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Dr. Pate’s Prescription for Change

St. Luke’s Health System’s Journey to Transform Health Care

Pathways for Cancer Patients Ease Minds and Fears When it Comes to Urologic Treatments

Dr. Stephen Brassell meeting with his patient Bill James, during a pre-admission visit.
By Chereen Langrill, News and Community
August 29, 2017

Evidence-based medicine. Patient centeredness. Shared decision-making.

These are three of the ingredients that are helping St. Luke’s achieve better care at a lower total cost, and St. Luke’s Mountain States Tumor Institute’s urology team is helping to lead the way.

Here to tell you about how the group is putting it all together for better patient experiences and outcomes is St. Luke’s Communications Coordinator Chereen Langrill.

- David C. Pate, M.D., J.D.


Thanks to state-of-the-art treatments, patients diagnosed with bladder cancer or prostate cancer can aggressively fight those diseases.

But while treatments aim to take control over the disease, patients can feel a loss of control when they experience side effects.

The urologic oncology team at St. Luke’s Mountain States Tumor Institute helps restore dignity and a sense of control by way of patient pathways that help people better manage important aspects of their lives. The pathways also support the clinical team by giving more information to patients on the front end, cutting confusion and reducing the need for follow-up calls.

Stephen Brassell, MD

“We want to give patients more control over their treatment by providing education and support,” said Dr. Stephen Brassell, St. Luke’s urologic oncologist. “That allows them to focus on their recovery.”

Education and support before treatment and after discharge can help reduce anxiety and fear, enhance recovery and minimize hospital stays and complications, said Jacque Vanderpool, urologic oncology clinical nurse navigator.

“The goal is to promote efficiency with discharge and minimize complications,” Vanderpool said. “Patients are better prepared for the post-operative period and have a clear understanding of when to contact the staff with questions or concerns once they have been discharged home.”

The patient pathways were developed in 2012 after Vanderpool, who was new to her role, noticed a need for additional patient support. Feedback from patients, physicians and nurses helped develop the new pathways. 

Jacque Vanderpool

Setting patients up for success

Bladder cancer is the fourth-most commonly diagnosed cancer in men (it is less common in women). Treatments can include medicine for the bladder or removal of the bladder, called a cystectomy. When a cystectomy is recommended, the patient and family receive a detailed plan of care to enhance recovery and minimize stay and complications. Specific care pathways help prepare patients for surgery and treatment and can contribute to successful recovery.

A urologic nurse navigator helps guide the patient and family through decisions and treatment. Depending on the specific situation:

  • Patients who smoke are counseled on smoking cessation.
  • Patients meet with a registered dietitian to determine any nutritional deficiencies or special needs and are given advice on how to maximize healing with nutrition pre- and post-surgery.

“It is not uncommon for these patients to lose 10 to 20 pounds in the post-operative period, so this is an important step in preparing for surgery to minimize weight loss,” Vanderpool said.

In some cases, a urostomy is needed. During a urostomy, the flow of urine is diverted away from the bladder and urethra to a new, artificial opening called a stoma. After surgery, urine travels through the stoma into a urostomy pouch. Patients must learn how to care for the skin around the stoma to prevent infection. A wound ostomy and continence nurse educates and works with the patient to determine the best site for the urostomy placement to avoid possible irritation by rubbing against clothing.

“Patients are able to participate in choosing the most appropriate site, depending on multiple factors,” Vanderpool said.

An appointment is scheduled one week before surgery to ensure the patient and family have plenty of time to prepare. Patients practice wearing, emptying and changing the ostomy bag. The site for the placement is marked for the surgeon to target during the procedure.

Before the care pathway is developed, patients meet with the wound ostomy and continence nurse in the pre-operative holding area or after surgery.

“This change has enhanced patient satisfaction and provides a better learning environment for the patient and their family to have time to absorb the information and have input on important decisions,” Vanderpool said.

Support for patients with prostate cancer

According to the American Cancer Society, one in seven men will be diagnosed with prostate cancer. Other than skin cancer, prostate cancer is the most common form of cancer among men.

But there is good news: When caught early, the five-year survival rate is almost 100 percent. Helping patients navigate their journey from diagnosis through treatment and on to recovery is an important factor in that statistic.

If the prostate is removed – a prostatectomy – the patient is placed on a pathway that includes a comprehensive care plan and a prostatectomy education class taught by the urologic nurse navigator. The class, offered weekly or on an individual basis for the patient and family, helps patients understand pre- and post-operative instructions and expectations.

When a patient with prostate cancer must have a prostatectomy, it is common to be concerned about urinary incontinence and sexual dysfunction, Vanderpool said. Education helps ease those concerns; through the pathways:

  • Patients are taught pelvic floor exercises to do pre- and post-surgery and encouraged to participate in a collaborative program offered at the YMCA that enhances recovery of continence and overall strengthening.
  • Sexual dysfunction is discussed and patients are offered a penile rehabilitation plan two weeks post-prostatectomy to enhance recovery of sexual function. When necessary, they are referred to St. Luke’s Men’s Health Clinic for a comprehensive evaluation by a urologist specializing in erectile dysfunction.

“The goal is to make it easier on these patients, have them less anxious and less fearful, and also help the staff by giving patients more information,” Vanderpool said.

About The Author

Chereen Langrill works in the Communications and Marketing department at St. Luke's.