4th Angel Mentoring Program

Podcast Transcript

Dale Shepard, MD, PhD: Cancer Advances, a Cleveland Clinic podcast for medical professionals, exploring the latest innovative research and clinical advances in the field of oncology. Thank you for joining us for another episode of Cancer Advances. I'm your host, Dr. Dale Shepard, a medical oncologist here at Cleveland Clinic, overseeing our Taussig Phase I and Sarcoma Programs. Today I'm happy to be joined by Carrie Emch, Program Coordinator for the 4th Angel Program. She's here today to talk to us about the 4th Angel Mentoring Program. So Carrie, welcome. Thanks for being here today.

Carrie Emch: Thanks for having me, Dr. Shephard. I'm excited to be here.

Dale Shepard, MD, PhD: So maybe just start out, just tell us a little bit about what you do here at Cleveland Clinic.

Carrie Emch: So I'm a Program Coordinator with 4th Angel Mentoring Program, which is a mentoring program managed by Cleveland Clinic. However, it's a national free mentoring program for any patient and caregiver across the U.S. The program is a one-to-one telephone and email-based adult peer mentoring service. So we provide confidential outreach and support to cancer patients and their caregivers.

Dale Shepard, MD, PhD: When we think about providing support, what kind of support are we talking about here?

Carrie Emch: So, first and foremost, we emphasize emotional support. A 4th Angel mentor serves as an active listener, and we really strive for them to empower patients and caregivers with knowledge, awareness, hope, and a helping hand. So a mentor is a cancer survivor. If they're a caregiver mentor, that means that they've cared for someone with cancer. That mentor is matched with a patient who has the same diagnosis, similar treatment plan, close in age when they were diagnosed, so the mentor really understands what the patients and caregiver are dealing with in going through their journey.

Dale Shepard, MD, PhD: So I'm going to take a step backward. 4th Angel Mentoring Program. Tell me about the name, 4th Angel.

Carrie Emch: Everyone always asks this, and it's a really great story. So Scott Hamilton, the Olympic gold medalist in figure skating, he came to Cleveland Clinic in 1999 and he was really happy with his care team. He's an inspirational person, as we all know, and he wanted to give back, so he created the program. The reason why he named it 4th Angel is because Scott always says he had his three angels by his side, which were his friends, his family, and his care team. He was missing that 4th angel, someone who could really understand what he was dealing with, someone who's been down the same road, the same cancer diagnosis, same chemotherapies, treatments, surgeries, et cetera. So he created 4th Angel.

Dale Shepard, MD, PhD: You said this is a very broad program, are there particular kinds of cancer that, really, we see more involvement? How does that work?

Carrie Emch: Yes. We try to get every single type of diagnosis, but definitely breast cancer is our largest mentor pool. We have about 1,200 active mentors in our database and approximately 300 are breast cancer. But that being said, across the board we have almost every single type of cancer in our mentor pool.

Dale Shepard, MD, PhD: How do people find the program? How do they reach out and get involved?

Carrie Emch: So, being a national program, we receive referrals mostly through Cleveland Clinic because we are managed through the hospital system, but we also receive external referrals from basically 900 organizations that we partner with. So that's places like, American Cancer Society refers callers to us. We have our brochures sent out to our ... we call them our partners, but probably 250 cancer organizations across the U.S. have our brochures on display, and then we accept referrals from physicians, nurses, social workers. Self-referrals are very common with the patients and caregivers and their loved ones. So really anyone can make a referral to get support.

Dale Shepard, MD, PhD: I asked about the tumor types and you mentioned things like breast cancer being more common, but what about stage of cancer? Is this something where people primarily get involved at the very, very early stage, or during active treatment, afterward? What does that typically look like?

Carrie Emch: I would say all of the above. We do get a lot of patients that call us right when they get diagnosed. But then we also, on the flip side, receive callers who are post-treatment. The patients are done and they just don't really know what to do next. They've been living this treatment and post-treatment, and it's just, it's a very confusing time, emotional for them, so they want a mentor after they're done with their treatment. So obviously, we're open to providing support to a patient or a caregiver whenever they need it.

Dale Shepard, MD, PhD: You mentioned patients and caregivers, and I just wanted to make sure that I was clear. So there are mentor relationships with not only patients, but also the caregivers independently?

Carrie Emch: Right, so we match caregiver to caregiver. So, basically, that match is whatever their relationship was. So if it's a caregiver who cared for their spouse, that spouse had cancer, then we could match two wives whose husbands had colon cancer, or a person who cared for their parents, or we even have a pediatric caregiver component to our program, where we match parent to parent or guardian to guardian. So that's also very flexible. So there's times where we'll match different types of relationships, because a caregiver's role has its own similarities, even if it's not the same relationship.

Dale Shepard, MD, PhD: How exactly are those matches made? How do you go about matching mentors to patients or mentors to caregivers?

Carrie Emch: So basically when a patient calls, our team members provide a thorough intake assessment, and we just, we need to determine the individual needs of each patient or caregiver. I mentioned earlier, primarily we match based on diagnosis, stage of cancer, treatment plan, their age, and their gender. We also try to dig deeper. If they're looking for a specific type of chemotherapy, or drug, or hormonal therapy, we'll do a match based on that as well. It's really an open book when it comes to the areas of what each patient needs and wants, and we do our best to fulfill their request.

Dale Shepard, MD, PhD: So this is a national program. There's very diverse populations. How exactly does it work? What does a normal relationship look like? Is it a phone call? Is it a Zoom link? How do people get together and get that support?

Carrie Emch: Well, it usually starts with a phone call. So when the patient is matched, the mentor always calls the mentee first within two days, and they have that initial conversation. It's really up to the mentor and the mentee how often they want to continue the communication and what type of communication. A lot of people text now, and a lot of people want to do Zoom calls, or FaceTime, or whatever.

So it's really up to the comfort level of the mentor and the mentee, but I would say that initially it's a phone call or an email. Those are the two most popular forms of communication. Then they can talk for as long as they'd like, communicate for as long as they'd like. The mentorship is open-ended. A lot of our patients and mentors end up staying friends for years. It's amazing how their relationships can build just from one phone call.

Dale Shepard, MD, PhD: How frequently do they normally ... I mean, I realize that there's a wide range, but if someone's thinking about being a mentor, what would they be considering as the normal sort of relationship? How often would that be?

Carrie Emch: Well, I would say it varies, because with some of our matches, the patient just has some very specific questions and they talk maybe once or twice, and then maybe the mentor will check in with them here and there. Then with others, it's more, the patient needs a little more support. So we try to set boundaries with our mentees, letting them know that the patient might have multiple mentors, it's a volunteer position, and they're not medical professionals. So we make that clear when we do our intake, to make sure that it's appropriate to match the patient. Then we let them know that speaking with their mentor, maybe once a week, once every two weeks, is the most appropriate amount of time that the mentor will provide.

Dale Shepard, MD, PhD: Since this is supposed to be providing emotional support and information, but not necessarily medical information, I suppose that's something that has to be managed as well.

Carrie Emch: Right. That's one thing that we make clear from the get-go when we're speaking with patients. One of the questions that we ask them in our intake is, what type of support do you have? Then they usually let you know if they don't have any family or they don't have any friends, or the opposite, or they're going to a counselor, or they don't want to have counseling.

So we try to make sure that they realize that the mentors are there for emotional support, but they are not clinicians, they're not counselors, and then we provide resources. So if a patient needs a little bit more help, we always refer them back to their social worker. But we also provide external resources, like cancercare.org or other type of support resources where they can have phone counseling with an oncology social worker, things like that.

Dale Shepard, MD, PhD: Is there a way that mentors can also help out from ... if they're providing emotional support, but they realize during that relationship that they really do need to double back to a social worker. Can they loop into that, or do they just make the recommendation back to the patient to do that?

Carrie Emch: No, we actually tell them to contact our team. So if there's any type of situation where they feel like their mentee needs more help than what the mentor can provide, they need to let us know so we can intervene. That's where we would reach back out to the mentee, and offer other resources, and check in, and see how they're doing, and what else we can do to help them.

Dale Shepard, MD, PhD: How does one become a mentor? How does somebody say, "Look, I've been helped in the past. I think I can provide support. I want to do this"? How do they go about doing that?

Carrie Emch: So, basically, they can self-refer. If somebody refers them to our organization, obviously they call, or email, or visit our website. We first do a background check on every single mentor, just like all Cleveland Clinic volunteers and staff. So the background check goes through, and then we have an online or phone training. The online training is through MyLearning, just like all of the Cleveland Clinic trainings that we have to do every year, and then we can also do it via phone. We used to do it in person, but obviously with the COVID-19, that's something we've halted.

Then once they go through their training, they become a certified mentor. We're in constant communication with our mentors, making sure they have everything they need. If there's any additional information or questions, we're always there, and we reach out to them every time, with every match.

Then we also do follow-up after the match. The Office of Patient Experience did a wonderful survey for us, so we send surveys out to all of our mentors and our mentees to follow up with each match. With that, we measure wellbeing, which is a very important component of our program. So we are always looking at our wellbeing scores, and currently, 75% of our patient and caregiver mentees reported an increase in wellbeing after being matched with a 4th Angel mentor, so we're pretty proud of that.

Dale Shepard, MD, PhD: That's excellent. So if a physician refers a patient to the program, do they get feedback that there is a relationship or a mentoring relationship that has been established? So are they in on the loop as well?

Carrie Emch: Absolutely. So right away we let them know that we'll be reaching out to the patient within 24 hours. Then as soon as the patient is matched with a mentor, we also let them know that the patient was matched. If there's any issue, if we can't connect with the patient, we do three attempts to contact each patient, so if after three attempts, we're still not hearing back, we always follow up with the person that referred the mentee to us. It's nice because sometimes they're going to happen to see the patient the next day, and they can talk to them about it and get the match made.

Dale Shepard, MD, PhD: So you certainly mentioned at the onset that this is widespread, there's a lot of organizations that are involved, and it has a wide scope, but what could be done to help get the word out? So physicians that might be listening in and say, "Hey, that's a great thing. I've got three patients I know would really benefit from this." How do we get the word out? How do we spread that word?

Carrie Emch: Well, I would just say that we're always available to do presentations and podcasts and do a lot of virtual huddles where we'll meet with teams, always ready to do any presentation, any time. Then, of course, we have brochures, the old-fashioned marketing wave. So we obviously can provide brochures to any physician that wants to display them or put them in My Journey binders, folders, et cetera, however each region is doing it.

Then we also have our website, which is a really easy resource, 4thangel.org. It's a Cleveland Clinic website, but it's an independent. So 4thangel.org is also a whole nother way to refer patients because they can create an account online, and be matched in real time, and message their mentor immediately on our website. So it's a real quick and easy way to get emotional support in the middle of the night if a mentee or a patient is looking for support, and it's great that they can go to our website and find that.

Dale Shepard, MD, PhD: We talked a little bit before about some tumor types, some types of cancer are better represented than others. What kinds of cancers do you need help with, if physicians might know of someone who might be a good mentor in an area that maybe is underrepresented? What kind of tumor types would those be?

Carrie Emch: That's an excellent question. The first off the top of my head would be pancreatic. We get so many requests for pancreatic mentors and we really don't have too many. Liver cancer. I would say with our lymphomas, any type of rare type of lymphoma. Of course, I'm not a doctor, a clinician, so, but like a T-cell, B-cell, things like that.

Dale Shepard, MD, PhD: Like T-cell lymphoma.

Carrie Emch: Yes. Things like that, where, any type of rare subtype, I would say, of any cancer is ... we're looking for that, because more and more often, people are getting diagnosed with these rare subtypes and they want to talk to someone with the same type. So those are the four that I can think of off the top of my head.

Dale Shepard, MD, PhD: I guess similar question, what about minorities or particular age groups?

Carrie Emch: I feel like our mentor pool is pretty strong with minorities. We have Spanish speaking mentors. Not a ton, but we do have some in each area. But we're always looking for more because that seems to be more and more common, that a mentee looking to speak to a mentor who speaks Spanish. Our demographic is older, I would say, 60s, 70s. We do have a lot of AYA mentors that have been signing up lately, but it's still lacking. So I would say that we would need more AYA, the young adult population, than the older population. The older population, we're pretty set with with all age groups 60 and above. But definitely, the 20s, even young 30s, we're always looking to add to our pool.

Dale Shepard, MD, PhD: So other than the tumors and age groups, where are the gaps? What do you think is the next step to make the program even more successful?

Carrie Emch: Well, we are definitely working hard to get as many mentors as we can signed up on our website. Like I mentioned with our demographic, when we have older mentors, they're not as likely to create online accounts. But we are learning, especially during COVID-19, that the online need is very high. People are not out and about, and a lot of young people don't use the phone in terms of talking on the phone. So I would say that what we're working on to be stronger is our website. It is a newer website, so it looks great and it's functioning excellent. We just need to add more mentors to it.

So we're working on that as a team, to reach out to all of our existing mentors to create accounts. We have about 250 out of our 1,200 that have online accounts. So you can see where, if a patient is on there, they might not find a match right away. So we obviously have a call to action to call our team to get them matched offline. So I would say that's our biggest job right now, is to get that website ... get our mentors registered as soon as possible and get it to be stronger, so we can make better matches online.

Dale Shepard, MD, PhD: A lot of these interactions by phone or by emails, things like that, but was the 4th Angel program ... has it been affected in any significant way by the COVID pandemic?

Carrie Emch: We were prepared that it would, and it's honestly been busier. So in a good way, I guess, we have received an over-abundance of patients and caregivers looking for support, because as we all know, those support groups have been dwindling, if they're meeting at all. I know they weren't in the beginning, and they might've stopped and gotten back together now, but the in-person ones are not around like they were.

People are struggling, obviously, with quarantine, and being isolated, and not being able to go out, and not seeing people. Then, of course, the people that are receiving chemotherapy and having to deal with going into treatment during a pandemic. I mean, there's just so many counterparts. So we have seen a big growth. We're very busy, which is great.

Our mentors have had to learn a new way to mentor, too, because the mentors have never been through a pandemic. They didn't go through treatment during a pandemic, so they don't really have that experience. So they're doing the best they can to provide the support during this whole new world that we're living in.

Dale Shepard, MD, PhD: Well, Carrie, you're doing great things to help our patients and I certainly appreciate it. So you've provided some great insights and information about the program. Do you have any additional comments?

Carrie Emch: I would just say that our local number to make a referral is 216-445-8734. Like I mentioned before, really easily, our website is 4thangel.org, and then our email is same thing, 4thangel@ccf.org.

Dale Shepard, MD, PhD: Very good.

Carrie Emch: I appreciate you having me, Dr. Shepard. It's always so nice to talk to you and see you over video chat.

Dale Shepard, MD, PhD: I appreciate it. So thank you very much for being with us today.

Carrie Emch: Thank you.

Dale Shepard, MD, PhD: This concludes this episode of Cancer Advances. You will find additional podcast episodes on our website, clevelandclinic.org/canceradvancespodcast. Subscribe to the podcast on iTunes, Google Play, Spotify, SoundCloud, or wherever you listen to podcasts. Don't forget you can access real-time updates from Cleveland Clinic's Cancer Center experts on our Consult QD website, at consultqd.clevelandclinic.org/cancer. Thank you for listening. Please join us again soon.