and direct face-to-face communication among providers. Additional communication takes place during weekly team meetings and monthly meetings with community partners. A designated community health program manager creates linkages between the cancer center and community groups. The center has integrated, on-site relationships with The Wellness Community, the American Cancer Society (ACS), San Diego Hospice, and ACS’s Cancer Navigator Program, among others. Patients and families receive help in illness self-management through an individualized orientation program designed to empower, inform, and guide them through treatment. A centrally located Patient and Family Education Center staffed by trained volunteers (most of whom are cancer survivors) offers computers with guided navigation to sources of information and services; information in print and video form; and donated items such as blankets, pillows, hats, and wigs. A Patient Advisory Council chaired by a family caregiver also meets monthly and makes specific recommendations to center leadership. For example, the council reviewed the center’s physical plant before the center opened, and reviews all marketing materials, website designs, and patient education materials.

Follow-up on the receipt of needed services, their effectiveness, and the need for any changes occurs in multiple ways. Rescreening of each patient takes place whenever there is a change in treatment (unless the person was screened within the past 30 days) or every 2 months, whichever comes first. Program evaluation also takes place on a quarterly basis when a random chart audit is performed.

The program staff includes eight social workers, one psychologist, one psychology fellow, a part-time psychiatrist, one community outreach manager, and many students. Social workers are funded with “hard money” as part of the center’s ongoing personnel budget. Although the psychologist bills for services provided, complete reimbursement often does not occur because of low payment rates and failure to receive any reimbursement when the provider is outside the network of some third-party insurers (see Chapter 6 for a discussion of this issue). Funding for the psychosocial program comes from philanthropy, the cancer center itself, clinical fees, shared programs with community groups, and grants. The director of the program spends substantial time fundraising for an endowed foundation to cover the costs of nonreimbursed services.

As a result of this year-and-a-half-old program, the center’s scores on its annual Press-Ganey Oncology Outpatient patient satisfaction survey have tripled. The director identifies two characteristics of the program as key to its success: (1) the collocation and integration of its services with biomedical cancer care; and (2) its active alliances with community organizations (e.g., the center implements programs for The Wellness Community at the



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