The Importance of Role Delineation in Navigation

The nurse navigator, the oncology social worker, the financial navigator, and the lay navigator all provide critical guidance to patients throughout the cancer continuum, but effective communication between departments, well-defined pathways, and role delineation are crucial to prevent the duplication of services and wasted time.

The Nurse Navigator

The role of the nurse navigator is based around the core competencies of navigation, including the facilitation of timely and coordinated care, education and empowerment of patients and caregivers, promotion of patient- and family-centered care, and effective communication within the multidisciplinary team.

Effective team collaboration can help to prevent unnecessary hospital admissions and promote adherence to the treatment plan. "The better we can communicate with the members of our team, the more efficient we can be for our patients," explained Kristina Rua, BSN, RN, ONN-CG, a gynecologic oncology nurse navigator from the Miami Cancer Institute.

The Miami Cancer Institute employs a system-based collaborative process during which nurse navigators conduct distress screenings to determine psychosocial and other barriers to care for patients. Once barriers to care have been identified, the nurse navigator will make appropriate referrals to licensed clinical social workers, financial counselors, and other support services.

Distress screening also assists in the determination of needs for other community resources, such as transportation, Medicare/Medicaid referrals, and referrals to cancer support programs (ie, cancer rehab/physiology, support groups, nutrition, and survivorship).

She said one of the main challenges for nurse navigators is that of role limitations: understanding boundaries and scope of practice, and determining where the nurse navigator's job stops and the roles of others on the care team begin. "As nurse navigators we have all sorts of challenges, but the biggest one is understanding what our role is," she said at the AONN+ Midyear Conference.

The Social Worker

According to Katherine Easton, LCSW, OSW-C, an oncology social worker at Atlanta Cancer Care, many oncology social work programs around the country are moving toward a more mental health–focused model. "Because there are now more patient and lay navigators, our role is changing," she noted. "We're finding the discipline is moving away from some of those more practical areas." But communication is key when it comes to clearly delineating roles among navigators, social workers, and other members of the care team working in different departments, she added.

Among other core functions, oncology social workers perform comprehensive psychosocial assessments, counseling, education, patient navigation, case management, resource coordination, and program development. "It should be pretty obvious that some of these areas overlap with others' roles, but through effective communication we avoid duplication," she noted. "For example, all of us on the team provide education, we just provide it in different areas."

For effective collaboration to take place, members of the care team must understand their limitations, focus on their individual clinical strengths, and realize where another clinician's scope of practice begins, she said. Effective and efficient pathways for communication, referral, and follow-up should also be in place.

The Financial Navigator

According to Clara Lambert, an oncology financial navigator at Cowell Family Cancer Center in Traverse City, MI, financial navigators should aim to maximize health insurance benefits, reduce economic barriers to care, and accurately explain insurance coverage. "That's where my portion of the education comes in, because many, many people do not truly understand their health insurance coverage," she said.

Financial navigators also manage, track, and report their interactions to contribute to navigation metrics, ensure providers and staff are aware of ongoing policy requirements, and help to mitigate financial toxicity. Even though patients may communicate their financial distress to many members of the care team, the financial navigator will be the one to deal with a patient's economic barriers to care and step in with actual resources, she noted.

The Lay Navigator

Michele Capossela, senior manager for patient navigation at the American Cancer Society, Northeast Region, said lay navigators should aim to begin fostering relationships with patients at diagnosis and work with them throughout the cancer continuum. "We really want to start from the beginning and make sure that we're part of that patient's journey, and also start around that baseline where the patient is," she said. "It's not episodic. It's not just one and done."

The American Cancer Society Patient Navigation Program utilizes a "disparities-reducing" strategy and employs nonclinical patient navigators who focus on connecting with newly diagnosed and underserved (uninsured, Medicaid, Medicaid + Medicare) oncology patients. These navigators work to identify patients' barriers to treatment and create a plan for addressing those barriers.

She said lay navigators can take on more "concrete" tasks than other navigators (ie, completing paperwork, finding local or statewide resources, providing information on clinical trials or survivorship programs), while triaging the more clinical questions.

"We're active listeners, face to face with that patient or caregiver, listening to their cues, knowing there's probably about 10 other questions that they need to ask, but they don't know the questions to ask right now," she said. "Going along with them at their speed is the role of a navigator."