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.
In order to accomplish all her activities in a given week, Dr. Winnie Henderson seems to defy the laws of time and space.
Henderson, a surgeon with Northwest Surgical Specialists, serves on local boards, fundraises for charities, participates in surgeon registries, and travels on volunteer missions to donate her surgical skills. When asked how she makes time for it all, she laughs.
“You have to find the time if you’re passionate about things,” she answers, “so I do.” Also, she concedes, “I have lots of energy.”
Earlier in her career, Henderson earned a bachelor’s degree in chemistry, a master’s degree in biochemistry, and a Ph.D. in molecular microbiology and immunology. She spent seven years conducting scientific research, but ultimately decided to become a surgeon, graduating from medical school at OHSU in 2004.
Henderson, her husband, Bill, and their two sons have lived in the Eugene area for about eight years. Henderson says she feels lucky to be a part of the Lane County community, and she believes in giving back.
“I love doing what I do,” she shares. “I just came back from a surgery where I removed cancer from someone – it’s just a wonderful thing that I get to do.”
Henderson leans over her computer screen as she brings up consented images of breast cancer patients, eager to talk about her work as an oncoplastic breast surgeon.
Oncoplastic surgery, she explains, is a state-of-the-art surgical technique that not only removes cancer from the breast but also reconstructs the breast tissue to restore natural appearance after a surgical procedure.
Pointing at an image of a reconstructed breast, Henderson describes how the patient received hidden incision surgery, with cuts made in such a way that it’s difficult to tell which breast had been operated on.
“A lot of breast cancer patients ask me, ‘How am I going to look?'” Henderson says. “So I feel this is very important. It’s like an art to us, to make people whole again.”
Because cancer plays such a big role in her work as a surgeon, Henderson is a board member of the Oregon Cancer Foundation, a local nonprofit that provides assistance to community members receiving cancer-related services in Lane County.
Henderson also sits on the board of the Oregon Cancer Alliance (OCA), a team of cancer specialists from a variety of practices who collaborate to provide coordinated care for patients. Cancer treatment requires a multidisciplinary approach, Henderson says.
Radiologists, pathologists, surgeons, oncologists, and other specialists all play a role in addressing cancer. The OCA simplifies this complex process and makes sure that all providers involved in a patient’s cancer treatment are working together effectively.
Patient navigators guide patients through the steps of cancer treatment, connecting them with the resources they need to access care.
“Lane County has a culture of independent specialty care,” Henderson explains. “Even though we are all working in individual practices, we want to come together to care for a patient and treat that patient’s disease.”
In 2015, Henderson became an OCA board member after Dr. Robert Schauer, also a breast surgeon and a mentor of Henderson’s, retired and recommended her for the position.
“Since then, we have built a lot of momentum launching the different disease branches of the Oregon Cancer Alliance,” Henderson says.
Currently, the OCA has a breast cancer team and a gastrointestinal cancer team, and Henderson says that the alliance is now working to form a team for lung cancer and gynecological cancer.
While Henderson works with cancer specialists on a local level, she also contributes on a national level by participating in the Mastery of Breast Surgery program, run by the American Society of Breast Surgeons. The registry keeps track of surgical data from participating surgeons all over the country.
Like any good scientist, Henderson has a passion for data. She brings up her statistics on the Mastery of Breast Surgery website, which displays how her percentages compare to those of other surgeons participating in the registry. Not only can she quickly see her own data on re-excision rates and rates of infection, but she can look at the national averages on those metrics.
Henderson has close to 700 patients in the registry, and within the last year, she has started collecting survey data from her patients. The survey answers contain revealing information that helps Henderson see patterns in her work.
For example, mastectomies are usually outpatient procedures. In her survey, Henderson asks patients if their pain is controlled post-surgery. According to her survey results, patients are controlling their pain well at home.
“That suggests we’re doing the right thing,” Henderson says. “They can rest at home and not be in the hospital where they risk contracting bacterial infections.”
Besides the breast surgery registry, Henderson also participates in the Americas Hernia Society Quality Collaborative, a similar registry for hernia surgeries. Northwest Surgical Specialists is one of three practices in Oregon that participates in this registry.
Henderson admits that contributing to the registries takes time, but she credits her clinical assistants and summer interns with assisting in data entry. Ultimately, she says, she wants to see more surgeons in Lane County start recording their surgical data through online registries.
“By doing this and getting the word out there, what I’m really striving for is to bring the standard up in the entire community,” she says. “If I’m able to bring the standard up, my loved ones don’t need to go out of town to have surgery. For me, I see it as challenging the community to keep up with the latest information and improve quality.”
When Henderson says she likes to give back, she doesn’t just mean locally. Every other year, Henderson joins the Cascade Medical Team on a mission trip to Guatemala. More than 24,000 Guatemalans have received help from Cascade Medical Team, which does everything from providing surgeries to installing fuel-efficient, smoke-reducing stoves.
Henderson excitedly shares the numbers from her most recent trip to Guatemala – 110 volunteers, 150 cooking stoves, 1,185 patients treated, and 118 surgeries performed (with 23 of those performed by Henderson).
She pulls up a slideshow of the trip and points at the screen. “That’s my husband,” she says with a grin. “He was part of the stove team. He’s wonderful.”
It took eight hours to reach the abandoned hospital where the team worked for about a week. Since the water there isn’t potable, the team brought in their own cooks, and all drinking water came from bottles, which made tooth-brushing a “very strategic” endeavor, Henderson laughs.
While there, Henderson treated a woman with an umbilical hernia, a girl with a tumor, a woman with a clogged milk duct, a girl with a lump above her eye, and a man with an inguinal hernia.
“It’s a lot of hard work,” Henderson says, “but we also have so much fun.”
In a video made by one the volunteers, team members can be seen dancing and hamming it up for the camera, keeping everyone in high spirits. All labor is donated by volunteers, but Cascade Medical Team uses $80,000 in medical supplies and $30,000 for the stoves. The team’s main fundraiser is called “Docs & Ducks,” which takes place this year on October 14 at Autzen Stadium.
Henderson usually goes on the mission trip every other year, but she had a special reason to sign up for next year’s trip.
“My 19-year-old son wants to go on his first trip, so I just filled out my application for next year,” she says. “He plans to go into medicine also.”
“But,” she adds with a laugh, “he has to go to medical school first!”
By Amy Klarup, Director of Communications, Lane County Medical Society
