Role of Navigation and Patient Education in the Treatment of Patients With Complex Cancers: Our Experience With Head and Neck Cancer Patients

Background: At Samaritan Hospital Cancer Treatment Center, we realized that patients with a diagnosis of head and neck cancer were having trouble navigating the healthcare system prior to starting treatment. These patients were overwhelmed with scheduling consults, tests, and procedures before treatment could even begin. Many patients became frustrated and confused and did not show up for scheduled appointments or went to the wrong appointment. We recognized patients were not starting recommended treatment in a timely manner. The goal of our mission-oriented organization is to keep patients appropriately educated so we can give them the best care possible. In 2010, we started to streamline the process and developed a Head/Neck Cancer Patient Care Plan. At this time, a navigator was assigned to work with these patients, their families, and physicians. The top priority areas of concern were improving patient compliance in attending scheduled appointments, assigning a navigator as point of contact and care coordination, educating the patient and family about the treatment plan,  reinforcing chemotherapy education, and reviewing side effects and symptoms. Also noted as important was incorporating detection and evidence-based symptom management as part of patient education. It is our goal to assist our patients in receiving treatment services in an equitable and timely manner, to remove barriers to their care, and to educate patients, thereby improving outcomes.

Objectives: (1) Develop and implement a process to streamline scheduled appointments, tests, and procedures. (2) Incorporate navigator in patient care from time of initial diagnosis through the continuum of care. (3) Encourage compliance through education. (4) Increase the percentage rate of successful treatment through a systematic approach to symptom management.

Methods: (1) Implemented a patient care plan for each head/neck cancer patient. (2) Assigned a navigator to each patient diagnosed with head/neck cancer. (3) Developed a chemotherapy education bag that each patient received that included an oral care protocol to promote early detection and management of stomatitis; information about chemotherapy-induced peripheral neuropathy and recommendations for management, including safety concerns and prevention of falls; a skin care protocol to promote early detection and management of dermatitis secondary to chemotherapy/biotherapy and radiation treatments; an explanation of neutropenia—what it is and what it means to patients and their families. (4) Developed a color-coded chart featuring 3 zones to visually indicate for patients and their families what should be done under various circumstances. The green zone indicates being at goal and stable; the yellow zone indicates caution and lists symptoms that mean a doctor should be called; the red zone lists symptoms that require calling 911 or taking the patient to the emergency room. (5) Developed a nutritional tip sheet for patients who are undergoing treatment in order to educate patients in managing taste dysfunction and changes in eating habits. Included is a copy of a BMI chart that nurses use when assessing patients. (6) Implemented a chemotherapy class that patients and families can attend in addition to initial individual chemotherapy instruction. This class optimizes the learning experience and standardizes education given to patients.

Results and Conclusions: Implementation of the Head/Neck Cancer Patient Care Plan closed the information gap, coordinated care, and decreased wait time for treatment initiation. Patient compliance increased, and appointments that were scheduled were attended, enabling patients to complete recommended treatment. Involving the navigator at the initial diagnosis and throughout the care continuum further strengthened this process. Time from diagnosis to treatment initiation decreased from an average of 45.38 days in 2009, to 19.20 days in 2010, and 12.60 days in 2011. The education materials provided with protocols for detection and management of stomatitis, skin care, peripheral neuropathy, and neutropenia provided patients with tools they needed to help be responsible for their own care. We developed and implemented a prechemotherapy and postchemotherapy class survey that further validated the importance of reinforced, standardized education. The creation of consistent messages and patient education and the development of the Head/Neck Cancer Patient Care Plan have led to improved care coordination and better outcomes for our patients.