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‘It’s a perfect job for me’: St. Luke’s breast care coordinator helps patients navigate their diagnosis

October 11, 2018

TWIN FALLS — When a woman undergoes a breast biopsy, it can be a stressful time full of fear and uncertainty.

That’s when Peg McKain steps in to help.

Once a pathology report comes back and a patient receives the results from her primary care provider, McKain calls the patient to offer resources and help them understand what’s going on.

McKain, a registered nurse, is breast care coordinator at St. Luke’s Women Imaging Center in Twin Falls. The center sees patients from all over south-central Idaho and northeastern Nevada.

As McKain sat in her office Oct. 3, she was wearing a pink dress and was surrounded by pink décor, from artificial flowers to a sweater hanging on a hook.

She provides information and resources, but ultimately, patients and their families decide what they’re going to do about breast cancer treatment. “I tell them they drive the bus.”

McKain — who works part-time — is essentially a case manager specific to breast care. She reviews patients’ medical records to make sure appropriate follow-up care happens after a biopsy and helps with other patient needs, such as referrals and coordinating testing.

“Once the patient has a biopsy, that’s where I step in,” she said.

McKain has an in-depth role until the patient is handed off to St. Luke’s Mountain States Tumor Institute, which manages patient care.

“Then, I’m more like a liaison to makes sure it’s going OK,” she said.

McKain has decades of experience as a nurse in many capacities, including in quality assurance for a large hospital, intensive care and specialties such as dermatology.

She started her career in 1980 as a traveling nurse, left Idaho for a while and came back. In the Wood River Valley, McKain was an employee health nurse and wellness coach.

Now, as breast care coordinator in Twin Falls, McKain said it’s the ideal culmination of her nursing experience.

“It’s a perfect job for me,” she said. “I love it.”

McKain’s patient caseload varies from week to week.

“My caseload is really contingent on if they have a positive biopsy,” she said. The last week of September, for example, seven of eight biopsies performed were negative.

What leads up to a biopsy? When women have a screening mammogram and something looks suspicious, the next step could be a diagnostic mammogram or ultrasound to allow a radiologist to have a better view and different angles.

Once results are back, a physician decides what happens next. That could include a biopsy that’s done on site at the Women’s Imaging Center or a hospital, depending on the type of biopsy that’s needed.

Breast tissue is sent to pathology, and a report comes back in three to five business days.

After a patient has heard from her physician with results, McKain attempts to make contact. It’s a time when patients are getting bombarded by so many people, so she leaves it up to patients how much they want to interact with her.

McKain can’t predict what kind of reaction she’ll get when she calls a patient or how receptive they’ll be to a conversation. And sometimes, patients want to try to cure their cancer using unconventional methods or don’t want to seek treatment at all.

“You just never know what you’re going to get on the other side of the phone,” McKain said.

She explains the results of the pathology report to patients in as simple terms as possible. “When I’m going through pathology, I’m going through understandable language,” she said.

It’s a delicate conversation where she discerns the patient’s level of understanding, and balances providing information with trying not to frighten or overwhelm the patient.

When she describes the diagnosis, McKain said she tries to put patients at ease and explain things in a simple way, including ways to help patients visualize what’s happening in their body. For instance, she commonly describes breast calcifications as being like a coral reef.

She said she can feel de-escalation in a patient’s level of tension when she explains pathology results. She offers to provide information about their condition to them via hard copy, email or refers them to websites from organizations such as the American Cancer Society.

McKain said patients love that they don’t have to make an appointment and can get help remotely.

Oftentimes, she interacts with older patients.

“I have to get in their head and figure out what they need from me,” she said.

Older patients don’t often Google their diagnosis, McKain said, and they want hard copies of materials. But younger patients often do research online.

When she reaches out to patients, she checks in on them to see how they’re doing and gives them a chance to vent, if needed.

With a breast cancer diagnosis, there’s a lot that goes along with it that people may not be aware of, McKain said, such as genetic testing and testing heart function to see if any potential issues may arise with chemotherapy.

As she helps patients, McKain reassures them about advances made in treatment.

“Our technology has really markedly improved our results with breast cancer,” she said.

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