From Ashley Kliewer, PA-C, Director, Advanced Practice
The Ann B. Barshinger Cancer Institute team recently received a 2018 Penn Medicine Quality and Safety Award for “Integration of a Palliative Oncology Disease Team at the Ann B. Barshinger Cancer Institute.”
Caitlyn McNaughton, PA-C, was an integral part of the work that went into receiving the award. The team also included Emily Gehron, CRNP, and Cassie Martin, PA-C.
Caitlyn graduated from Franklin & Marshall College in 2004 and received her Master’s in Behavioral Neuroscience from Cornell University in 2006. She worked for Merck as a research scientist in pre-drug discovery, studying medications for schizophrenia for a few years before deciding to pursue more direct contact with patients. She graduated from Lock Haven University’s Physician Assistant Program in 2011. After working at Susquehanna Health Cancer Center for three years, she and her husband returned to their hometown of Lancaster, where she began in her current role with Penn Medicine Lancaster General Health Physicians Hematology & Medical Oncology. She was initially hired to provide acute symptom management for cancer patients, but her role was expanded and diversified through a series of quality improvement and research projects, leading to the invitation to co-chair the Palliative Oncology Disease Team with Shanthi Sivendran, M.D., in 2016.
The team found that even though early integration of palliative care has shown to improve quality of life and survival, and decrease aggressive care at end of life, most palliative care medicine at LG Health was delivered inpatient. In collaboration with Hospice & Community Care, a pilot medical oncology physician assistant-led primary palliative care clinic was offered five days a week, with consultant-level palliative care offered by a physician one day per week. Palliative care in both cases included an interdisciplinary team with social work and chaplaincy. The pilot offered palliative care management for patients by addressing goals of care, disease process, illness understanding and goal setting. As a result of improved access to early palliative care services, chemotherapy use at end of life decreased from 17.6 percent to 8.3 percent in two years, and hospitalizations within 30 days of death decreased from 43.6 percent to 37.7 percent in 18 months.
Because of this study, as of January 2019, patients with advanced lung cancer, advanced pancreatic cancer, bladder cancer and acute leukemia now have an automatic referral to the palliative care clinic, now staffed by palliative care physicians four days per week.
When asked what makes her relationship with her supervising physicians successful, Caitlyn said, “Physicians in our practice have a stake in our success because it drives better care for our patients. When they invest in us, the return is there.” She noted that this required adaptability and new exploration on the physician side.
Caitlyn highlighted Dr. Elizabeth Horenkamp’s investment in her APCs and driving high-quality care. Each APC dedicates a few hours per week to quality improvement projects, allowing development of a greater level of expertise and improving clinic processes. For example, Cassie Martin, PA-C, is working on immunotherapy education, and Anne Marie Calvello, PA-C, spearheads standardization of oral chemotherapy toxicity management. Additionally, while the APCs function very autonomously, they have found success with having a defined role: running a symptom management clinic, treating side effects of cancer-related treatment symptoms. Lastly, APCs are included in every level of decision-making within the practice, serve on committees, attend provider meetings and have high-functioning collaborating pods in the office.
When asked about opportunities for advanced practice, Caitlyn noted the changing health-care culture and continuously expanding medical knowledge of disease process and treatment. “While advanced practice clinicians are trained as generalists, one of the ways we can excel the most is when we narrow our focus [in a disease state or process], taking ownership in that training and becoming experts in that defined role,” she said.