Exploring the Nurse Navigator’s Role in Advanced Care Planning for Early-Stage Cancer Patients

November 2018 Vol 9, NO 11
Kay Hankins, RN
Sarah Cannon
Jolene Hetsler, RN, ONS
Sarah Cannon
Cynthia Kuhn, RN, CBCN
Sarah Cannon
MaryAnn Pedersen, RN
Sarah Cannon
Beth Matthews, MSN, RN, OCN
Sarah Cannon

Background: Advance care planning (ACP) is central to patient-centered care and improves alignment between patient preferences and care received at end-of-life.1-3 Limited research is available regarding the impact of nurse navigators on ACP in early-stage cancer patients.

Objective: To explore ACP for early-stage cancer patients transitioning into survivorship care and the nurse navigator’s role in supporting individual ACP needs.

Methods: A multihospital convenience sampling was conducted in Central and Panhandle Florida during a 3-week timeframe. A blinded, cafeteria, and ranking questionnaire was distributed to patients meeting eligibility. The eligibility criteria for selecting patients were (1) stage I or II breast, lung, and gastrointestinal cancer patients; (2) completion of active cancer treatment; and (3) receiving of survivorship care plan.

Results: A consecutive sample of 30 eligible patients completed a patient self-report or telephone interview with 80% response rate (n = 24). A total of 7 (29.2%) male and 17 (70.8%) female respondents completed the survey. Age of respondents varied from 26 to 49 years old (8.3%) to 50 to 64 years old (29.2%) and 65 and older (62.5%). All respondents spoke English, with 3 (12.5%) black/African American and 21 (87.5%) white/Caucasian ethnicity. Twelve (50%) breast, 9 (37.5%) gastrointestinal, and 3 (12.5%) lung cancer patients were included in the study. Results revealed that 9 (37.5%) respondents did not have a component of ACP (ie, estate will, living will, power of attorney, healthcare proxy). Of that population, 71.43% revealed no discussion of end-of-life (EOL) preferences within the last 6 months. Respondents indicated preference for children involvement in medical decisions than spouse (66.67% vs 41.67%, respectively). Respondents ranked spirituality (M = 4.5; SD = 3.595), choosing power of attorney and/or healthcare proxy (M = 4.5; SD = 3.310), and creating a will (M = 4.25; SD = 3.435) as most important affairs to settle before EOL. Respondents indicated preference for nurse navigators to provide emotional support during EOL (23.81%), explain EOL expectations (23.81%), make EOL wishes known to others (19.05%), and advocate for comfort care (19.05%).

Conclusions: Although limited, evidence from the study revealed a need for continued promotion and integration of ACP into oncology care. Nurse navigators are key facilitators for identification, coordination, and advocacy of ACP inclusion in patient care planning. Evidence supports improved inclusion of children and addressing the spiritual dimension with ACP discussions. Subsequent research is needed to explore the benefit of early ACP assessment by nurse navigators with early and advanced cancer.


  1. Baker JN, Hinds PS, Spunt SL, et al. Integration of palliative care practice into the ongoing care of children with cancer: individualized care planning and coordination. Pediatrics Clinics. www.pediatric.theclinics.com/article/S0031-3955(07)00154-X/abstract. Published February 2008. Accessed June 25, 2018.
  2. Barnes S, Gardiner C, Gott M, et al. Enhancing patient-professional communication about end-of-life issues in life-limiting conditions: a critical review of the literature. Journal of Pain and Symptom Management. www.jpsmjournal.com/article/S0885-3924(12)00206-0/fulltext. Published December 2012. Accessed June 16, 2018.
  3. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomized controlled trial. BMJ. 2010;340:c1345.

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Last modified: November 15, 2018

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