Utilizing Volunteer, Nonclinical Navigators as Extenders of the Breast Nurse Navigator to Provide Patient Education and Support

Background: The role of the breast nurse navigator (BNN) during the treatment phase of the care continuum involves educating patients and families and assisting them with overcoming barriers to care by linking them to appropriate resources. Our BNN provides education to approximately 15 new patients per month. Additional navigation services are provided to 114 patients per month, with an annual caseload of 580. The time and volume of her caseload limits the number of patients she can see in 1 day. We have an existing volunteer nonclinical navigator (NCN) program. We decided to conduct a 3-month pilot project utilizing NCNs in our breast clinic to provide navigation services while the BNN was out on medical leave.

Objectives:

• Evaluate the effectiveness of the NCNs in the setting of the breast clinic
• Identify nonclinical services that NCNs can provide to increase the number of patients served

Methods: Three NCNs were trained by the BNN to provide breast navigation services. Each NCN received a minimum of 10 hours of one-on-one training, which included education regarding breast cancer, common barriers to care, and resources. The BNN created a navigation tool indicating the education and services to be provided at diagnosis, presurgery, postsurgery, and systemic therapy. The NCNs provided education by utilizing videos and written materials. Patient medical questions were then deferred to nursing staff and physicians. The BNN provided training and a resource guide to aid NCNs to identify and link patients with appropriate resources and support staff.

Results: The NCNs provided services to 78 patients, including approximately 10 new patients per month. A total of 24 surveys were completed by the healthcare team and patients. Results revealed 94% of patients agreed/strongly agreed services provided helped them feel better and allay fears, 100% reported helpfulness in linking to resources and support programs, and 50% viewed a video and reported better understanding. The healthcare team overwhelmingly reported that the emotional support provided was beneficial and that NCNs were helpful in providing resources and recommended continuing the NCN breast services.

Conclusions: NCNs can be utilized to provide effective navigation services. Our breast navigation program has shown a 64% increase in new patient encounters and a 79% increase in returning patient encounters compared with the previous year prior to the addition of NCNs. We plan to expand this model into other multidisciplinary clinics.