538: Dr. Lisa VanHoose: Are you Harming your Patients?


Manage episode 290318161 series 79220
โดย Karen Litzy, Dr. Karen Litzy, PT, and DPT และถูกค้นพบโดย Player FM และชุมชนของเรา -- ลิขสิทธิ์นี้เป็นของผู้เผยแพร่ ไม่ใช่ Player FM โดยมีการสตรีมเสียงโดยตรงจากเซิร์ฟเวอร์ผู้เผยแพร่ กดปุ่มติดตามเพื่อติดตามการอัพเดทใน Player FM หรือวาง URL ฟีดนี้ไปยังแอพพอดคาสท์อื่น

In this episode, Associate Professor and Program Director in the Physical Therapy Department at the University of Louisiana Monroe, Dr. Lisa VanHoose, talks about the provider role in cancer survivorship.

Today, Lisa talks about implicit provider bias, survivorship as a concept, social determinants and healthcare access, and provider trust. How can physical therapists help lessen the overload? How do you determine whether or not you’re a trustworthy provider?

Hear about the effects of cancer on co-survivors, get some advice for screening when working with cancer survivors, and learn about the disease burden on marginalised communities, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

  • The definition of cancer survivor: “You become a survivor from the time of diagnosing.”
  • “When we talk about survivorship, it really is a conversation about how well are you able to live your life.”
  • “Cancer and its treatment is one of the top causes of bankruptcy in the US.”
  • “Cancer and Alzheimer’s Disease are two chronic diseases where we’re seeing the caregivers die earlier than the survivor because of the caregiver burden.”
  • “Medical access accounts for about 20% of someone’s health outcomes.”
  • “Cancer survivors who have unmet social determinants of health are more likely to miss appointments.”
  • “If you want to know if you’re a trustworthy provider, you should probably ask.”
  • “You can condition yourself to have less bias, but you have to actively do it.”
  • “100% of physical therapists are going to see someone who had cancer or has cancer.”
  • “Everyone needs to be doing a self-assessment of where they’re at in regards to their own biases.”
  • “African American women were dying at rates 3 to 4 times higher than those of their Caucasian peers.”
  • “That difference in healthcare is avoidable if we would just stop and be intentional about the care and the way in which we deliver care to each other.”
  • “We’re one decision away from someone having a different type of cancer survivorship journey.”
  • “Although we know cancer survivors are recording these side-effects to cancer and its treatment, only about 20-30% get referred to a provider to address them.”
  • “In our quest to provide care for others, we forget to refresh and replenish ourselves.”

More about Lisa VanHoose

Dr. Lisa VanHoose is an Associate Professor and Program Director in the Physical Therapy Department at the University of Louisiana Monroe. Dr. VanHoose received her PhD in Rehabilitation Science and MPH from the University of Kansas Medical Center. She completed fellowships at the University of Arkansas Medical Sciences Donald W. Reynolds Institute on Aging and the National Institute of Heart, Lung, and Blood Institute PRIDE Summer Institute with an emphasis in Cardiovascular Genetic Epidemiology. Her Bachelor of Science in Health Science and Master of Science in Physical Therapy were completed at the University of Central Arkansas. Dr. VanHoose has practiced oncologic physical therapy since 1996. She is a Board-Certified Clinical Specialist in Oncologic Physical Therapy. As a NIH, PCORI, and industry funded researcher, Dr. VanHoose investigates socioecological models of cancer related side effects with an emphasis on minority and rural cancer survivorship. She has been an advocate for movement of all persons, including the elimination of social policies and practices that are barriers to movement friendly environments. Dr. VanHoose served as the 2012-2016 President of the Academy of Oncologic Physical Therapy of the American Physical Therapy Association. She currently provides oncology rehabilitation services through the Ujima Institute, PLLC, as the owner and service provider.

Suggested Keywords

Physiotherapy, Research, PT, Health, Therapy, Healthcare, Cancer, Oncology, Survivorship, Rehabilitation, Mental Health, Providers, Biases, Movement, Wellness,

To learn more, follow Lisa at:

Website: https://www.ujimainstitute.com

ULM - Lisa VanHoose

Facebook: Ujima Institute

Instagram: @ujima_institute

Twitter: @LisaVanHoosePT


LinkedIn: Lisa VanHoose

Subscribe to Healthy, Wealthy & Smart:

Website: https://podcast.healthywealthysmart.com

Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264

Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73

SoundCloud: https://soundcloud.com/healthywealthysmart

Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart

iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927

Read the Transcript:

Speaker 1 (00:07):

Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy.

Speaker 2 (00:35):

Hey everybody. Welcome back to the podcast. This month is all about cancer survivorship. So if you missed the episode two weeks ago with Christine Carol and Jillian's Schmidt, make sure you go back and listen to that episode. Lots of great information, especially for providers on how to treat people with cancer currently, or cancer survivors. Now today's episode is brought to you by net health and tomorrow, which is Tuesday, April 20th, net health has a three-part mini webinars series bet with best-selling author, Stacy Fitzsimmons and Kelly Castillo of net health. They'll be talking about the three T's of creating revenue ownership beyond just billing beyond just the billing department, training tools and transparency. Stacy and Kelly have over 25 years of combined experience helping private practices give the best possible care while increasing their revenue head over to net health.com/litzy. To sign up as a bonus. If you put Litzy in the comment section and show up, they've arranged for net health to buy lunch for your office.

Speaker 2 (01:44):

Once again, that's net health.com forward slash L I T Z Y. So head over and sign up now and moving on to today's episode again, following in our theme of the month, which is cancer survivorship. I'm thrilled to have on the program, Dr. Lisa van hus. She is an assistant professor and program director in the physical therapy department at the university of Louisiana Monroe, Dr. Van who's received her PhD in rehab science and MPH from the university of Kansas medical center. She completed fellowships at the university of Arkansas medical sciences, Donald W. Reynolds Institute on aging and the national Institute of heart lung and blood Institute pride summer Institute with an emphasis in cardiovascular, genetic epidemiology, her bachelor of science in health science and master of science and physical therapy were completed at the university of central Arkansas, Dr. Van, who says practiced oncologic physical therapy since 1996.

Speaker 2 (02:40):

She is a board certified clinical specialist in oncologic physical therapy as an NIH, P C O R I and industry funded researcher, Dr. Van who's investigate socioecological models of cancer related side effects with an emphasis on minority and rural cancer survivorship. She has been an advocate for movement of all persons, including the elimination of social policies and practices that are barriers to movement friendly environments. She served as a 2012 to 2016, president of the Academy of oncologic physical therapy of the APGA. She currently provides oncology rehab services through the Ujima Institute PLLC as the owner and service provider. So on today's episode, what do we talk about? Well, it's all about the provider. So in today's episode, Lisa talks about implicit provider bias, survivorship as a concept social determinants of, and the healthcare and healthcare access and provider trust. So how can physical therapists help lessen the overload? How do you determine whether or not you're a trustworthy provider we'll hear about effects of cancer on coast survivors, get some advice for screening when working with cancer survivors and learn about the disease burden on marginalized communities. So there's lots to dive in. This is a long episode but it is well worth it. I highly encourage you to listen to the very end because everything is so good and you will get so much information from Dr. Van who, so I want to thank her and thank net health and thank you for listening.

Speaker 3 (04:20):

Hey, Lisa, welcome to the podcast. I am very happy and honored to have you on, so thank you. Thank you. Hi, everyone. Super excited to be with you today. And now all this month, we are talking about cancer survivorship. This is your research. This is your wheelhouse. This is what you teach. So let's get to it. What we're going to talk about today is provider bias in that lens of cancer survivorship. So can you tell us how that works and what that is? Yes. So I think most of us are now familiar with the term implicit bias because of all the things going on in the social environment, right? So implicit bias is basically those preferences, attitudes, stereotypes that we might have towards a person or towards a specific group of people. And so when you talk about provider bias, it's that implicit bias, but it's something that is hailed by a provider that might then potentially impact have a interact with that patient or client, and even the decision-making process for that client and the research to just that it, a lot of times occurs either subconsciously or unconsciously. And so we're not even realizing how we might be negatively impacting somebody's care. And how can that provider bias affect outcomes affect treatment and affect the survivorship of these cancer

Speaker 4 (05:58):

Or patients with cancer. I don't want to say cancer patients. I want to say patients, people with cancer almost, almost, almost set it wrong.

Speaker 3 (06:09):

No worries. So when you think about provider bias so the research should just that most of us have a bias towards people that are a bigger body size or what we call obese, right? And so if you were a PT, a nurse, a physician, and you were talking with someone that is of a larger size, and they're trying to articulate to you that maybe their knees hurt, or maybe they've got, you know, some type of discomfort provider bias might make you minimize their complaint. It might make you not do a full assessment because you're like, ah, it's just related to their weight. Or you might just go, well, you know, it's part of their lived experience because they chose to be fat. And so there are things that instead of us doing the standard care, we actually will deviate from it because of our bias.

Speaker 3 (07:04):

And so where we see that happen, where that has an influence on cancer survivorship is we know that every cancer survivor will have at least one physical impairment and most of the time it's fatigue, but let's say that cancer survivors, someone who identifies as as a sexual orientation, that's not heterosexual. And you as a provider, you may believe that, you know, there's a moral or religious issue with that. So then when that person's talking to you about their fatigue, as it relates to maybe their sexual activity, or maybe just how it relates to their everyday life, you may decide consciously or unconsciously to not listen. Or you may decide that, you know what, that that's, God's answer to, you know, their, their lifestyle choice. So, sorry, y'all just, somebody is having a healthcare emergency right now.

Speaker 4 (08:06):

That's okay. Normally it's on my end because I'm right on Broadway. So there's always a siren going off. The listeners are used to it, please continue.

Speaker 3 (08:14):

So I think when we think about, you know, someone's care, we're all talking about, you know, high quality care and standardized care and trying to minimize variations. But a lot of the variations we see are related to our biases.

Speaker 4 (08:29):

And so let's talk for a minute about, so we know outcomes may be different because of this provider bias. And, you know, we are talking about cancer survivorship, but there's a difference between you're alive. You lived, you survived and the concept of survivor ship. So can you talk a little bit about that and how again, where that bias may play a role?

Speaker 3 (09:01):

Yes. So the new definition for cancer survivor is that you become a survivor from the time of diagnosis. And so often we think of that as binary, right? Are you alive or not alive? When we talk about cancer survivorship, it really is this conversation about how well are you able to live your life? Right? So regardless of the cancer diagnosis are, do you have the resources that you need to live the life that you choose at the best level that you so choose? And so when we talk about survivorship, now we want to know about all of your physical wellness. We want to know about your emotional wellness. We even talk about financial wellness because one of the side effects to cancer is financial toxicity cancer and his treatment is one of the number one causes of bankruptcy in the United States. So survivorship is really about how well are you able to live your life?

Speaker 4 (10:05):

And I would also have to assume that within that survivorship is the environment in which you're surviving. So can you talk a little bit about that as well?

Speaker 3 (10:14):

Beautifully stated. So the hot topic everywhere right now is social determinants of health. And I think that is also just as true for cancer survivors. And I also want to say their caregivers because when we talk about cancer survivorship, we want to also talk about the coast survivors, right? So a lot of times we'll focus in on the cancer survivor. But the work that we did in Arkansas, a couple of years back, we went throughout the state talking with cancer survivors and caregivers. And the thing that cancer survivors told us over and over again, was I'm more concerned about my loved one. I'm more concerned about my coast survivor because everyone's focused on me as a person with cancer, but no one is thinking about the lived experience of my of my caregiver. And I was at a conference once and they were talking about how that cancer and Alzheimer's diseases, Alzheimer's disease are two chronic diseases where we're actually seeing the caregivers die earlier than the actual survivor, right. Because of the caregiver burden. And so that's a trend that people are watching in the data. So, yeah.

Speaker 4 (11:29):

Yeah. So it's, it's more of, it's more than just the patient, it's the caregiver and it can also be their community. Do they have access to their treatments? Do they have access to the things they need to help them survive and survive? Well, if you're living perhaps in an area that you don't have access to a lot, these things might

Speaker 3 (11:54):

That also be something that can cause a bias in the provider, almost definitely. So I think you have to think about all of the social determinants of health. So in the, the literature suggests that the medical access, like the healthcare access, a counselor, about 20% of someone's health outcomes. Now we do know that your ability to get to a provider of choice is important. And we also know that people typically don't want to travel more than a 20 minute drive to get to care, but there are some areas where people are driving hours. I remember when I was in Kansas practicing, I had clients that would drive three to four hours one way to see me. And so when you think about cancer survivorship, and we know one of the number one complaints is fatigue. If you're driving three to four hours to get to therapy, then the expectation is you're going to work with a therapist for an hour, hour and a half.

Speaker 3 (12:58):

It's just not a realistic journey. So we have to figure out a way to improve access. Most definitely. We also have to think about the fact that, that it's not just can someone access care, but can they access high quality care? So there is a time and a place for generalists. I totally love my generalist, right. Shout out to you. But then there also Toms for specialists. And so there are certain geographical areas where it would be really difficult to find a specialist in cancer, be it an oncologist, be it a PTB in an OT, be it a dentist. So we have to think about those issues when we talk about healthcare access. But then you talk about the 80% and the 80% are going to be the things like what is the environment that that person with cancer has to live in.

Speaker 3 (13:50):

So like I'm here in Louisiana and Louisiana has a stretch of highway that's known as the cancer corridor, right? Because we have hundreds of production, meals and industries that have a lot of waste products. And so because of that, we see this uptake in cancer prevalence, we see a different survivorship experience for those cancer survivors because they're constantly exposed to these environmental exposures. So I think, you know, that's one thing when you think about cancer, survivorship is what is the environment in which they're living right now? We're talking to everybody about, you know, physical activity, the, the APA has just launched a physical activity campaign, but then you have to think about, okay, what, what is their green space availability? Is it safe for them to be out and walking, right? Then you have to think about how are they going to fuel that movement. So are they close to grocery stores, right? Or, you know, community gardens. So I think when we think about cancer, survivorship, healthcare is one piece, but then we also have to think about all those other determinants of health as well.

Speaker 4 (15:02):

And it's does it not seem overwhelming? I mean, gosh, to me it sounds, seems so overwhelming. So how can as providers, let's say, as physical therapists, healthcare providers, what can we do to help lessen that? What that

Speaker 3 (15:19):

Overload? Yeah. So I think if we, number one, just all can agree that we have some level of implicit bias because we're all animals. So therefore we are slightly tribal in animalistic, which means that you're naturally going to have a preference towards people who look like you or people who act like you or think like you, so you have to engineer the system to combat that. And the best way to do that is with screening tools, right? So could you introduce a screening tool that asks that client about their cultural beliefs and their lived experience? Right. so then that way you can incorporate that into their care because I was pulling up some articles that looked at the lived experience of black or African-American and Hispanic or Latino X cancer survivors. And one of the things that they talk about is the fact that their provider, who is often, you know, someone who identifies as white, doesn't really ask them about their life.

Speaker 3 (16:27):

They might give them instructions, but doesn't ask them about the context right. In which they're supposed to implement this. And they're like, that's part of the reason why I don't follow those instructions and then they get dinged for noncompliance, right. Or, or non-adherence, and they're like, that person never asked me anything about me. So could you potentially introduce that as a screen in regards to kind of getting some information about their cultural values and beliefs, and then introduce a social determinant of health screen. So then you can find out kind of what their needs are because one of the articles I pulled up was talking about how that cancer survivors who have unmet social determinants of health are more likely to miss appointments. And so how often do we all get frustrated at that patient? That's a no show. Well, have you asked them about what's going on in their life and then help to align them or connect them with some community resources, because that might be the root of a no-show right. So I would say start off with some screening.

Speaker 4 (17:37):

Yeah, that's great. And you know, we had a conversation last night on clubhouse with a group of physical therapists and it was about the female athlete, but one of things that

Speaker 2 (17:50):

Was very clear is, are we asking the right questions? And I think that completely aligns with what you just said. So what is your food security? Like, what is your home security like, right. Do you have children? And this is another one, do you have pets? But if you have, what is your responsibility in your home life? If you have a dog, if you live alone or do you have to walk this dog? We just talked about fatigue being one of the major aspects. So what if they have to walk their dog three times a day and they have physical therapy that day? Well, which one do you think is not going to happen?

Speaker 3 (18:28):

Exactly great points. You know,

Speaker 2 (18:31):

These are all great questions to ask. So it's, we're asking questions, but are we asking the right questions? And I think that was a solid point that you just made.

Speaker 3 (18:41):

I love that. Are you asking the right questions and then are you living?

Speaker 2 (18:47):

Hmm, well, even more important because like you just said, implicit bias can make us our brains be like, blah, blah, blah, blah, blah, blah, blah. Oh, were you saying something or, or, you know,

Speaker 3 (19:01):

Often someone will say something, someone will tell us what they value and then, because we don't value that we'll minimize it and that might've actually been the secret sauce to them being able to achieve their healthcare goals.

Speaker 2 (19:15):

Yeah. Yeah. Another and again, gosh, another great question that was brought up yesterday is, well, what kind of successes are you having right now? And then, like you said, that might be it, that might be the secret sauce. So if we're not tuned in, are we going to miss it?

Speaker 3 (19:33):

Great points. And then I think often as providers, we tend to ask all the questions about the negatives. And especially when you add in your provider bias your implicit bias, because we've been conditioned to think so many negative things about different subgroups. So we automatically start asking them all these questions about all of these negative things that we think should be occurring in their life. So I love this concept of saying, well, what's going well, right? What are the successes? Because then it also changes the dynamic of the relationship, because then that helps you to understand what are the things that you could leverage. Right. And expand. So I, I really think, you know, the other hat I wear y'all is I'm an educator. And so when we talk about culturally responsive pedagogy, one of the core elements is are you coming into that exchange with the student from a positive lens?

Speaker 3 (20:36):

And I think we also have to think about that as a provider. Because anytime you interact with a human, it's an exchange of energy, and if the energy I'm putting to you as negative, that's going to impact you. So I think always kind of, you know, asking, you know, what's going on. Well also thinking the best of the person that's sitting in front of you. That's one thing that I've learned from the patients that I've been able to serve is they're like, there are some days that I just have to borrow the positivity from my providers. Right. And I think we have to recognize that that some days we are, we are that, that shining star, that good vibe for another human, but that requires us to actually believe in that other human and in their experience. So you got to see that human in front of you perfectly said, of course. And that leads me to the next topic. Is, is, are you a trustworthy provider? And how do you determine that? Because is, is trust normally determined by the person in front of you? They feel you're a trustworthy provider. If you feel you, are, are you biased towards yourself? Like, yeah, I'm awesome. Right. So can you expand on that? And on that note, we'll take a quick break to hear from our sponsor and be right back

Speaker 2 (22:03):

Tomorrow, April 20th, as part of net health, three part webinars series bestselling author, Stacy Fitzsimmons, and Kelly Casio of net health. We'll be talking about the three T's of creating revenue ownership beyond just the billing department, training tools and transparency, head over to net health.com/lindsey to sign up as a bonus. If you put Lindsey in the comment section in the registration page, sign up and show up net help, we'll buy lunch for your office. Once again, that's net health.com forward slash L I T Z Y. Sign up today.

Speaker 3 (22:39):

Oh, that's a good one. So there are two dynamics that occur in the therapeutic Alliance. There is the trust that the patient or the client, or maybe their caregiving unit, the stove's on us as providers, right? So that's the gift. And I think often as providers, we feel like we're entitled to trust and you're not, it's no different than any other relationship. It is something that someone is gifting to you, if they're dressed. And then for us as providers, we have to prove to be trustworthy and trustworthy is reliable and honest, right. And authentic. And so how do you know if you're trustworthy is that patient or client is actually the judge of that. It's not you. And so the definition of trustworthy may slightly vary for different patients, right. Because they are actually the judge and the jury in that. So if you want to know if you're a trustworthy provider you should ask, or maybe it should be part of your customer satisfaction survey, but I think, you know, when you think about provider bias or even implicit bias most of us can sense when the person that we're interacting with is not being authentic.

Speaker 3 (24:03):

Right? And so your bias thing can impact your ability to be, to be perceived as trustworthy as a provider or even just as a human. And so that's why it's really important for us to do the self work, to really kind of sit with ourselves, know what our triggers are. So, you know, who is it that we have these really negative perceptions of, or thoughts about, and then really questioning that. So Eckhart totally talks a lot about watching your mind. And so my challenge to providers is even in that interaction with the client or the patient in front of you, you know, always kind of paying attention to what are the voices in your head saying, you know, as you're doing that interview, listening to that client what, what is really S what else is going on? You know, like when that patient says, you know, no, I've not been able to, you know, take my blood pressure medicine, are you like, yeah, it's probably because, you know, you're doing X, Y, and Z with your money, or, you know, you're always telling a lie, but could you say to yourself, is that true?

Speaker 3 (25:12):

Cause Bernay Brown talks a lot about asking yourself is that the story is, you know, what's the story I'm telling myself. So could you really question that and then push back on, push back on that a little bit, cause you can condition yourself to have less bias, but you have to actively do it

Speaker 4 (25:32):

And it takes work and it can be uncomfortable. Yeah.

Speaker 3 (25:35):

It takes a lot of work, takes a lot of work. Because it's easier just to believe your own little echo chamber that you've created.

Speaker 4 (25:44):

My next question is what is your advice to providers when it comes to dealing with cancer survivors? Because as I spoke about in another podcast with Kristin is a hundred percent of physical therapists are going to see someone who had cancer or has cancer, the numbers are there. So what is your advice to providers when working with this population and kind of checking themselves? Quote unquote,

Speaker 3 (26:15):

Great question. So I'm, I'm going to say, first of all, we're going to go with your statement of ask the questions. Because I have actually seen therapists, physicians care for a client and never know that they had cancer because we didn't do a complete history. Right. and so you, you want to ask people that because the data says that one in two men will have cancer in their lifetime, one in three women. So just like you said, the odds are, is that you're going to care for someone that has had cancer or currently has cancer. So ask the question, number two is ask some details about it. So now the standard is, is most cancer survivors will have, what's known as a cancer survivorship plan that outlines the details of their tumor and also the treatment of it. And that's really beneficial to you as a provider because it'll help you be able to explain maybe some of the symptoms that they're reporting and also potentially anticipate some of the symptoms that they might have in the future.

Speaker 3 (27:23):

And there are things you could do to prevent that so that they have a better survivorship journey. Then number three, just listen and listen with a beginner's eye and beginner ears. Right? So be really curious about what that person is saying. Everything doesn't have to be judged because I always remind people, there are 8 billion people on the planet, so there are 8 billion ways of doing this thing. There's no rights or wrongs. And then the fourth thing is a screen, right? Because I have to recognize as a provider that I'm going to ask the questions, I'm going to do the things that are often comfortable for me because you get in this routine. And then, because this is a human sitting in front of me and everyone is diverse. I have to have some screening so that I don't miss anything. Right. Because often my pattern is based on what I like and the things that I do with the community that I'm, you know, most accustomed to.

Speaker 3 (28:28):

And so when I'm treating someone that might be different from me and everybody's different from me, then it's always good to have a screen that way you make sure you're not missing anything. And then I would say the last thing is ask that person what is important to them because often as providers will create a whole plan of care and never really asked people to rank or prioritize, what's really important to them. We often make judgements for people and that's not our jobs as providers, we're, we're part of their team. So those would be the things that I would say to remind people love. And then, you know, I think everyone needs to kind of be doing a self assessment of where they're at in regards to their own biases. And then just getting curious about it, be okay with talking with someone who doesn't think like you or who doesn't look like you.

Speaker 4 (29:23):

Yeah. Every point. Excellent. And hopefully people were taking notes on that. And now Lisa, where can people find you if they want to learn more about you and what you're up to and what you're doing.

Speaker 3 (29:35):

Awesome. so you can typically find me at the university of Louisiana Monroe. So I am the associate I'm associate professor and program director of the physical therapy program there. Or you can find me through Jima Institute. So the Ujima Institute is a grassroots organization that we started to primarily look at ways in which we could collectively come together to address the health and wellness of black communities. Because one of the things we didn't even talk about was health disparities as it relates to minority or marginalized communities. So when you think about black and Brown cancer survivors, when you think about cancer survivors from LGBTQ communities their disease burden is significantly different than the majority group. And even things like just their mortality rates are significantly different. That was some of the work that we did early on in Kansas city where we found that, you know, African-American women were dying at rates three to four times higher than those of their more of Caucasian peers. So yeah. Of white peers.

Speaker 4 (30:47):

And is that because of lack of access, was it because of lack of belief that they were ill or what, what did you, what did your findings

Speaker 3 (30:59):

So some of it was an access issue. So when you think about where the mammography centers located also the quality of the equipment at different sister centers varies as well. I think people often don't think about that. Then also the providers. So there's often a difference in which providers are available to which subgroups then also, and this is one thing that even, I think PTs and healthcare providers should think about in general is our typical office hours, right? So we tend to do eight to five. Well, if I'm a second or third shift worker that might not work for me, or if I work in an industry where I do a 12 hour shift that may not work for me. And those are often jobs that black and Brown community members are holding down. And so the very nature of how we deliver care often introduces some inequities. And I love that Def to my favorite definition of inequities talks about how they are avoidable, right? So that difference in healthcare is actually avoidable. If we would just stop and be intentional about the care and the way in which we deliver care to each other.

Speaker 4 (32:18):

Mm gosh, it's so multifactorial. But changeable

Speaker 3 (32:25):

Very changeable. I often say we're just one decision away. We're one decision away from someone having a different type of cancer survivorship journey because for your audience, fatigue is the thing that we often talk about, but the other things are like pain. Most cancer survivors are also experiencing a high level of anxiety. And in the United States, we're actually going the opposite direction in regards to our mental health resources, right. And cancer survivors need that support. Other things that bother them are things like neuropathy and even like itching. Like I cannot tell you how many cancer survivors are like, can you just make the itching stop? And people are like, well, who is it that big of a deal, but if I have a job and if my job is customer service and my receptionist is scratching, I'm like that impacts employment. So I'm like all of these things are, are part of the cancer journey where there are things we could do to prevent that or to attenuate it, even things like weight management, there are so many parts of this cancer sequella that we could adjust address early on. The other thing that has always been really interesting to me in the data is although we know cancer survivors are reporting these side effects to cancer and it's treatment only about 20 to 30% of them actually get referred to a provider to address them. So there are a lot of people live in a life that has less quality that really, that doesn't have to be right. And to me, that's not kind that is not con no.

Speaker 4 (34:14):

So you survived then what?

Speaker 3 (34:19):

Yes. Yeah. So, yeah. Yeah. So, and especially when we know that there are clinicians and providers out there that could be helping.

Speaker 4 (34:30):

Absolutely. And you know, I think don't you think that this is such an opportunity for the world of physical therapy? You know, we can be a conduit to other providers. Yeah. So, so if they, the cancer survivor is only spending 10 minutes with the doctor, but Hey, maybe they are coming to us maybe. Well, now it's like an automatic PT referral at the time of diagnosis. At least that's what the guidelines say. Am I correct in that

Speaker 3 (34:59):

Is the preferred guidelines. So that's kind of the pre rehab standards, right? That you get that diagnosis, you get a PT a Val, so we can get some baseline data.

Speaker 4 (35:10):

Right, right. Exactly. So might we also be the person to have the time to listen? And like I said, be that conduit and that super connector to people they need. So something to think about for the PT profession, you know, it's a huge opportunity for us to expand our reach, to be helpful and to make a difference in people's lives. And that's what we're supposed to be doing anyway. I totally agree. Because early

Speaker 3 (35:38):

On in my career I went through patient navigation certification and I remember people going, why would a PTB here? But it's a great place for us to be as a, as a rehab professional and especially as movement specialists, right? Because movement is the key to life. And so if I can help a cancer survivor, figure out the resources, they need to be able to keep their movement and function. That's a game changer in regards to health and wellness, even cancer outcomes. Some of the data even suggest in regards to mortality recurrence rate. So PT might, you know, often we talk about nurse navigation, but actually having a PTs, a navigator is not a bad idea.

Speaker 4 (36:28):

Absolutely. Well, I have to say, I thoroughly enjoyed this conversation, Lisa, and as always, and last question is knowing where you are now in your life and in your career, what advice would you give to your younger self, maybe that fresh face gal right out of PT school.

Speaker 3 (36:47):

Yeah. If I could talk to her, I would tell her to put herself first. Cause I think there is a reason why that the triple aim moved to the quadruped blame, right? To include burnout of providers because often in our quest to provide care for others, we forget that we need to refresh and replenish cash sales have. That is really, really important. We take better care of the equipment in our clinics and our hospitals that we do of our providers.

Speaker 4 (37:20):

And if it's, if we can't take care of ourselves, we are the most important piece of equipment.

Speaker 3 (37:26):

Yes we are. So we are the most important piece of equipment as it. If you wanted to talk about resources and I think also in regards to, when we think about our patient you know, client interactions, cause I often ask therapists nowadays, are you causing harm to the client that you're serving because of who you are. And maybe that's because you've not done yourself care, maybe it's due to your provider bias. Maybe it's due to, you need to re upskill in regards to your clinical skills. But I think it's always good for us to ask ourselves, are we doing somebody harm and why?

Speaker 4 (38:04):

Excellent. And on that we will end. So I will thank you so much for coming on, Lisa. Thank you.

Speaker 3 (38:10):

Thank you so much for having me. It's always a blessing to be in your space.

Speaker 4 (38:15):

Thank you so much mutual mutual and everyone. Thank you so much for listening. Have a great week and stay healthy. Well, the in smart, a huge thing.

Speaker 2 (38:23):

Thank you to Dr. Lisa van who's. And of course, to our sponsor for today's episode net health, again, sign up for their webinar, which is out tomorrow, April 20th, as part of their three-part mini webinars series, bestselling author, Stacy Fitzsimmons and Kelly Casio of net health. We'll be talking about the three T's of creating revenue ownership beyond just the billing department, training tools and transparency, head over to net health.com/lessee to sign up. And remember if you put Litzy in the registration page, sign up and show up net health. We'll buy lunch for your office once again. That's net health.com forward slash L I T.

Speaker 1 (38:59):

Why thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.

491 ตอน