Nurse Navigation: Implementing a Program and Improving Outcomes, One Prostate at a Time

Background: In February 2019, to more fully support prostate cancer patients with sexual health and urinary recovery posttreatment, Sutter Medical Center Sacramento implemented a nurse navigator to facilitate patient participation in a survivorship support group and education around symptom management. To understand treatment pathways and patient throughput when navigating prostate cancer, the new nurse navigator retrospectively reviewed the charts of patients who had a consult in the urology clinic for treatment of their disease. Following the National Comprehensive Cancer Network (NCCN) guidelines, the nurse navigator observed a recurring theme and barrier to care: intermediate- and high-risk prostate cancer patients were not routinely referred to Radiation Oncology and Medical Oncology for education of additional treatment options per NCCN guidelines.^1,2 Of 94 patients who had urology consults, 59 were identified as intermediate-risk and 22 as high-risk. While 53 intermediate- or high-risk patients had surgery, only 10 of the 53 (19%) were referred to Radiation Oncology prior to surgery, and only 1 patient was referred to Medical Oncology prior to surgery (0.01%). Thus, per American Urological Association and NCCN guidelines, 81 of these 94 patients (86%) should have been referred to both Radiation and Medical Oncology for consultation of their disease.^1,2

Objectives:

1. Participants will learn how to utilize data to achieve stakeholder buy-in to implement change and best practices.
2. Participants will learn how the implementation of best practices may introduce new revenue streams and improve patient satisfaction with outcomes.
3. Participants will gain knowledge around navigating institutional norms and participating in crucial conversations to implement best practices and improve patient outcomes.

Methods: A retrospective chart review was conducted. Data were obtained from 94 medical records from 1st quarter 2018.

Results: With thoughtful consideration for institutional norms, nurse navigation and leadership were able to bring all stakeholders together in the development of multidisciplinary tumor boards. This programmatic enhancement ensures that all patients with intermediate- and high-risk disease will have their case reviewed by each specialty and referred per NCCN guidelines for consultation of treatment options.

Conclusion: Multidisciplinary prostate tumor boards will commence September 4, 2019. A process agreed on by all stakeholders has been put in place for the nurse navigator to identify patients for review (data to follow). Per current volumes of prostate cancer patients requiring treatment, we anticipate discussing 2 to 4 patients weekly, which will generate up to 8 additional referrals to other pertinent specialties each week. Most importantly, patients will have the additional information necessary to make an informed decision in regard to the best treatment option for their cancer.

References

1. Sanda MG, Chen RC, Crispino T, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline. American Urological Association Education and Research. 2017.
2. Chin J, Rumble RB, Kollmeier M, et al. Brachytherapy for patients with prostate cancer: American Society of Clinical Oncology/Cancer Care Ontario joint guideline update. J Clin Oncol. 2017;35:1737-1743.