January 2018 VOL 9, NO 1

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AONN+ Conference Highlights, Breast Cancer

The Complexities and Challenges of Navigation in Breast Cancer

Navigating patients through the complexities of breast cancer is a unique challenge, but cross-collaboration between breast patient navigators and oncology nurse navigators can make a world of difference in improving patient care.

At the Academy of Oncology Nurse & Patient Navigators (AONN+) 8th Annual Navigation & Survivorship Conference, Susann Burnett, RN, BS, CN-BN, Breast Nurse Navigator at Women’s Wellness Center at Mission Hospital, Mission Viejo, CA, and Carrie Stauder, BA, RT, (R)(M), Patient Navigator at Mary Lou Beshears Breast Care Center at the University of Colorado Health in Colorado Springs, CO, discussed their respective roles in navigating patients through the continuum and the importance of teamwork in delivering quality cancer care.

The Nurse Navigator

“My passion for our patients is to reduce the overwhelming task of traversing this new landscape—they’ve just been told they have breast cancer—now what?” said Ms Burnett. “I’ve been called a GPS, an angel, a saint, and a wedding coordinator. But the bottom line is, we’re here to facilitate patient-centered care, assist patients through the cancer continuum, address barriers to their care, and reduce patient outmigration.”

In her setting, the goals of navigation include connecting with the community, removing financial and other barriers to care (whether the patient is fully insured or uninsured), streamlining the timeliness of care, improving patient outcomes by ensuring the patient is cared for throughout the entire course of treatment and into survivorship, and communicating with care providers. “Thank goodness for text message,” she noted. “I’m now communicating with surgeons all the time.”

She stressed the importance of utilizing the AONN+ Standardized Navigation Metrics. Her institution has focused on several metrics, including “number of referrals to revenue-generating services per month by navigator.” Navigators at her center obtain a thorough family history of all incoming mammogram patients, and as appropriate, refer them for genetic counseling and testing. As a result, navigators at her center have significantly increased the number of patients referred for genetic counseling and testing—often before they are presented at Tumor Board—thereby generating downstream revenue through the Cancer Genetics program, she reported.

“Our surgeons really like that because it cuts down on time. If there’s a high-risk patient who goes forward with testing, and those results will be important in the patient’s surgical decisions, then it’s important we get the ball rolling on that,” she explained. “That’s where the clinical skills of the nurse navigator are really important.”

According to Ms Burnett, nurse navigators make keeping the plates spinning and balls in the air look easy by breaking down barriers and clearing a path for patients to make informed decisions. But because the work is never done, a patient navigator is a wonderful help in moving patients toward survivorship and follow-up, as well as in supporting the nurse navigator in working at the top of his or her license, she said.

The Patient Navigator

In the process of navigating across the continuum, community outreach is critical. Patient navigators and collaborative community partnerships enhance patient care by providing emotional support and financial guidance, breaking down language barriers, providing education, dealing with limited transportation, referring patients to cancer and career information, and pursuing patient follow-up.

According to Ms Stauder, the Breast Center Model for Patient Navigation at her organization has improved patient care by increasing the timeliness of services and reducing unnecessary emergency department and physician visits.

“I’m told that the patient navigation model gave our nurse navigators approximately 10 to 15 extra hours a week to assist their patients,” she said. “In the past, much of the nurse navigators’ time was spent delivering benign results to patients, and they weren’t able to spend the necessary amount of time with patients with positive pathology.”

In her role as a patient navigator, Ms Stauder reviews biopsy results with the radiologist and the patient, offers support to the patient at the time of diagnosis, coordinates the initial consult appointment with the surgeon, supplies educational information to the patient about the diagnosis, follows up the next day over the phone, and documents all encounters in the electronic medical record.

“All patients leave that consult appointment with a surgical appointment scheduled, ideally within 48 hours of diagnosis,” said Ms Stauder. “The goal is to schedule their next move.” After the patient meets with the surgeon, he or she is handed off to an oncology nurse navigator.

According to Ms Burnett, a patient’s own fear could be the only thing standing in the way of her care, but education, encouragement, and guidance from a navigator can decrease that anxiety of the great unknown and bring some order to the chaos. “Patient satisfaction is always improved when they feel they have more power and are in a safe harbor,” she said.

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