Oregon Surgical Wellness has teamed up with The Dartmouth Institute for Health Policy and Clinical Practice to help women in North America diagnosed with early-stage breast cancer make informed decisions about treatment options. As Lane County’s highest volume center taking care of more than 300 breast cancer patients annually, Oregon Surgical Wellness, LLC was recently selected as a learning collaborative partner by the Patient-Centered Outcomes Research Institute (PCORI) at The Dartmouth Center for Shared Decision Making. Drs. Henderson and Kollmorgen are honored to be working side by side with leading decision scientists at Dartmouth Hitchcock Medical Center. Over the next 24-month period, Oregon Surgical Wellness will be a test site; using specifically designed patient centered option grids for shared decision making. Their focus will be on helping women with early-stage breast cancer make informed choices for treatment. They are thrilled to be selected as one of only 30 collaborative partners across the Americas. Phase 1 research suggests that one of the most effective ways to improve health outcomes and increase people’s satisfaction with care is through better communication and more responsive, patient-centered decision making.
This model for care—often called shared decision-making (SDM)—has at its core a strong partnership between health care provider and patient. The Dartmouth Institute is at the forefront of patient engagement and shared decision-making research, working to develop tools to improve communication between patients and healthcare providers and strategies for integrating SDM into healthcare practice at many levels. A team of researchers at Dartmouth’s Geisel School of Medicine and The Dartmouth Institute, led by Glyn Elwyn, MD, PhD, MSc, has received a $2.1 million funding award from the PCORI to develop a shared decision-making process to help women with breast cancer choose their surgical treatment options using the SHAIR OptionGrid in three different languages (English, Spanish and Chinese) and in picture format. Their methods will soon be studied further right here in Lane County. The strategy to be implemented at 30 sites including Lane County includes four components:
An assessment of each organization’s readiness for SDM and a tailored strategy to address potential organizational barriers to implementation
Online or in-person training of clinical teams
Implementation of a paper-based text or picture version and/or a web-based interactive OptionGrid encounter decision aids
Integration of the new evidence and the SDM approach into existing clinical practice guidelines
Dartmouth’s research, as well as many other studies, support the idea that well-designed conversation aids lead to improved patient education and increased SDM, which is highly valued by patients and widely recognized by healthcare professionals as the moment of epiphany in the patient-provider relationship. Drs. Henderson and Kollmorgen feel strongly that these conversation aids be made available to all women with early-stage breast cancer on a routine basis. In keeping with their mission of being an innovation-focused organization passionate about continuous improvement, Drs. Henderson and Kollmorgen are ramping up the program called SHAIR Collaborative by training their staff and attending national webinars for participants. The team at Oregon Surgical Wellness is confident this emerging approach, unique in Lane County, will add tremendous value to the comprehensive care of their breast cancer patients. Most importantly, they feel these new tools will ensure that every patient has a voice and a choice in their care. Informed decisions result in improved patient engagement and better decisions. Better decisions in turn lead to better outcomes, an exciting new advance for our community’s breast cancer patients.
Gearing up for Docs and Ducks on October 23, 2021 (Ducks vs UCLA), we are proud sponsors of the Cascade Medical Team who was established in 2001-2002 by a group of healthcare professionals in Oregon. Their first medical mission was launched in 2002. They are just one of several medical teams, dispatched to Guatemala annually through our affiliate, HELPS International. Their teams range in size from 80-100 volunteers. They are a non-profit 501(c) 3 organization. We seek to help them achieve their mission of providing free healthcare and health education, where medical services are severely lacking along with supporting community development projects to the impoverished population in the Highlands of Guatemala. We both share the vision of providing high quality care where it’s needed most. Since their first medical mission in 2002, the Cascade Medical Team has treated over 22,700 Guatemalans!
Dandelions Flowers & Gifts in Eugene has been a family-run business for more than 40 years. Over that time, owner Shirley Lyons and her daughter Toviana Jackson have come to know their customers well, during the good times and the not-so-good times.
“We see the births, we see the deaths, we see illness, and we send flowers for those occasions,” Shirley says. “So our work is touching people’s lives during the greatest and most difficult times in their lives.”
In 2012, Shirley and Toviana were compelled to create an event that would bring awareness to breast cancer and raise money to support patients going through treatment. Borrowing a concept that has been used around the country, Bras for Cause was born: Invite people to decorate a bra, put the creations on display, and encourage the community to donate by voting for their favorites.
A PARTNERSHIP FOR HOPE
Since Bras for Cause began, proceeds raised have helped support the work of Oregon Cancer Foundation. The Foundation provides stopgap financial assistance to Lane County residents and individuals receiving cancer-related services in Lane County. That help is delivered to patients in ways it’s needed most, like gas money to get to treatment, a rent check, or money to pay a utility bill or buy groceries.
“We wanted to do something that people would be excited about, while making sure the money raised stays right here in our community,” Shirley says. “It’s important to have national cancer research, but people going through treatment have real financial needs.”
LAUGHING IN THE FACE OF CANCER
Those who participate in Bras for Cause run the gamut, from creatively inclined individuals with big hearts, to local businesses, teams, clubs and even cancer survivors themselves.
“The woman who won the Grand Prize award the first year created a bra in memory of a loved one who had recently passed away from breast cancer,” says Toviana. “For her, creating this bra was a big part of the grieving process. Her creation was truly a piece of art.”
“Cancer is a downer. It’s a serious disease affecting so many people,” Shirley says. “But this fundraiser is meant to pick people up. We invite the community to get involved.”
This is why we at OSW support BRAS for CAUSE and we hope you will support our bra made with love by our very own!
Approximately 5-10% of breast cancer cases can be linked to hereditary genetic mutations. Physicians at Oregon Surgical Wellness in Springfield are helping to identify patients who may be at a higher risk for developing breast cancer and offering them tools and information to protect themselves.
Cevia Yellin is one of those patients. Two decades ago, her family participated in a cancer risk study through the National Institutes of Health, and she learned that she carries the BRCA1 gene, the same genetic mutation that is responsible for her father, grandmother and other family members developing cancer.
“When I initially agreed to participate in the study, I was doing it to help other people,” Cevia says. “But once I found out I was a carrier of the mutation, it was suddenly all about me. I was told at one point that I have an 87% chance of developing breast cancer in my lifetime. It’s been a bit of a roller coaster emotionally.”
Identifying cancer risk
Inspired by Cevia and patients like her, breast surgeons Christine Kollmorgen and Winnie Henderson at Oregon Surgical Wellness developed and launched the first comprehensive high-risk breast clinic program in Lane County. The program allows them to screen and identify patients who may be genetically predisposed to breast cancer and offer them genetic testing and licensed counseling through a partnership with Ambry Genetics.
“If we can identify a patient’s risk, then we can develop a risk management strategy for them, which may include prophylactic surgery or more close monitoring and following. And that’s pretty empowering,” Dr. Kollmorgen says.
Patients who believe they may be genetically predisposed to cancer can request a referral to Oregon Surgical Wellness. The patient will then receive a text screening tool which enables them to answer a series of questions right from their phone and based on the algorithm of their answers to those questions, they may or may not be a candidate for genetic testing. The test is a simple blood test done in the clinic and Dr. Kollmorgen says results are typically received within three weeks.
“Once the results are back and it’s been confirmed that they carry a genetic mutation, we take care of the rest. We’ll have a post consultation with them and they have access to true genetic counselors which are rare to find in the age of telehealth. We are right there to walk them through the process and help them make decisions that are right for them to help reduce their risk of developing breast cancer.”
Dr. Henderson says approximately 80% of people diagnosed with breast cancer qualified for genetic testing, but they didn’t have it done. “If we can identify these individuals and help them prevent their breast cancer, we are going to save so many lives.”
Hidden scar breast surgery
In addition to their high-risk breast clinic program, doctors Kollmorgen and Henderson are certified hidden scar breast surgeons, which means if a patient decides to have prophylactic surgery, or if they have a type of breast cancer that makes them a good candidate for this technique, the surgeons can place the incision in a location that is hard to see so the scar is not visible when the incision heals. As a result, the patient has little to no visible reminder of the surgery or their cancer.
“Scars are a reminder of trauma,” says Dr. Henderson. “Every time a breast cancer patient sees the scar from their surgery, it is a reminder of what they went through. Not having a visible scar allows them to live their life without that reminder.”
While some people may see breast surgery scars as a symbol of beating cancer, studies show that they can significantly impact a woman’s psychological and emotional recovery and can have an impact on self-confidence, intimacy and body image.
Dr. Kollmorgen says, “What’s wonderful about the hidden scar techniques is that they can be used with mastectomy, where we’re removing the entire breast, and they can also be used in breast conservation with the goal being to hide all visible reminders of the fact that you had breast cancer.”
Supporting cancer patients in the community
Doctors Henderson and Kollmorgen have been longtime supporters of the Oregon Cancer Foundation, which provides financial and emotional support, as well as education, to cancer survivors in the community.
Displayed in the Oregon Surgical Wellness lobby is the clinic’s 2021 Bras for Cause entry, one of 16 bras created by businesses and individuals in Lane County that will be used to raise money for the foundation throughout the month pf October.
The clinic’s Bras for Cause entry is titled, “Wellness Wins,” a true testament to the staff’s desire to help support their patients’ overall wellness, not just treat their cancer.
“We truly believe that when ‘I’ becomes ‘we,’ ‘illness’ becomes ‘wellness,’ says Dr. Kollmorgen. “And overall wellness for our patients is our goal.”
Cevia says it isn’t easy knowing she’s predisposed to developing breast cancer; however, she feels empowered knowing that she has options. She’s made lifestyle changes focusing on nutrition, exercise and stress management, and she never misses her yearly screenings. Cevia underwent surgery to remove her ovaries and fallopian tubes, which significantly decreased her risk of ovarian cancer and reduced her risk of breast cancer by 50%. She is now considering having her breasts removed to further protect herself.
“Dr. Kollmorgen is coaching me and supporting me through that decision process. I feel fortunate that I have this information and that I found out. I have peace of mind knowing that I’m doing what I can to reduce my risk for cancer.”
Regardless of the profession you’re in, there’s always a way to channel your entrepreneurial spirit!
Drs. Winnie Henderson & Christine Kollmorgen shared their journey with the Eugene Springfield Area Chamber of Commerce at their Women Business Leaders Conference. Surgical specialists and now entrepreneurs gave the group a taste of their inspiration & shared their recipe for career fulfillment. The Women Business Leaders Conference is presented by Northwest Community Credit Union. Enjoy networking with dynamic women and consider attending one of their upcoming events or simply check out the Eugene Springfield Area Chamber of Commerceto see how they are helping to make our community thrive.
Up until 2021, Drs. Winnie Henderson and Chris Kollmorgen were part of a surgical specialist group, here in Lane County for many years. In their daily work, they always set their sights on providing the best in medical care. Over time, they developed a growing concern with their more tangled and bureaucratic health care delivery environment. As generalists, they performed all kinds of general surgery, but gradually, they sub specialized, developing a primary focus as breast surgical oncologists. They also noticed that their patients had become more anxious, more medically complex, and more often disadvantaged due to their social determinants of health. After years of watching this unfold, they began their journey of finding a better way. Here in their own words, they identify solutions to these intricate problems.
How can we minimize stress to our patients and promote healing while finding our interactions more rewarding? “The surgical aspect of breast oncology is often traumatic, stressful, and too rushed. To help these patients through their journey in a “minimally invasive” way, we realized soon that we needed to form a dedicated team of specialized medical assistants, a nurse navigator, data collection specialists, and evidence-based integrative care specialists. Our team approach is key to patient wellness. Our new team environment is called Oregon Surgical Wellness.
How do we track our data to ensure we offer the very best reproducible care possible to our patients? “Quality data reporting is a commonplace conversation. Payers have threatened doctors repeatedly over the last decade, claiming that they must produce quality data to receive payment. As it turns out, producing quality data is not so easy. Most independent practices and nonacademic centers, either don’t have the time or lack the financial incentives to collect data. Thankfully, we don’t have those issues. Our highly trained data collection specialists have registered over 3800 patients on breast, endocrine, hernia and general surgery national quality outcomes registries. We compare it to wearing a fit bit that tracks your physiology over time. You begin to see what works and what does not work regarding your health. The same goes for data tracking in the medical field. These registries are invaluable to us, as they help us understand our trends in care. We go this extra mile because it makes us better.
How do we support the whole patient during treatment and promote the highest quality of life for them in the future? “Personal choices are a huge part of the healthcare continuum. When a patient receives a life-threatening diagnosis, such as breast cancer, they are faced with some hard choices to make on how to treat their cancer best. Oftentimes, patients don’t have a lot of time to decide and are plunged into an overwhelming sea of information that may or may not even be pertinent to their situation. As breast surgical oncologists, it’s up to us to educate them on their choices, and it is our goal that they select not only a healthy choice but also one driven by science and sound medical data. We use a method called “patient shared decision making,” serving as a research site for the Dartmouth-Hitchcock Center for Shared Decision Making. patient’s satisfaction with their outcome is greater when they decide based on their personal needs, not the doctor’s. Most doctors stop there and leave out one of the most crucial parts; preventative care and survivorship. By the time the patient has a disease that requires surgery, the problems that promoted that disease’s manifestation have been there for quite some time.”
How do we: Maximize the healing potential before, during, and after treatment while also helping to prevent patients from getting a similar illness in the future? “Our surgical skill can only solve a portion of the bigger problem. Rather than merely “cutting things out,” how do we help our patients understand some of the things that led to the problem and offer prevention choices? Our surgical clinic will pioneer the offering of on-site integrative medical care. It was natural that we came together with Pacific Integrative Oncology due to our shared vision and goals. Drs. Dunn and Niesley focus on diet, supplements, acupuncture, and botanical medicine. This opportunity to focus on the intersection between evidence-based medicine from all angles of care is truly unique in our community. We are confident that this new venture will result in a more rewarding experience for both the patient and healer. While our primary focus will be breast surgical oncology, we have also used our model very successfully with endocrine surgery, hernia repair, robotic and general surgery. As we start the new year with a fresh perspective, we sincerely look forward to working with you and appreciate our medical community’s support.”
When faced with a surgical problem, most people are not exactly sure how to find the right surgeon. We rely on our primary caregivers, family, or friends’ recommendations to help point us in the right direction. Unfortunately, friends, family, and primary caregivers never see the inside of an operating theater. They have no way of knowing what goes on in there. What is the demeanor? What is the relationship between the surgeon and the team? Is it a friendly team environment or one that is plagued by stress and “command & control” style behaviors?
The “operating theatre” was a non-sterile theater where students and other spectators could watch surgeons perform surgery, but they are no longer in use. Thankfully, contemporary operating rooms are devoid of a theatre setting and are aseptic, giving patients and surgeons the best possible environment for a successful surgery.
We assemble our team in the operating room carefully as every person has an essential and equally important role. Our surgical team methodically plans your surgery; in fact, at least 25-30 people have “touched” your surgical plan before you even come to the facility. Then, once you’re in the operating room, we take a team approach to give you the best outcome possible. We take our team seriously, invest in their wellbeing, and appreciate the work they do for you every day because we could not perform to our highest standards if we were without them.
“The strength of our team allows us to combine our individual talents for the patient’s best outcome,” says Mitch Wagner, CTS, a surgical technician at Day Surgery at RiverBend. Born and raised on a cattle farm in central Oregon, he understands that your team’s success relies on the feeling that your coworkers are like your family. When you know and care about each other, it is easier to create synergy, which makes an operation like a dance. There is a blend of well-rehearsed and improvised moves. The result is fun to watch, and the patient’s excellent outcome is profoundly fulfilling.
Heather Bowles, RN, BSN, CNOR, and OR charge nurse at Day Surgery, says, “Our team, and what we do together in the operating room is magical. Our patients are in their most vulnerable place throughout their journey as they enter our world. They aren’t able to fight or advocate for themselves, but we are, and we do, with excellence. We unite as their voice and fight for them. For me, it’s the most rewarding part of being in the operating room.”
We, at OSW, could not be more proud of our surgical teams. They are diligent, reliable, talented, and kind. They are accountable to each other, but most importantly, our patients can count on them. They help us do our best. So when you are contemplating your surgical needs, rest assured, if you choose an Oregon Surgical Wellness Specialist, you will not just be in the hands of your well-trained surgeon; the ever essential hands that you don’t see are there for you too.
(1.) Investigating Teamwork in the Operating Room, Engaging Stakeholders and Setting the Agenda Surg. 2017;152(1):109-111
Trust is at the heart of one of our core values: Integrity. And we firmly believe that you cannot build trust without transparency.
To improve our community’s health, we must serve all people from all backgrounds. As care givers, we want this commitment to be apparent to every patient with every touch and interaction. We believe that the health and wellness of all of our patients matter, and as a medical group, it is essential that we display this belief in our actions and deeds. Along those lines, OSW is committed to the following:
As we continue to grow, we promise to create the most talented and compassionate Wellness Team possible seeking well trained, energetic and compassionate members to join our team.
We commit to being mindful of our patients’ cultural origins and identities so that every patient, no matter their background, feels heard and understood.
We promise to create dialogue around healthcare’s social determinants to encourage measurable progress that significantly impact our community’s health as a whole.
We do not and shall not discriminate on the basis of race, color, religion, gender, gender expression, age, national origin, disability, marital status, sexual orientation, military status, or political affiliation in any of our activities or operations.
If you feel that we are not living up to our promises, please have a conversation with us; we’re committed to our growth. We appreciate your patience as we learn and grow as a new practice.
