Abstract: Patient navigation as a care coordination model continues to evolve. With no standard credentials, titles, training, or job descriptions, navigation programs are as varied as the people who perform [ Read More ]
April 2015, VOL 6, NO 2
Navigator Discusses Patient Needs, Barriers to Care
The Journal of Oncology Navigation & Survivorship had the opportunity to speak with Sharon Gentry, RN, MSN, AOCN, CBCN, at the fifth annual Academy of Oncology Nurse & Patient Navigators (AONN+) Conference. A breast health nurse navigator with Novant Health: Derrick L. Davis Cancer Center in Winston-Salem, NC, Ms Gentry is a member of AONN+ as well as its Quality, Outcomes, and Performance Improvement Committee.
What do you think are the most pressing issues facing oncology patients seeking care in your community?
Sharon Gentry (SG): Economics, transportation, and insurance are the biggest issues. We have been hit with some very challenging economic times: the tobacco industry is gone; the furniture industry is also gone. The leading employer in our area is actually the medical center. When each patient comes in, his or her financial needs are evaluated. We are very lucky to have a lot of giving people in our area who can provide some sort of transportation to patients, because there is no formal program in our rural community at this time. Another concern is insurance is- sues among young adults who are deciding whether to sign on for coverage. They feel that they are invincible, that they may not need insurance.
What are the most pressing issues that nurses and physicians who care for these patients face on a regular basis?
SG: Some issues include trying to balance work and other life enjoyments. I often find that people who work with oncology patients are very driven and empathetic. That can often lead to burnout. They have to find a balance between work and life, and they do a very good job at doing that because of the team aspect of care. You will find that sometimes some patients can relate better to other team members; sometimes you work harder with one patient and your colleague may work harder with the next patient. It does balance out.
Are there any barriers to care within the patient community that your institution serves?
SG: The patient community is becoming more multicultural than it ever has before. We are fortunate to have a program we can call on 24 hours a day to help us communicate with patients, which is important from a healthcare perspective. Then we need to think about the support that they are getting back in their own communities, and provide survivorship support and education on cancer prevention as well as prevention support. The challenge is how to serve the needs of a number of different cultures.
What is the most pressing need among patients with cancer and their caregivers?
SG: Having the energy to cope with their disease is a pressing need. It could be that a grandparent is raising his or her grandchildren. It could be that an adult is coping with aging parents and, at the same time, is caring for young children at home. Keeping the balance between everyone’s routines can be a challenge. I do get very concerned about caregiver fatigue, and we are trying to address that more. How can we help that caregiver understand what is going on with the patient? What are some of the resources we can connect them to within the community?
Is the oncology community providing adequate psychosocial support for this population, and what can be done to increase the awareness of social support services within the cancer community?
SG: The oncology community does provide psychosocial support; the world of oncology often looks holistically at the patient. The 2015 Commission on Cancer requirement to have a distress screening tool is going to even the playing field even more. The key is going to be when to do the dis- tress screening: not at diagnosis when patients are definitely distressed, but more as the patient has been educated about what to expect. Then you can do some distress screening and pick up on things that might be bothering them, whether it will be family issues, travel issues, or financial issues.
Are there barriers that prevent patients and caregivers from seeking social support? If so, what can be done to overcome these barriers?
SG: A barrier that might prevent patients from seeking social support may be the personalities of the patients themselves. I come from a rural area where people have taken care of themselves for years. They are very much used to relying on family members, relying on church members. Sometimes when a patient is diagnosed with cancer, I think, “We are a healthcare team and we want to take care of them.” But for the patient, it is a privacy issue, where he or she may feel, “I have taken care of myself before,” or “I will take care of my family.” We can offer help often, and consistently offer that help again as patients go through the continuum of care, but we have to be very aware of that mind-set and respect that that is where they are from.
What do you think navigation will look like in 2020 and beyond?
SG: My hope is that each patient who enters a cancer center for care will have access to navigation. A vision would be for them to have access in the community for outreach navigation, that they would have navigation through their diagnostic care, through their treatment care, and also through survivorship and end-of-life care. I hope that we would be making patients, as they come through the door, healthy or healthier as they leave our care, that we are focused on improving the health of the entire population.