Nurse navigator Susan Coples is the engine that drives patient-centered cancer care at the Georgia Cancer Center for Excellence at Grady Health System: in just two years, she has both influenced hospital policies and made a real difference in the lives of her patients.
Conventional wisdom perceives nurse navigators as caregivers, dedicated primarily to seeing patients safely through their cancer treatment journey. Susan Coples’ experience shows that there is so much more that happens behind closed doors. Nurse Coples joined the staff of the Georgia Cancer Center for Excellence at Grady Health System in October 2017, thanks to a grant by the Merck Foundation. In two short years, she has not only helped patients, but she also restored a lay navigation program, improved health outreach in the community, and reduced the time patients go from diagnosis to treatment by more than 30%.
Nurse Coples first realized that patients were in need of additional support before she ever considered working as a nurse navigator. As an infusion nurse and shift supervisor, she spent the majority of her 38-year career working with patients undergoing chemotherapy. Patients at this stage of their cancer journey are supposed to have finalized most treatment decisions. They should have a clear picture of what lies ahead. Nurse Coples was surprised to find that this was not always the case. As she explained: “When our patients would come to the infusion center, they still had a lot of questions, they still had information that had not quite ‘come together’ yet.” Not only did patients have questions about their diagnosis and treatment, oftentimes they were unsure of how to secure transportation to and from the cancer center and lacked access to social support. Nurse Coples often found herself advocating for her patients, working to connect them to important resources.
Given her experience, stepping into the newly created role of nurse navigator at the Georgia Cancer Center for Excellence felt like a natural fit. However, establishing a program from the ground up was no easy task. The first issue nurse Coples encountered was figuring out a way to integrate the navigation experience into the course of patient care: “You’re learning the process of working with the doctors, really making sure they understand what your role is and how you can be a helping hand to them. It’s about being available, making sure that we’re having that conversation about the new patient.” With the support of physicians at the GCCE, including Alliance Co-Program Director Dr. Roland Matthews, nurse Coples was able to build and expand her position. She soon started working with breast and gynecologic cancer patients referred to her by the GCCE, Emory University and Morehouse College.
As her position continued to expand and clinical staff started to see the benefit of working side-by-side with a nurse navigator, Susan Coples started to notice the work of a plucky group of lay navigators, the Pink Ladies. As women who had a personal experience with cancer, nurse Coples recognized that they offered an important perspective: “Culturally, we don’t really talk about family members who have breast cancer. Patients come in with tragic stories of family members who passed away soon after a diagnosis, and we need them to experience a different outlook.” Because of their lived experience, lay navigators were a perfect counterpart to her clinical role. Where she was covering appointments and medication, they were encouraging patients to fight on. Where she could share clinical guidelines on side effects, they could provide their perspective on managing symptoms.
When the lay navigation program lost its funding, nurse Coples helped develop a task force to ensure that the program could continue: “I saw the way navigators responded to the patients, how they held their hands, how they wiped their tears, how they shared their stories, how they prayed with them. It really gave us this real surge to keep that program going.” Working with Alliance Co-Program Director Dr. Sheryl Gabram, Executive Director Pooja Mishra, and Practice Administrator Darica Flood, the task force was able to secure funds to keep the program going. The Pink Ladies became regular employees of the Georgia Cancer Center for Excellence at Grady Health System and were able to expand nurse Coples’ outreach beyond the confines of the Cancer Center. They now take part in public health fairs, provide psychological support to patients undergoing treatment, and help patients schedule appointments.
Navigation work begins as soon as a physician suspects a patient may have cancer. Since data show that someone other than an oncology specialist delivers approximately 53% of cancer diagnoses, a nurse navigator may interact with a patient before a specialist sees them. Susan Coples is therefore in a position to offer unique insights on a patient’s history during departmental interdisciplinary meetings, a time when all clinical staff at the GCCE meets to discuss their patients and develop a treatment strategy. Information may be shared both ways, with physicians suggesting topics for the navigator to cover. These exchanges are essential to developing a treatment plan that looks at the whole of the patient, including factors that could limit compliance or adherence to treatment.
The issue of treatment compliance is an essential component of cancer care, and one that is often misunderstood, as nurse Coples explained: “As a nurse navigator who works primarily with women, I often meet people who spend their lives tending to everyone’s needs but their own.” In this context, the issue of treatment compliance is not an unwillingness to listen to physician’s advice, but rather an inability to conform to what can be a very onerous set of recommendations. For example, it’s not uncommon for cancer treatment to require weekly hospital visits and entail an extensive and challenging recovery. This is where the work of a navigator is crucial: by taking the time to inquire about a patient’s home life, among other issues, nurse navigators can help craft a patient-centered care plan that is responsive to all of their needs. Quality of life during treatment can have a significant influence on cancer care outcomes.
All of these issues came into focus throughout nurse Coples’ experience with her very first navigation patient – a patient she was called in to see while she was still attending her new employee orientation. In October 2017, Bobbie Jean Clay was at Grady Health System to support her husband. When she noticed a lesion on her breast, she dismissed it as a tick bite and opted not to seek medical attention, something that she mentioned in passing to her husband’s physician. From there, she was immediately referred to Alliance Co-Program Director Dr. Sheryl Gabram’s Comprehensive Breast Health Center, where Dr. Preeti Subhedar was assigned to her case. She was officially diagnosed with breast cancer on Nov. 13 2017.
After more than 40 years without seeing a physician, Ms. Clay could not come to terms with the severity of her diagnosis: “She was sticking with – it’s a tick bite. Dr. Subhedar told her that they wanted to biopsy it and make sure, but her buy-in was not there” Susan Coples recalls. She started to open up only after being introduced to the nurse navigator: “Ms. Clay took her eyes off the floor, and looked up at me, and gave me just a little glimpse of a smile. And from there on we had been connected.” In this frightful moment, Ms. Clay immediately identified nurse Coples as a source of support: “When I raised my head I saw Susan Coples standing near the door. She was silently and serenely looking toward me with compassion and concern.”
Nurse Coples encouraged her patient to develop a support network that could help her get to and from her chemotherapy appointments: “I had to learn to depend on others because I had always been the caregiver when others depended on me. Susan, with her compassion, taught me that lesson in life.” Ms. Clay was able to lean on her family and her pastor throughout her “season of sickness,” as she refers to it. They all took turns to drive the patient to and from the Georgia Cancer Center for Excellence, a process that could often take hours: “She lived an hour and a half away, and they were driving from a small town into metropolitan Atlanta, where the traffic is no joke,” nurse Coples clarifies. Throughout this first phase of her treatment, she was right there with Ms. Clay every step of the way: “I fractured my arm, I had a blood clot, I had to get blood transfusions,” Ms. Clay explains. “Susan Coples has always gone the extra mile. Her strong character exemplifies and encourages everyone to be strong and courageous, to believe and be brave. She listens intently to what we say. That is a gift.”
When it came time to schedule surgery, Ms. Clay was once again apprehensive about the process. She asked Dr. Subhedar if nurse Coples could be present during her surgery and hold her hand, and she agreed. Nurse Coples arrived at the hospital early on the day of the surgery and sat with the patient, her son, her husband, her pastor and his wife: “Ms. Clay let her guard down a little bit, got calm, we prayed, and she was able to get her surgery.” Before going under, Ms. Clay asked Susan Coples to save the stinger from her tick bite, confident the surgeon would find it. Nurse Coples smiled and assured her that this was still not the case.
In early 2019, Bobbie Jean Clay spoke to the Alliance about her experience. She attributed the success of her treatment to the Georgia Cancer Center for Excellence at Grady Health System: “Grady is my family. They tell us we are, but team Grady is the superheroes. Susan Coples is more than a nurse navigator. Nurse navigator is her title and it fits her well, but our well-being as patients is what means the most to her. We can’t ever be more appreciative or grateful for Susan Coples and Grady.” The nurse navigator left a lasting impression on the patient, and like her, many others have benefited from her dedication and compassion. The Georgia Cancer Center for Excellence at Grady Health System reports that, since Susan Coples started working as a nurse navigator, patients transition from diagnosis to treatment much faster than before. Where the average Gynecologic patient received their first cancer treatment within 55 days of diagnosis, they now only have to wait 38 days; Breast cancer patients’ waiting times have decreased from 44-48 days down to a whopping 31 days.
These impressive results did not go unnoticed; in May 2019, Grady Health System awarded nurse of the Year to Susan Coples. This important recognition allowed her to sit on a board with other nursing staff, providing input on existing hospital policy and driving change from within. Nurse Coples is quick to point out that she would not have been able to get there without the support of her organization: “I learned from Dr. Gabram, Dr. Subhedar, and Dr. Matthews. It’s all just been really enlightening to me as a nurse. Even with all the experience I have, I am still learning, I still incorporate new things into what I’ve done.”
Their encouragement allows her to rejoice in her victories and to weather difficult times: “There have been a lot of humbling moments for me as well. The workload, some days it is heavier than others, situations are heavier than others. But we come together, we really are stronger because of what we do every day. I’m just really proud of my direct manager Darica” she emphasizes, referring to GCCE Practice Administrator Darica Flood. “I feel really fortunate to be where I am today.” Her family is an important source of appreciation as well: “I’m grateful to my husband and my two children because they put up with me and at the same time they’re very supportive. I’m just grateful, I’m very very grateful.”
The Alliance to Advance Patient-Centered Cancer Care, an initiative funded by the Merck Foundation, created a video on the GCCE’s nurse navigation intervention. The full story is available here: https://youtu.be/40tD_z5h-WA.