Structured Oncology Nurse Navigator Assessment (ONNA) Leads to Process and Outcome Metrics While Enhancing Patient and Family Experience

Background: The oncology nurse navigator (ONN) team at our academically affiliated community cancer center offers comprehensive navigation across treatment modalities from prediagnosis through survivorship care for patients with a variety of malignancies. While oncology nurse navigation roles are increasingly well established, the utility of structured assessment, use of assessment data in care planning, and integration of an ONN assessment in the electronic health record (EHR) are less apparent across the navigation and care coordination literature.^1-3

Objectives: To develop a structured Oncology Nurse Navigator Assessment (ONNA) to improve patient assessment, be imbedded in EHR, and build a database as a foundation for data-driven navigation and quality assurance.

Methods: The ONN team used combined methods of literature review and nominal group consensus technique to identify and refine domains and write items to include in the assessment.^4,5 Literature search terms included nurse navigator, barriers to care, oncology, and care continuum. The service line manager and oncology faculty from our associated school of nursing reviewed the draft ONNA before we piloted it in practice.

Results: The ONNA allowed ONNs to move beyond anticipating general patient needs, as indicated in the navigation literature, to appreciate and then document a more complete and individualized understanding of each patient. Using the ONNA, the ONN team quickly learned how often questions about patient and family situations remained unasked by other clinicians and, when asked, returned information essential to treatment planning, resource identification, and elimination of barriers to care. Preliminary analysis suggests assessment data are helpful in achieving both process and outcome metrics while enhancing patient and family experience. Illustrative case studies are reported to support highlighting the link between assessment approach and clinical care delivery. Questions in the ONNA align with common barriers to care faced by cancer patients such as transportation, coping, insurance, and finances, among other topics.⁶ The ONNA also evaluates patient understanding and knowledge of their disease and ability to make decisions.⁷ The ONNA appears to be most effective when initiated during the first office visit or first encounter with the ONN to identify needs and plan interaction with the ONN and the interdisciplinary team.

Conclusion: Initial application of the ONNA supports use of this structured assessment. Trial experience shows that modification to include clinical population-specific addenda are likely helpful in refining this current structured approach. Population-specific addenda include, for example, nutrition screening for patients with head and neck cancer; genetic screening for women diagnosed with breast and gynecological cancers; and frailty screening for multimorbid patients at risk for complications, 30-day readmission, and emergency department use. After incorporating these modifications in the next phase of the ONNA project, work to integrate the ONNA into the EHR and develop targeted studies of quality and quality improvement projects is slated to begin. Continued application of the ONNA may help limit overuse and misuse of acute and emergency care as well as support patient and family satisfaction by reducing barriers to care and improving communication across the care continuum.^8,9

References

1. Burhansstipanov L, Shockney LD, Gentry S. History of Oncology Patient and Nurse Navigation. In: Shockney LD, ed. Team-Based Oncology Care: The Pivotal Role of Oncology Navigation. Cham, Switzerland: Springer International Publishing; 2018:13-42.
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3. Gordils-Perez J, Schneider SM, Gabel M, Trotter KJ. Oncology nurse navigation: development and implementation of a program at a comprehensive cancer center. Clin J Oncol Nurs. 2017;21:581-588.
4. McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38:655-662.
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6. Hendren S, Chin N, Fisher S, et al. Patients’ barriers to receipt of cancer care, and factors associated with needing more assistance from a patient navigator. J Natl Med Assoc. 2011;103:701-710.
7. Hudson AP, Spooner AJ, Booth N, et al. Qualitative insights of patients and carers under the care of nurse navigators. Collegian. https://doi.org/10.1016/j.colegn.2018.05.002.
8. Baileys K, McMullen L, Lubejko B, et al. Nurse navigator core competencies: an update to reflect the evolution of the role. Clin J Oncol Nurs. 2018;22:272-281.
9. Wells KJ, Campbell K, Kumar A, et al. Effects of patient navigation on satisfaction with cancer care: a systematic review and meta-analysis. Support Care Cancer. 2018;26:1369-1382.