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Management science guru, surviving cancer, offers hope to fellow sufferers, doctors

When Stephen Barrager was diagnosed in 2007 with acute multiple myeloma, a form of bone marrow cancer, he endured the same anxiety that troubles all those who receive an upsetting diagnosis. The way he went about dealing with his disease and its treatment, however, was different. Barrager drew upon his engineering and management science background to help him make difficult decisions. Now he is sharing his insights with hospitals and doctors in his native Bay Area and with colleagues at a conference coming to Austin on Nov. 7, 2010.

The annual meeting of the Institute for Operations Research and the Management Sciences (INFORMS) takes place at the Austin Convention Center and the Hilton Austin from Sunday, Nov. 7- Wednesday, Nov. 10. Dr. Barrager speaks on Sunday, Nov. 7 at 11 AM at the Convention Center in Session SB 31 on Level 4 in Room 18B. The program is open only to conference participants and reporters.

Dr. Barrager is available for interview.

When Dr. Stephen Barrager was diagnosed with multiple myeloma in February of 2007, he found himself facing numerous choices that were hard for a patient to process. Which of the recommended medications should he take? Was he a candidate for a stem cell transplant? Were there drug trials?

"I didn't understand the medicine, I didn't know the people who were treating me, and the people who were treating me couldn't explain things in a way that made sense to me," he recalls. "I was scared, very sick, and totally confused." Barrager's wife, his advocate, who accompanied him to every doctor consultation and hospital treatment, was also overwhelmed. She ran interference for him and tried to make certain his care was the best possible, but she agrees there is something missing in the system.

During this troubling time, Barrager referred to a book written by his friend, the late Nobel Laureate Stephen Schneider of Stanford University. Schneider had gone through his own battle with cancer, and lived to write The Patient from Hell, a book about his experiences and his recommendations for improving the cancer care system. In addition to advising patients to have an "advocate," Schneider's book recommends that doctors and hospitals use more management science thinking and tools, and do a better job of communicating probabilities.

When Barrager presented these ideas to his doctors, they responded that bringing in management science thinking and tools would present a host of challenges: doctors are trained as scientists, not engineers. Doctors are restricted by insurance regulations and other system constraints. Patients themselves vary in their ability to process this different way of deciding.

So Barrager went back to the drawing board and modified his friend's recommendations. He came up with his own unique adaptation, which features two concepts: the "Cancer Quarterback" and the "Decision Coach."

The Cancer Quarterback's role is to help the patient stay healthy within the constraints of the medical system; confer with specialists; help patients learn more about their disease; and communicate with a Decision Coach.

The Decision Coach's job is to help the Cancer Quarterback by structuring decisions; gathering and processing treatment information; doing analysis of potential treatments; and collaborating with fellow coaches.

In his case, Barrager's family doctor served as his Cancer Quarterback. Barrager, a trained management scientist, served as his own Decision Coach. He obtained information that let him assess the probable success of each possible treatment.

Almost four years later, the collaboration between Cancer Quarterback and Decision Coach seems to be working: Stephen Barrager's rare and raging, blood-based cancer is currently under control.

Dr. Barrager is now beginning to advocate that many more cancer patients be provided with a Cancer Quarterback and Decision Coach. To his satisfaction, hospital administrators believe that the model may help patients and save medical costs. He is exploring the concept of Cancer Quarterback and Decision Coach with doctors, specialists, and administrative executives at his Bay Area hospitals: California Pacific Medical Center, Stanford University and UCSF.


Contact: Barry List
Institute for Operations Research and the Management Sciences

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