April 2015, VOL 6, NO 2

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Interview with the Innovators

Navigator Shares Perspectives on Psychosocial Support

The Journal of Oncology Navigation & Survivorship had the opportunity to speak with Virginia Vai- tones, MSW, OSW-C, at the fifth annual Academy of Oncology Nurse & Patient Navigators (AONN+) confer- ence. Ms Vaitones is an oncology social worker at Pen Bay Medical Center in Rockport, ME, and represents the Association of Oncology Social Work at the Commission on Cancer (CoC). She is also on the CoC Executive Committee, and was involved in writing and updating the CoC’s Can- cer Program Standards 2012: Ensuring Patient-Centered Care. Ms Vaitones served as a faculty presenter at the 2014 AONN+ conference.

What do you feel is the most pressing need among oncology patients, as well as their caregivers?
Virginia Vaitones (VV): The most pressing need that I have seen is having adequate insurance; that is the main concern for patients and their families. They often ask how their treatment will be paid for, or what will not be paid for. Being uninsured adds a huge burden to our patients and their families, so this is very relevant and important to them; it is the number one question they ask after their chemotherapy teaching, or after they learn they are going to have chemotherapy. Transportation to and from appointments is also a major concern, as some patients must travel great distances to reach us.

What barriers prevent patients with cancer and their caregivers from seeking psychosocial support, and, if so, what can be done to overcome these barriers?
VV: The biggest barrier that keeps our patients and family members from seeking support is the stigma that may be attached to asking for help for depression or perhaps financial concerns. There is also the fear that there may be a breach of confidentiality; that everyone within their community may find out that they do not have enough insurance, or that they need some type of counseling to help them deal with their cancer diagnosis. One of the ways that we can educate our patients and break down that barrier is that we can do telephone support groups. We can also as- sure patients that if they are in the grocery store, that we will not acknowledge that we know them. It is so important to ask patients, and just talk with them about their concerns. I think that is the biggest way to break down those barriers.

More and more institutions are considering starting a navigation program; however, some institutions may feel too intimidated to begin. What would you recommend to start the process?
VV: If you are interested in starting a navigation program, it is important to ensure you have support from top administrators, the financial team, medical officers, and the medical staff. That is essential. Once you have their support, then start by developing a program for 1 disease, and from there start building across your top 5 disease sites. It is a great program to have, but you have to have that buy-in from everyone.

What types of issues do you discuss with team members such as oncologists, pharmacists, payers, and practice managers? How do you play a role as a navigator in those conversations?
VV: As a navigator for our patients, I am talking on a daily basis with all of the team members about psychosocial issues that patients have that might impact care: concerns such as insurance issues, prior authorization issues, specialty pharmacy issues, you name it. Every single day, I interact with the team to ensure that patients are receiving the care that they need.

What will navigation look like in 2020 and beyond?
VV: Navigation in 2020 is going to be really exciting. Navigators will need to be experts regarding the economics of cancer care. They will have to be skilled at psychosocial is- sues, as well as very skilled at understanding personalized medicine. In 2020, the treatments are going to be very different. When I first started in oncology care, all of the chemotherapy that we had at the time was given in an inpatient setting. Now, we have moved almost all their treatments in the outpatient arena. I think by 2020, we will have mostly oral chemotherapy. It is going to be targeted therapy, and I think that is going to be even more expensive than it is now. Navigators are going to have to have many more skills, or perhaps not more skills, but the skills they have will have to be more finely tuned, because there will be greater costs and more challenges to patient care in 2020.

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