The Role of the Nurse Navigator in Women’s Health

The role of the oncology nurse navigator in women's health is "education, education, and more education," according to Kristina Rua, BSN, RN, Gynecology Oncology Nurse Navigator at Baptist Health South Florida in Miami.

At the AONN+ Midyear Conference, she discussed the vital role of the nurse navigator in treating cancers specific to women, as well as the common barriers that keep those women from receiving the care they need.

Navigators are responsible for coordinating care and breaking down barriers, she said. In Miami, for example, many patients are uninsured, underprivileged, undocumented, and uneducated, making advocacy and education for these patients particularly important. Additionally, many of them do not speak English, so explaining their disease process—while taking into account multicultural learning styles—can be incredibly challenging.

Coordinating care involves making the appropriate referrals to genetic testing, particularly for patients with breast, ovarian, and endometrial cancers. Financial counseling is also of utmost importance. Whether a woman is her family's provider, caretaker, or both, her cancer diagnosis and treatment will affect her entire family.

Treatment planning is vital, including coordinating the start of chemotherapy with concurrent radiation therapy. This might involve reaching out to other navigators at outside institutions to make sure that coordination is actually carried out. And planning for radiation therapy involves even more education, particularly explaining to patients that treatment won't start right away but involves preliminary steps like imaging, Ms Rua noted.

Addressing women's health means addressing family planning and referral to fertility preservation programs. It includes education on postsurgical recuperation, addressing issues like postoperative pain and recovery, and recognizing signs and symptoms of lymphedema. It means educating women on the realities of dealing with surgically induced menopause and pelvic floor rehabilitation.

"A lot of women don't understand the concept behind pelvic floor rehabilitation, so education is key in breaking down that stigma," she said. "Telling them, 'you are going to have cystitis, you are going to have vaginal stenosis, and those dilators they're giving you are crucial to use.'"

Educating patients about human papillomavirus (HPV)-associated cancers is vital, she stressed, because many patients with HPV are unaware of the dangers of neglecting their follow-up care.

Women should be educated about chemotherapy and its side effects, including the potential for devastating hair loss and therapies—like cold caps—to mitigate it. They should be prepared for chemotherapy-induced nausea and vomiting, which tends to be more intense for women than for men, and told about treatments for it—such as acupuncture.

The nurse navigator plays a crucial role in the survivorship phase and in making sure a patient receives a treatment summary plan, particularly to address late and long-term side effects that will no longer be monitored by a physician.

"Psychosocial support is big for coordination of care," Ms Rua said. She told a story of a GYN patient who went to a cancer support community center in Miami. She was looking for other women with whom she could discuss her side effects but was told there was no GYN support group because "all of them died."

"When she came back to me, it broke my heart," she said. She was compelled to start a GYN support group for those women at her own institution. That group now hosts between 30 and 40 patients at their monthly meetings. They offer education programs, discuss comorbidities, tackle the stigma around depression and anxiety, talk about side effects and treatment modalities, and bring in experts on integrated medicine, nutrition, and sexual health. Conversations about sexuality and treatments for sexual dysfunction are crucial, she added, particularly for younger women.

"The support group has made a big difference," she said. "Eighty percent of my ovarian cancers recur, but it's not the end of the world to them anymore. They realize that they're still going to have good quality of life, and that maintenance therapy is something they're prepared for."

"We're all patient advocates," she added. "We have to empower our patients. We have to educate them."