Transforming health with new models of care

Long distances to medical centers, limited access to specialists and fewer health care professionals create barriers for underserved and rural communities in North Carolina.

However, at Duke, faculty and researchers across the university and the health system are launching new, innovative ways to deliver world-class care to those most in need.

From Duke’s School of Nursing to its Divinity School and beyond, Duke is helping to ensure that no matter where a patient lives in the state—and no matter that patient’s needs—they have access and compassionate care.

Finding World-Class Care Where You Live

When Debra Quick of Laurinburg, North Carolina, was diagnosed with breast cancer, a Duke doctor in her own community was there to help.

Laurinburg is not located close to a major medical center. However, Duke Health’s partnerships with local hospitals ensures Duke cancer doctors are placed throughout southeastern North Carolina. In all Duke Health has more than 400 Duke medical clinics serving patients throughout the state.

Dr. Hannah Woriax, a surgical oncologist for two rural cancer centers affiliated with Duke, was able to treat Quick regularly without doctor or patient having to travel a long distance. Quick received surgery, radiation and chemotherapy—all in Laurinburg.

“People here deserve the best care possible, just like patients anywhere else,” says Woriax, who also serves as a Duke assistant professor of surgery.

Quick, who is cancer-free today, says she is thankful for access to Duke doctors, despite living so far away from Duke’s main hospital. It’s one of the many ways the university health system is touching lives and reducing suffering for North Carolinians across the state.

“I’d always heard about Duke and its great doctors,” Quick says. “My doctor was a shining light. She’s meant to do what she does.”

My doctor was a shining light. She’s meant to do what she does. ”

Debra Quick

Cancer patient

Nursing Mobile Health Units on the Move

New efforts by Duke’s School of Nursing are opening up health care access to those most in need.

The school’s Mobile Prevention and Care Team Clinic program is a nurse-led mobile health unit created to increase nursing student, faculty and staff knowledge of the social drivers of health and to partner with patients and community organizations in rural and underserved urban populations.

Nursing students apply to the program, where they participate in 112 hours of longitudinal experiential clinical training, including an immersion in a rural North Carolina health setting and a project with a local community partner to address a health issue.

The ultimate goal is to ensure that more patients across the state not only have access to top care but have the knowledge to understand the drivers and determinants of long-term health.

In addition, the School of Nursing is pioneering efforts to support family caregivers, recognizing their critical role in patient recovery. Nearly a quarter of adults ages 45 to 64 are caregivers, according to the Centers for Disease Control and Prevention.

Cristina Hendrix, associate professor of nursing at Duke and founder of Duke’s Elder Family/Caregiver Training Center, helped to design a new app especially for caregivers, who often must juggle many critical care details for their loved ones at home. The app provides instructions for managing care at home, self-care tips and other helpful information that bridges the gap between hospital discharge and home care.

“I think the weakness on how we provide support and training to caregivers is we use a one-size-fits-all approach and also overwhelm them with a lot of information,” Hendrix says. “What we are doing in the app is trying to prioritize what information to give at a certain time.”

A New, Holistic Approach to Health Care 

Duke Divinity School is providing opportunities for students, clergy and health care practitioners to reimagine contemporary practices of health care through its Theology, Medicine, and Culture Initiative. The program seeks a holistic approach to health that upholds top care with an intention toward a patient’s spiritual or faith formation.

“Here at Duke, we are fortunate to have a world-class medical center, and we have a world-class divinity school,” says Dr. Warren Kinghorn, co-director of the initiative. “Practically, it means bringing people who are in training or in the practice of health care disciplines to the divinity school, to be in cohorts, to be in community.”

Dr. Amanda Lucashu, a hospital physician in Oklahoma, earned a Certificate in Theology and Health Care, one of the many options of the initiative, which offers a residential fellowship program aimed at current and future practitioners in any health profession, a hybrid online program, and a dual degree program with Duke School of Medicine.

Through her experience learning at Duke, Lucashu says she worked with a patient who was hesitant to accept a recommended treatment. But instead of focusing on persuading the patient to accept the surgery, Lucashu focused on building trust and offering her recommendations as a choice that the patient could either accept or decline. The patient noticed the approach, and expressed deep gratitude to Lucashu for considering the patient’s autonomy and dignity.

For Lucashu, this experience showed her that the true measure of success isn’t always a medical outcome.

“It wasn’t about getting him to accept the treatment. It was about building trust and allowing him to be heard,” Lucashu says. “That was healing in its own way.”