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August 2013 VOL 4, NO 4

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Evidence into Practice

About Elaine Sein, RN, BSN, OCN, CBCN

Elaine Sein, RN, BSN, OCN, CBCN 

Senior Project Manager
Fox Chase Cancer Center Partners
Chair, Quality, Outcomes, and Performance Improvement Committee
Academy of Oncology Nurse Navigators

I began my journey in oncology nursing more than 40 years ago and have never looked back. My passion for care coordination of oncology patients began with my own experience as a breast cancer patient at 22 years of age. In the 1970s, there was little support for patients with breast cancer, especially young patients. In collaboration with our breast cancer?specific social worker, I developed a mastectomy rehabilitation program for newly diagnosed patients with breast cancer at Fox Chase Cancer Center. That began my role as a patient care coordinator navigating patients from the point of diagnosis through treatment. I performed many of the activities that nurse navigators do today, including individualized preoperative education; postoperative classes regarding drain care, exercises, hand and arm care, and psychosocial adjustment to diagnosis; connecting patients with community resources to support their needs; and providing ongoing support as needed.

I have held several different positions over the years, but making sure we provide patient-centric care for our patients has always been my highest priority. I have always had a soft spot in my heart for patients with breast cancer and survivors. Through the Oncology Nursing Society (ONS), I have worked on various project teams to enhance breast cancer care; authored a chapter in the second edition of the ONS Site-Specific Cancer Series: Breast Cancer, entitled, “Building Breast Centers of Excellence Through Patient Navigation and Care Coordination”; and chaired the Oncology Nursing Certification Corporation Task Force for the Certified Breast Cancer Nurse credentialing that occurred in 2009. I am also a member of the leadership team for the Pennsylvania Patient Navigator Network.

Approximately 10 years ago, I joined Fox Chase Cancer Center Partners as a clinical liaison to the community hospitals in Pennsylvania and New Jersey that link with Fox Chase Cancer Center for oncology services. At that time, community hospitals were creating the position of breast care coordinator, and I saw the opportunity to support this role through education. “Developing the role of the breast care coordinator in a community setting” was my Leadership Development Institute project for the ONS, and I can enthusiastically say this project has seen no end point but has evolved from 6 breast navigators in 2003 to 26 navigators in breast, lung, gastrointestinal, gastrourinary, gynecologic, head and neck, and generalists in 2013. We meet quarterly for role development, education, sharing of best practices, and networking. The Fox Chase Cancer Center Partners’ nurse navigator group has sponsored a conference for breast program development, authored a navigation manual for nurses new to the role of breast navigation, and developed a multi-institution research project in collaboration with Fox Chase Cancer Center entitled Measuring Quality Improvement in Breast Cancer Care at Fox Chase Cancer Center Partner Institutions. The primary objective of this project was to benchmark participating institutions against each other and national benchmarks. Secondary objectives included assessment of causes for variance, impact of patient preference for treatment options, and time to care. The third objective was to explore the role nurse navigation plays in real- time quality metrics addressed at the cancer committee level. Key outcomes included the ability of the navigator to capture and report real-time data and variances regarding patient preference or medical reasons for noncompliance to the cancer committee and real-time quarterly reports provided data that promoted practice and process change. This prospective quality study demonstrated the positive impact that clinical navigation has in assessing and evaluating quality care metrics as a member of the multidisciplinary team. It was presented at the AONN conference last year where it won the original research award as well as at the American Society of Clinical Oncology’s first quality care conference in the fall of 2012.

I firmly believe the role of the navigator in care coordination has a huge impact on patient care across the care continuum; however, we need to continually provide evidence that will ensure the sustainability of the navigator role in an ever-changing healthcare environment. One way is to work together on outcomes-based projects at both the community and national levels to ensure the longevity of this role. AONN has launched a Quality, Outcomes, and Performance Improvement Committee to provide support to navigators to look at outcomes-based projects in a broad sense and provide the mentorship needed to bring these local projects to fruition. We just disseminated a survey to the membership to assess the understanding of the various aspects of outcomes-based performance improvement and research projects. Our goal is to develop educational programs and mentorship support to increase the navigator’s comfort level with the development of their own projects. We have monthly conference calls and will be meeting during the November conference in Memphis to engage new members. We are seeking abstract submissions for this year’s conference that provides a forum to showcase the work you are doing within your own navigation programs. I encourage anyone with an interest in learning more to contact me and add the Quality, Outcomes, and Performance Improvement Committee meeting to your AONN conference itinerary.

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