Shared medical appointments for lifestyle counseling benefit cancer survivors

Key takeaways:

• Healthy lifestyle counseling to help cancer survivors lead a better life is crucial.
• The lifestyle medicine program provides access to personalized counseling for any patient with cancer or a history of cancer.

DENVER — Providers at Massachusetts General Hospital Cancer Center have developed a successful shared medical appointment model to deliver lifestyle medicine counseling to cancer survivors.

In a session at Lifestyle Medicine 2023, Loren N. Winters, MSN, APRN-BC, OCN, DipACLM, an oncology nurse practitioner at Massachusetts General Hospital, shared with attendees how she and her colleagues and mentors conceived of and executed the program, the lessons they’ve learned along the way and future directions.

“With the increasing number of cancer survivors, most of whom have had breast, prostate, colorectal, melanoma or gynecological cancers, it is crucial to provide healthy lifestyle counseling to help them lead a better life,” Winters said. “But barriers to making shifts in lifestyle, like age; treatment sequela such as taste changes, fatigue, anxiety and depression; and inadequate knowledge or lack of resources, exist.

“[Cancer survivors] want guidance and information about how and what to do from their oncology teams. Exercise is now considered a standard component of cancer care per the 2022 ASCO guidelines,” she continued. “These guidelines mandate the inclusion of healthy lifestyle guidance to patients undergoing cancer treatment. However, few providers feel comfortable providing lifestyle counseling.”

Through the lifestyle medicine program at Massachusetts General Hospital, any patient with cancer or a history of cancer who wants to improve their physical fitness, nutrition, quality of life or cancer prognosis has access to personalized counseling. During the first visit, the patient meets with a doctor or advanced practice provider and an oncology dietician. Following assessment, the team makes recommendations for things like physical therapy, behavioral health and sleep medicine, as well as community resources. Due to the program’s popularity, patients faced a 6-month wait for the initial visit, which led Winters and colleagues to explore the option of a shared medical appointment model.

As the COVID-19 pandemic hit in spring of 2020, the team shifted to virtual visits and began implementing shared medical appointments via Zoom. They adapted the PAVING the Path to Wellness Program developed by ACLM president, Beth Frates, MD, FACLM, DipABLM, to their patients. The PAVING program is a 12-step wellness program, initially designed for stroke survivors, that integrates the six pillars of lifestyle medicine.

The adapted program includes six visits that pair two PAVING topics per visit, including:

• exercise for wellness and recovery;
• nutrition in cancer care;
• starting and sticking with healthy habits;
• better sleep, more energy;
• stress management tips and tools; and
• making meaning: social connections and purpose.

“For each visit, we cover evidence-based education and lifestyle medicine pillar assessment, we facilitate group discussion, and we practice SMART [Specific, Measurable, Achievable, Relevant and Time-bound] goal setting,” Winters said.

Since beginning, they’ve determined that the ideal size for group visits is eight to 10 patients and 75 minutes allows enough time for check-in and patient arrival, as well as wrap-up and referrals at visit conclusion. They have also streamlined the process by using templates for letters, reminders and documentation, and they meet with their billing department to ensure compliance.

“We’ve successfully built a shared medical visit program from scratch, with incredible support from our mentors and colleagues. We learned to be more efficient during the visit by reducing the number of content slides and asking more reflective questions. This has led to increased satisfaction for all,” Winters said. “We’re interested in developing a program for cancer survivors living with advanced stage disease and we’ve received a grant to fund this pilot research.”

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