A Quantitative and Qualitative Quality-of-Life Evaluation of a Large Navigation Team

Background: Sarah Cannon Cancer Institute, the Oncology Service line for Medical City Healthcare in the Dallas/Fort Worth, Texas area, has a team of 13 disease-suite oncology nurse navigators and 2 survivorship navigators. They cover 11 hospitals, with each navigator caring for a high volume of patients. Navigation program leadership observed the impact of emotional stress on the navigators and challenged the survivorship navigators—a social worker/nurse team—to develop a self-care program for the navigation team.

Objectives: To assess and monitor the team’s professional quality of life, common stressors, and self-care needs using a quantitative professional quality-of-life survey and a qualitative self-care survey.

Methods: The Professional Quality of Life Scale (ProQOL) is an evidence-based system of measuring levels of compassion satisfaction, burnout, and secondary traumatic stress. The ProQOL is a 30-item self-report measure of the positive and negative aspects of caring. The tool measures both Compassion Satisfaction and Compassion Fatigue, which has 2 subscales: Burnout and Secondary Trauma.

The self-care survey was created by the survivorship navigation team to gather open feedback from the navigation team to assess the ongoing, ever-challenging nature of the navigation role and in turn provide information to help build a self-care program to meet identified navigator needs.

Results: The oncology navigation staff was polled via SurveyMonkey in the spring of 2016, fall of 2016, and spring of 2017. The navigation team has remained intact throughout all 3 rounds of polling with one exception; 1 navigator was only present for the spring 2016 reporting cycle. The ProQOL scale is divided into 3 sections: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress. The results were as follows: The Compassion Satisfaction scores have remained the same and were noted as “high” per the results scale. The Burnout section showed a lower score in 2017 than in 2016, which was a positive outcome. The Secondary Traumatic Stress section continued to be “low,” congruent with results from 2016.

The self-care survey detailed navigation barriers both in general and specifically in working with oncology patients. Common general barriers the navigators listed include: high-volume workload balanced with time management, intense patient needs, and amount of data entry. Patient-specific challenges related to working with physicians and office staff, having feelings of helplessness/not doing enough, and wanting more knowledge about patient resources. The navigation team also identified the ideal frequency of “self-care modules” (time to address self-care concerns) and navigator retreats, topics, and meeting formats (eg, speakers, open forum, etc).

Conclusions: The initial quantitative and qualitative results from these surveys provide a comprehensive overview of the navigation team’s professional quality of life—specific and general barriers identified by the navigators, and interventions for how navigation leaders/facilitators can address navigator needs moving forward. Based on these results, the survivorship navigation team and navigation leaders have developed monthly self-care modules. In addition, as the navigators provide ongoing feedback, programs have been tailored to meet their identified need to include topics related to discussions with community partners and resources, an open time of collaboration within the navigation team by disease site, presentations by behavioral health guest speakers, and finally time to socialize as a team, as well as team building activities. Our survey functions as an ongoing way to monitor team health and address common challenges in real time by using both a quantitative and qualitative approach.