treatment schedules and change some follow up appointments, especially during that first initial wave where everybody was kind of winging it and figure and things out kind of as we as we went. You know, there were certainly patients that I think oral therapy came into play a little bit more than IV therapy because, you know, oral you can do at home and IV they didn't have to come back for. So a good example of that is we we switched some of our full Fox patients to KBOX and and tried to turn down on how many infusions they were getting and how much they had to be in clinic. And so that was kind of a wild time. I think every every physician and pharmacist and nurse was kind of at a different level of comfort hurt, and then every patient was at a different level of comfort. So it was very, very, you know, patient specific interactions and and provider specific decisionmaking. As time went on, things got much more streamlined. You know, I think we were able to you health had a committee that was sort of dictating some of the things that needed to happen as far as tell a medicine and and you know, who comes on site versus who doesn't. And and from a pharmacy standpoint, we were obviously doing a lot more education and follow up over the phone. And so there's there's pros and cons to that. You know, there it's, from a time management standpoint, a lot easier to call somebody than to block off time, you know, to go make sure you're seeing them in clinic. But from a impact standpoint and and ensuring that the patient is paying attention and actually taking in what you're telling them. It's harder over the phone. So I yeah, I would say that was kind of a double edged sword. It's hard to say whether or not that was actually a positive thing or whether it was a negative thing. I think in years to come we'll have a lot more data about how covid has impacted cancer care and and oncology outcomes, which I'll be interested in. I think we already have a little bit of that in showing that patients are presenting with, you know, more widespread disease because they put off screening or they put off coming in initial so that's heartbreaking. But yeah, I mean a lot of working from home and a lot of phone calls, a lot of zoom, so we've gotten used to, you know, the zoom outfit, which you know right now I'm guilty of having a chance but looking fashional on top. So yeah, I mean, you know, it's changed a lot about about life and about cancer care, but not all that has been bad. So you're thinking that my imagine that we'd have a bigger spread because we can do tell health, so people who are more moral might be able to have access where they could it before they couldn't drive in it. You know it's right draw yeah, but you think that maybe because there's not that facetoface interaction, while we may be able to do more visits, the impact of each visit is diminished... not being facetoface. Yeah, I think we need to find a hybrid right. I think once all of this is hopefully a thing of the past, it would be great to continue to use till in medicine and to continue to utilize phone calls and phone visits to try to cut down on some of that travel and to try to extend our reach, like you said, but I think there's still has to be certain time points where it's in person, because otherwise I think there are definitely going to be patients that maybe aren't paying as close of the tension or there's something lost in translation over the phone or something missed, whereas maybe it wouldn't have been in person. I think that's true for the physicians ought as well. You know, talking to somebody over the phone or seeing them on camera, you can, you know, get some information and it's probably enough for one visit here and there, but you really want to be able to do the physical exam and to make sure they're listening to you when you're going over things and you know that they can consent to what is happening. So I think, yeah, I think we'll have to find a hybrid. Absolutely, and I can't wait to see those studies. Yeah, see, what did the number say? Yeah, I think it's going to be eye opening, but that's just a hunch. So you had given us so much great informations that's available, widely, accessible and complimentary. But sometimes, you know, we do get overwhelmed. HMM. What do you think is one thing that we can change today or add to our routine to improve our patient communications? WHOO, one thing to add our routine? One, one change, one change. I think the easiest and quickest thing to change is is just your your personal mindset and your personal focus. So again, I mean I said this earlier, but really it matter how overwhelmed you are or how overwhelmed the patient may seem. You know, slow down and really focus on that next to twenty minute interaction. I had a good friend of them on a long time ago. I was I was going through, you know, just a very stressful Tom and and she said, you know, love joy and you don't need to be focused on three weeks from now or even three hours from now. Focus on what's right in front of you. Focus on the next twenty minutes. You can do anything for twenty minutes, and so I've really taken that to heart. And you know, if there is something that seems overwhelming or there's a patient that you know you need to go see but you are in the middle of a different project, that's okay. You know, just focus on what needs to be done for the next twenty minutes and and that's all you can really do. Week there's a lot that we can't control, especially in oncology. So yeah, I mean I think the one thing we probably can change is our individual approach and how present we are with that patient. Excellent, I love it. If it reminds me of frozen, to a Disney person and there's a song, it's just do the next right thing. Yep, to trade on the challenge in front of you and then when you're done with that task, concentrate on the next challenge in front of you. Exactly. I think that resonates loudly with oncology care. If you get bogged down with with what needs to be done and what large process needs to be improved and and you lose sight of what you can be doing right now. You know that's a disservice to everybody. I appreciate it. Appreciate your insight, Julie, and thank you so much. This has been a great conversation. For any of our listeners who want to reach out to you for any follow up questions or just to stay in touch, how should they do that? Yeah, I'm available via email. It's Joyan dot darling at Encoda dot work, so pretty straightforward there. And I'm also on Linkedin and all the social media platforms, so just... me down. I'd be happy to answer any questions us and I'll be sure to include all of the links that we talked about today. Thank you for sharing your insights. We really appreciate you being a guest on the show. Yeah, thanks for having me. Are You satisfied with your patients currency to therapy, or are you just settling? You can improve patient outcomes with bioplus specialty pharmacies power of to the first ever two hour, two day to gather promise. It's faster and easier for you and your patients to learn more. Visit bioplus R xcom you've been listening to working in oncology. To ensure that you never miss an episode, subscribe to the show in your favorite podcast player. If you're listening in Apple Podcast, we'd love for you to leave a quick rating of the show, just to have the number of stars you get the podcast deserves. Thank you so much for listening. Until next time,.

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