December 2012 VOL 3, NO 6

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Prostate Cancer Navigation

Juli Aistars, RN, MS, APN, AOCN

Ms Aistars discussed the development of the prostate cancer navigation role, which was implemented in 2007, from the perspective of a suburban, independent community hospital. Patient navigation roles for prostate cancer, which is more common in men than breast cancer is in women, include earlier detection, timely diagnosis and treatment, better coordination of services, and overcoming financial and cultural barriers. The key elements of the Northwest Community Hospital program included a physician champion, prostate advisory board, marketing, evaluation using quality data, community outreach, professional networking, and program evaluation. Some of the gaps that the program identified and needs that were addressed were a lack of referrals to radiation oncology, ability to obtain a second opinion closer to the patient’s home, anxiety concerning discharge with an indwelling catheter that was addressed with preoperative education, and concerns about survivorship and side effects. These concerns were addressed with an onsite prostate cancer quality-of-life study, a postoperative guide for patients undergoing prostatectomy, and follow-up care.

One barrier to implementing navigation programs is return on investment because navigation is typically not a service that is charged for. Increased referrals to radiation oncology, recognition of the facility as a comprehensive prostate cancer program, growth of the program, and grant funding from the Northwest Community Hospital Foundation may address this barrier. Ms Aistars pointed out that there are many potential initial contact points between patient and navigator, such as at the time of suspicious findings, at the time of diagnosis, in the decision about treatment phase, postoperatively, after radiation therapy, at recurrence, and in advanced disease. She illustrated this with several case studies.

Take-Home Messages

  • Nurse navigation should be based on the needs of the community and the patient population
  • The role of the nurse navigator is always evolving
  • Measurable outcomes are key
  • Return on investment should be taken into consideration
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