The Development of Navigation Tools to Assess Medical and Social Barriers to Care

Background: The role of the registered nurse patient navigator at Lehigh Valley Health Network (LVHN) is to educate and support people diagnosed with cancer through the continuum of care. The care provided by the navigator begins at diagnosis and continues through to survivorship. At LVHN, we recognized a need for a comprehensive program whereby the navigator would identify the patient’s medical and social needs early in the treatment course and chart the barriers to care as well as interventions in a central database accessible by the entire care team.

Methods: The development of a comprehensive navigation role at LVHN began with the creation of navigation tools. The templates and completed forms have all been incorporated into our electronic medical record, MOSAIQ. Our tools include the Nurse Navigator Patient Interview and Barrier Identification form, the Tumor Board Pre-conference Presentation worksheet, and the Navigation Data Base. By using the Patient Interview template during the first encounter with the newly diagnosed patient, the navigator can identify barriers to care and make necessary consults to resolve them. By using the Pre-conference Presentation worksheet, the navigator can present a multifaceted overview of the patient’s medical and social history and needs at the Multidisciplinary Tumor Board. By using a central database, the care team has a single place to access the information.

Results: This poster  will showcase the tools described above and the data that have been collected regarding 4 specific barriers to care as well as the steps taken by the navigator to help overcome these barriers. Of the 102 patients identified with barriers to care, 6 patients with a language barrier were referred to our bilingual navigators and social worker for their care. Eleven patients had transportation issues and were referred to our social worker, who helped set up volunteer drivers through the American Cancer Society and a local program called “Wheel Time.” Twenty-four patients who were either underinsured or uninsured were referred to our financial counselors for help, and 28 patients with social or personal issues were referred to our Cancer Support Team for counseling or to our Smoking Cessation program.