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May 28, 2020

Oncology Advanced Practitioners and the COVID-19 Pandemic

By Brianna Hoffner, MSN, ANP-BC, AOCNP^®, and Wendy H. Vogel, MSN, FNP, AOCNP^®

As many US states begin the process of reopening, the past few months are put into stark relief. An unprecedented current of change has swept through our lives, and much remains uncertain. However, what has been clear during the pandemic is the perseverance, compassion, and adaptability of health-care providers during this health crisis.

In the past 8 weeks, the APSHO Advance Special COVID-19 series has highlighted oncology advanced practitioners (APs) navigating the relentless changes that the pandemic has brought. Reflecting on these past weeks, the editors consider the evolution of AP roles in patient care and contributions to further oncology advanced practice.

Disease Management

Several oncology APs shared their clinical experiences of treating various cancers during the pandemic. One of the most widely read articles was written by Donna Catamero, ANP-BC, OCN®, CCRC, and colleagues from Mount Sinai Hospital on how treatment plans for patients with myeloma were modified during the pandemic.

Cathy Featherstone, FNP, of Memorial Sloan Kettering Cancer Center, was interviewed on how to keep bone marrow transplant patients safe during the COVID-19 pandemic. Ms. Featherstone described decision-making, process, and treatment modifications required to care for immunocompromised patients. Casey Brown, DNP, RN, AGPCNP-BC, and Mary Lou Affronti, DNP, RN, MHSc, ANP, of Duke Cancer Institute, wrote on the diagnosis and management of patients with glioblastoma during the pandemic. They reviewed the relationship between steroid intake and the increased risk of needing mechanical ventilation with a COVID infection. Kathy Sharp, MSN, FNP-BC, CCD, of Ballad Health Cancer Care, examined the effect of delaying treatments with bone-modifying agents, suggesting alternative plans for patients who cannot come to the clinic.

Telehealth

Telehealth has revolutionized health-care delivery, and our discussion on it evolved as more practices got on board. First, we discussed the initial change in CMS guidelines in March, allowing Medicare to pay for office, hospital, and other visits when performed via telehealth. A team from UCHealth in Colorado discussed in a podcast episode a collective effort to operationalize more than 600 clinics in just 2 weeks for virtual health functionality. They described increased acceptance and satisfaction among both patients and providers as more visits became virtual.

In week 4 (early April), APSHO hosted a webinar with telehealth expert Jason Astrin, PA-C, MBA, DFAAPA, of The US Oncology Network, to discuss topics including billing, reimbursement, scheduling, and the future of telehealth. Hundreds of APs tuned in to hear these expert tips and ask their questions. In the same week, Beth Faiman, PhD, MSN, APRN-BC, AOCN®, FAAN, of Cleveland Clinic provided clear steps of a virtual visit, including a video demonstration of a typical telehealth video exam. She encouraged telehealth providers to spend time with their patients, ask lots of questions, and allow the patient to disconnect from the visit first.

As telehealth became more integrated into clinics in late April, Sara Toth, FNP-C, AOCNP®, AGN-BC, of Texas Oncology, discussed the variety of services that can be offered virtually, including coumadin clinics, advance care planning, and survivorship. During week 6 of this series, CMS issued further updated guidance on Medicare telehealth, waiving the video requirement for certain telephone services and adding them to the list of Medicare telehealth services.

Reflecting on this progression of dialogue on the topic of telehealth, it is evident that the evolution will continue. Providers will have to think creatively about digital patient education as more visits are conducted in this fashion. They will need to develop algorithms to determine which concerns noted during a telehealth visit will require an in-person appointment and the safest methods to allow for that to happen. APs will be required to stay abreast of the constantly evolving policies and guidelines, and the ways in which they affect practice, autonomy, billing and reimbursement. The effects of telehealth will be ubiquitous though all areas of practice as the scales have tipped indefinitely toward the inclusion of virtual healthcare.

Communication

Additionally, APs began to note some of the challenges of telehealth, including the delivery of bad news. As Deborah Rust RN, MSN, CRNP, AOCN®, described in her article on delivering difficult news, while oncology APs are accustomed to providing a hug or holding a hand while discussing upsetting findings, the ongoing nature of the viral pandemic has mandated that APs adapt to empathetically delivering this news virtually.

Self-Care

Several of our oncology AP authors wrote about the psychosocial aspects of caring for patients with cancer during the pandemic and the need for self-care. Andy Guinigundo, MSN, RN, CNP, ANP-BC, of Oncology Hematology Care, reached out to friends and colleagues for their strategies for finding a healthy balance. One oncology AP, Dwight Macero, PA-C, MS, shared his own experience of contracting COVID-19 and enrolling in a COVID-19 clinical trial. Moved by the overwhelming experiences of oncology APs, the APSHO Board of Directors filmed a special video checking in on our members.  

Key Takeaways

There are several key takeaways from the collective wisdom of this incredible group of oncology professionals:

1. This is a marathon, not a sprint
   
   
2. COVID-19 may be tough, but we are tougher
   
   
3.  Be flexible
   
   
4.  Stay up-to-date
   
   
5.  Your colleagues have some great answers to difficult questions
   
   
6.  Compassion and caring are not lost through telehealth
   
   
7.  Be kind to yourself
   

These articles and many others highlight the role of oncology APs during the pandemic, demonstrating resilience, knowledge, and passion for oncology care. Every oncology AP has continued compassionate care, even in the most trying of circumstances. Oncology APs rose during this crisis to share their knowledge and experience with their colleagues at a time when their own practices were experiencing challenges.

Although this special series is drawing to its end, APSHO will continue to support oncology advanced practitioners with education and resources to inform practice. Our webinar on the oncology phase-in process is open for registration, and for APSHO members, the forums and blog are avenues to share information and experiences.

Read more from the APSHO Advance: Special COVID-19 Series