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Susan Sabo-Wagner Describes the Importance of Socio-Cultural Competence in Oncology Care


Susan Sabo-Wagner MSN, RN, OCN, executive director of clinical strategy for Oncology Consultants of Houston, Texas, explained how cultural competency allows for better care delivery to patients with cancer.

Nurse navigators and community health workers are essential for developing trust and identifying patient needs within and beyond the clinical sphere, explained Susan Sabo-Wagner MSN, RN, OCN, executive director of clinical strategy for Oncology Consultants of Houston, Texas.


Can you describe the role of nurse navigators and what they do for Oncology Consultants?

We have 2 types of staff that work within our HOPE Initiative project. There's the nurse navigators and then the community health workers. They're certified community health workers, and for the practice we call them patient advocates. We bring them on, and they work under the nurse navigators to provide holistic care from the get-go for our patients.

Our oncology patients, when they're referred to the practice, they get a call. We try to call them the day before their first appointment; if that doesn't work, then we do talk to them on the day of their first appointment. Bur community health workers reach out to the patients and do a social determinants of health survey for each patient. It's the screening tool that CMS uses that is looking at housing, food, security, childcare—all the top social needs that patients are potentially dealing with. Then they match the resources that our patients may have a need for. If it's transportation, they'll work on getting transportation matched, or whatever the case may be.

They also keep in touch with the patient throughout their treatment journey here at the practice. So, they reach out again, after the first appointment; they reach out again, before and after treatment. There are certain cadences that's built in to the programs so that they're reaching out to check in and build a rapport with the patient as a true advocate.

In Houston, we're one of the largest and most diverse cities in the US. Part of that comes with different cultures and different languages. The 3 top languages that our patients speak within our practice are Spanish, Vietnamese, and English. Our first 3 languages that we wanted to make sure that our advocates spoke were those 3 languages. One of our advocates speaks Vietnamese; 3 of tem speak Spanish; and of course, all of them do speak English. That way, we have some cultural competence, reaching out to the patients and making sure that they are not just able to do a survey, and speak to them in a language that they can understand, but really to build that trust.

There's a lot of mistrust that happens in different cultures, different populations for very different reasons, depending on whichever population it is. We find that that's one of the best ways to bridge a small gap and build some confidence and comfort for the patient coming in.

Oftentimes, we have found, and our community health workers have reported, that patients, in a lot of ways, are less worried about the cancer itself and what they're diagnosed with and more worried about the financial stuff. “How am I going to pay for it?” Or “how am I going to take off of work to even be there?” Or “who's going to take care of my kids?” Or “I don't have enough gas money to get my car to that office.” A lot of these interviews and letting them know, “we're going to provide something” or “we're going to be in touch with some resources for you” has really provided a lot of ease right from the get-go.

Not to mention, the Vietnamese population, especially the older Vietnamese population, there's a lot of trust issues to come into the office and to feel comfortable. Even though we have physicians and staff in the office that speak Vietnamese, that are Vietnamese, just getting here can sometimes be scary enough. Having someone reach out, it’s been a really good program for them.

The community health workers or patient advocates, they're in touch. They're hands-on, patient-facing, for all the socioeconomic needs. The nurse navigators that they're reporting to, they handle all the clinical needs. They also handle socioeconomic needs, as well, but if there's something like home health care or hospice or something more clinically integrated, then they're working together and collaborating together so that the clinical need is also addressed. They're handling other things that are happening with patients that are also currently within the practice, as well, that they need referrals to different, like, lymphedema clinics and things like that. Plus, they're overseeing the counseling that happens, the different programs that we have set up within the practice.

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