Background: In June 2017, Massey Cancer Center at Virginia Commonwealth University Health (VCUH) identified a need to improve the patient experience by increasing collaboration among oncology service lines. Stakeholders identified opportunities based on: Press Ganey ratings, prior multiprovider clinics, and patient desires.
A breast cancer patient’s treatment plan requires the work of multiple providers including surgical oncology, medical oncology, and radiation oncology staff. A pilot project, the Breast Cancer Collaborative Care Clinic (BC4) was implemented on October 17, 2017. BC4 offers an appointment with a care team that includes a breast nurse navigator, social worker, research nurse, clinic nurse, nurse practitioner, surgical oncologist, medical oncologist, and radiation oncologist.
Objective: Massey Cancer Center at VCUH will utilize the breast nurse navigator to screen and recommend 100% of newly diagnosed breast cancer patients for BC4.
Methods: In 2016, an experienced oncology nurse navigator was hired to revamp the breast nurse navigator role. Due to the breast nurse navigator’s role across the care continuum, the team identified the breast nurse navigator as being instrumental in reviewing and verifying accurate scheduling for all new breast cancer patients. This step was imperative in developing an effective BC4 program.
BC4 provides an opportunity for the patient to meet with multiple providers during a single visit, receive a real-time comprehensive treatment plan, and leave with follow-up appointments scheduled. The breast nurse navigator is key for a successful appointment; contacting and assessing patient’s needs in advance, providing details on what to expect, and placing the patient on the weekly breast tumor board agenda for discussion.
Validation was completed using quantitative data; institutional data collected included new calls by service line, satisfaction scores, percentage of second opinions who stay for care, percentage who travel more than 50 miles, and count of new versus existing patients to health system. Qualitative data (nurse navigator encounters) methods were also used.
Results: Data at the 12-month point showed increases in patient satisfaction scores and patient retention and a need for expansion due to patient demand and increasing provider participation. In April 2019, BC4 expanded to a full day (morning and afternoon clinic), with the addition of another surgical and medical oncologist, and into a new space. In July 2019, BC4 expanded again adding an additional location, increasing patient accessibility. Nine providers participate in BC4; 1 nurse practitioner and 3 surgical, 3 medical, and 2 radiation oncologists; additionally, 3 social workers provide support at each location. The breast nurse navigator actively participates in all 3 BC4 experiences.
Conclusion: The implementation, coordination, and completion of every BC4 involve collaboration with multiple individuals across oncology service lines. The success of the program is dependent on the breast nurse navigator, who ensures that the needs of the patient are met and coordination of care across service lines occurs. Processes utilized in BC4 have streamlined identified barriers within the organization and have been utilized as models in other strategic initiatives. The plan is to use BC4 as a template to expand to other cancer service lines treated at VCUH.
Source
- Franks B, Iverson M, Miller J. Breast Cancer Navigation. In: Blaseg K, et al (eds.). Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum. Pittsburgh, PA: Oncology Nursing Society; 2014.
