At the heart of the Oncology Medical Home is triage, according to Barbara L. McAneny, MD, a board certified medical oncologist at New Mexico Oncology Hematology Consultants, and founder of [ Read More ]
February 2017 VOL 8, NO 2
Advice for Beginner Navigators
Oncology navigators in the early stages of their career need navigation assistance, too. At the Academy of Oncology Nurse & Patient Navigators (AONN+) 7th Annual Navigation & Survivorship Conference, Tricia Strusowski, MS, RN, offered advice and tools for navigators starting out in this burgeoning, but often daunting field.
According to Ms Strusowski, manager at Oncology Solutions, LLC, a consulting firm for oncology programs, patients recently diagnosed with cancer often complain about duplication in their treatment. They doubt whether members of their healthcare team are communicating with one another, and even the most knowledgeable individuals feel overwhelmed and confused. But navigators offer guidance and relief during this devastating time, and as one of her patients puts it, provide “a flashlight in a dark hallway.”
“We often hear about fragmented navigation programs,” she said. “But a navigation program, by definition, is about managing the patient across the entire continuum of care.”
What Does a Navigator Do?
The goal of a navigator, be it a nurse, social worker, patient, or nonclinically licensed navigator, is to educate the patient, family, and caregivers about the cancer diagnosis, treatment, side effects, and clinical trials. They provide emotional support and conduct a comprehensive assessment of needs, and they should always “aim to figure out what a patient needs right now,” she said, noting that it might not even be in regard to their cancer diagnosis, but rather about their finances, finding a babysitter, or transportation issues.
Navigators remove barriers across the continuum while coordinating timely access to support services, appointments, and tests and procedures, as waiting time is one of the most anxiety-inducing factors for patients. According to Ms Strusowski, navigators should always aim to “keep it very, very simple, utilizing the same educational materials across the continuum.” She underlined important navigator characteristics such as flexibility, adaptability, and knowledge of community resources and support services, but said the most important trait is listening skills. “It’s helpful to ask patients what their doctor told them about their cancer and their treatment,” she advised. “We have to start at their level and get rid of that glazed-over look patients get after they sit through a discussion with their physician.”
She stressed the importance of maintaining continuous support, education, and monitoring of patients, and ensuring access to clinical trials. Additionally, collaboration and communication between patients, family/caregivers, and the healthcare team is vital. “It’s impossible to overcommunicate when it comes to navigation,” she said.
She pointed out that patients enrolled in a navigation program should be under active treatment, and navigators should get involved in the treatment plan as soon as possible, “because engaged patients are happy patients,” she said. Simply telling the patient something along the lines of, “I’m your navigator, you’re stuck with me, and I’m going to take great care of you,” is proven to decrease outmigration, she added. She advises sticking to the facts when developing a navigation program, and utilizing patient-centered resources like the Institute of Medicine conceptual framework, the Commission on Cancer (CoC) program standards, and other available community resources and predesigned core competencies. “Don’t reinvent the wheel,” she advised.
The CoC is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard setting, prevention, research, education, and the monitoring of comprehensive quality care. Ms Strusowski strongly encourages utilizing the CoC as a resource for best practice standards in successful patient navigation, especially Standards 3.1 to 3.3, regarding the Continuum of Care.
For example, Standard 3.1 pertains to the Patient Navigation Process and Community Needs Assessment. It underlines the importance of conducting a community needs assessment to address healthcare disparities and gaps in resources and barriers to care for patients prior to establishing a navigation program. Ms Strusowski said she builds this assessment into every curriculum she creates. “If you don’t know your population, how will you navigate them?” she asked.
The Oncology Nursing Society Nurse Navigation Core Competencies serve as another valuable tool for navigators. The competencies define the role of the navigator and outline deliverables in the areas of education, coordination of care, and communication. “Education is a huge piece of what we do with our patients. It empowers them so they know what to ask their physicians,” she said. “And any opportunity in which we can increase communication amongst the healthcare team and decrease duplication for patients is essential.”
The AONN+ Certification Domains are another outstanding tool, she said. The domains aim “to establish baseline competencies for oncology navigators centered on their roles, responsibilities, educational level of knowledge, and evidence-based best practices that will help to ensure consistent delivery of optimized patient care across the continuum.”
Patient Flow and Managing Transitions
Navigators can get bogged down, so it’s important to simplify things, she said. For example, distress screening should not be performed more than once. She trained her staff to use a more immediate approach, and to simply ask patients, “What can I help you with right now?” This eventually leads to patients divulging their immediate needs without a prompt, she added, empowering them to speak up about their concerns. Since most programs don’t share patient information as well as they perceive that they do, it is extremely important to communicate the assessments, needs, and barriers of the patient, family, and/or caregiver to all of the appropriate departments, support staff, and physician offices.
Ms Strusowski provided a list of “do’s” and “don’ts” in managing patient transitions. For example, do conduct morning meetings to share information across the continuum and invite navigators, social workers, discharge planners, dietitians, pastoral care, etc. And do invite internal and external resources to attend these meetings and provide updates (ie, finance department, community agencies, etc). Don’t create silos by assigning navigators to a specific department or office setting (eg, radiation therapy), and don’t assign all poorer prognosis late-stage patients to a particular navigator, as this will cause potential burnout and assignment fatigue. Managing patient transitions is an especially significant role for navigators, as it helps take the fear out of what’s happening next, she said.
“Navigators have got to get more business savvy, because administrators want to know the return on investment for navigation programs,” she counseled. Patient registration and intake forms, surveys, electronic medical records, and tumor registries are helpful resources for keeping track of metrics regarding patient experience, clinical outcomes, and business performance. And last, she stressed the importance of creating partnerships in the community with organizations like the American Cancer Society, the National Cancer Institute, the Leukemia & Lymphoma Society, the Breast Cancer Coalition, and various cancer support groups and educational programs.
“Bottom line, this is an amazing field you all are walking into,” she said. “I want you to learn from my mistakes and enjoy it, because what you provide to these patients and their families is invaluable.”
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