June 2015 VOL 6 NO 3

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Online Exclusive, ONS 2015 Meeting Coverage, Patient Navigation

Lay Navigators Improve Patient Care

Alice Goodman 

Lay navigators can improve the care experience and coordination of care for patients with cancer, as a demonstration program instituted in the Outer Banks of North Carolina shows.

At the recent 2015 Oncology Nursing Society (ONS) annual meeting, Jean Sellers, RN, MSN, Administrative Clinical Director at the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, described her experience with setting up a volunteer lay navigator program in an underserved area and the lessons that were learned from that experience.

Lineberger Comprehensive Cancer Center is a statewide facility that comprises 3 National Cancer Institute–designated comprehensive cancer centers with 244 sites; however, 17 counties in North Carolina do not have a hospital, Ms Sellers explained.

Counties without hospitals typically have low-income patients and fewer patients with adequate health literacy. Often, there are unnecessary fatalities related to tobacco use and failure to get appropriate cancer screening.

She and her colleagues received funding to develop nurse navigation programs at 3 sites: Mission Hospital in western North Carolina; Vidant Health, an academic site; and the Outer Banks in the barrier islands of North Carolina, which had no hospital association at the start of the project.

The goal of the nurse navigator initiative was to improve provider efficiency, referrals to physicians, patient satisfaction, care coordination, and enhanced treatment adherence. Data collected from these sites suggested that lay volunteer navigators could address many of these goals at a lower expense.

The Outer Banks site only had 2 nurses, and they needed more help. A lay navigator program was initiated in partnership with a hospital volunteer program.

“ONS gets the credit. They recognized in their 2010 statement that navigation services can be delegated to trained nonprofessionals and/or volunteers, and should be supervised by nurses and social workers,” Ms Sellers stated.

Important components of the lay navigator initiative included:

• A community leadership team

• Physician and nursing leadership

• Partnering with the University of North Carolina Healthcare volunteer program

• Job description development

• Orientation/training development

• Selection of a volunteer coordinator.

“We started this program in a community that wanted us. The community felt ownership of the program,” she said.

The partnership started in 2010. Flyers were distributed in the community to attract volunteers and to announce the lay navigation program. A training manual was developed, and training programs were started.

“Ongoing training will be needed for these volunteers. They need to learn how to talk to people with cancer. It is an evolving process, and the definitive model for lay navigation has not yet been developed,” Ms Sellers explained.

She reviewed her experience with the Outer Banks lay navigation program from January 2010 to March 2013. During that time, 125 new patients with cancer were served, with a total of 2236 repeat visits, which involved patients traveling 22,459 miles.

The program has 45 active volunteers. “This is the largest volunteer program in the county,” Ms Sellers noted.

The services provided for patients at the Outer Banks lay navigation program include transportation, caregiver respite, yard work, running errands, meal preparation, home chores, and picking up drugs from the pharmacy.

Ms Sellers and colleagues came up with core competencies for the lay navigator and the oncology nurse navigator, so the model can be replicated. The lay navigators work under the supervision of the oncology nurse navigators. The core competencies focus on diversity and culture, and the training includes at least 20 hours of orientation. Navigators are reminded not to connect with patients on social media.

Some of the important lessons learned from the first lay navigator program include the importance of collaboration between the hospital and the community, ongoing training and support, the untapped retired healthcare population (ie, many became lay navigators), meaningful work for the volunteers, additional support for the volunteers, and the complexities of working with volunteers.

She emphasized the following keys for developing a successful lay navigation program:

• Do not give up

• Collaborate

• Work hard

• Have courage

• Think outside the box

• Trust yourself. 

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