Breast Nurse Navigator Role Impacts Timeliness of Care for Breast Cancer Patients

Background: Breast cancer care is delivered by multiple providers over an extended period of time within an already fragmented healthcare system, which has led to gaps in the care process. The breast nurse navigator (BNN) role seeks to address those gaps and improve patient outcomes. Research is needed to measure the effectiveness of the BNN role in improving patient outcomes.

Objective: To evaluate the impact of the BNN role on the timeliness of care across the breast cancer treatment continuum for the breast cancer population served in our healthcare system.

Methods: The BNN contacted patients within 2 weeks of their breast cancer diagnosis and offered ongoing support and guidance to them. The BNN performed a needs-based assessment with each interaction, which resulted in individualized interventions. Those interventions included providing education, emotional support, advocacy, and help with eliminating barriers to needed care. A retrospective study was conducted comparing breast cancer patients who received BNN services (fiscal year 2010) with those patients who received their care prior to the initiation of our BNN program (fiscal year 2009). Specific intervals were evaluated to assess timeliness of care for each time period; the number of days from breast cancer diagnosis (ductal carcinoma in situ or invasive breast cancer) to first treatment (surgery or chemotherapy), the number of days from surgery to the initiation of adjuvant treatment (chemotherapy, radiation, or antiestrogen therapy), and the number of days between more than 1 adjuvant therapy, as was applicable. Data were collected from the cancer registry, the Michigan Breast Oncology Quality Initiative database, nurse navigation worksheets, and the patients’ electronic medical records.

Results: Timeliness of care from diagnosis to first treatment was improved by 17% overall (reduction of 6.3 days), by 19% for invasive breast cancers (reduction of 6.6 days), and by 29% for those needing neoadjuvant chemotherapy. The overall number of days to first adjuvant treatment was improved by 19% (reduction of 8 days). Statistical analysis confirmed a significant reduction in the number of days from diagnosis to first treatment for patients receiving navigation (t[396] = -3.872, P <.001).

Discussion: The role of navigator includes removing barriers to care, improving patient outcomes, and perfecting the overall quality of healthcare delivery.¹ Breast cancer treatment and care can be improved by recognizing the value the nurse navigator role brings to the patient experience and enhancing that role.² Conclusion: The role of BNN serves as a valuable resource for optimizing patient outcomes by significantly improving the timeliness of treatment and supportive care for breast cancer patients.

References

1. Pedersen A, Hack TF. Pilots of oncology health care: a concept analysis of the patient navigator role. Oncol Nurs Forum. 2010;37(1):55-60.
2. Korber SF, Padula C, Gray J, et al. A breast navigator program: barriers, enhancers, and nursing interventions. Oncol Nurs Forum. 2011;38(1):44-50.