Improving Non–Small-Cell Lung Cancer Care Delivery: Findings for Oncology Nurses and Patient Navigation from a National Quality Survey

November 2020 Vol 11, No 11
Jennifer Aversano, MSN, RN, OCN, BMTCN
Advocate Lutheran General Hospital,
Park Ridge, IL
Leigh Boehmer, PharmD, BCOP
Association of Community Cancer Centers
Alexander Spira, MD, PhD, FACP
Virginia Cancer Specialists, Fairfax, VA
US Oncology Research
Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD

Background: Oncology nursing and patient navigation are vital components of optimal cancer care planning, coordination, and delivery within multidisciplinary teams (MDTs). Although widely implemented in clinical practice since its inception, the design and delivery of patient navigation services in cancer care is often heterogeneous. The role and function of patient navigation within cancer MDTs, including evidence-based interventions that can positively impact patient outcomes, needs further clarity.

Objectives: To evaluate care coordination for advanced (stage III/IV) non–small-cell lung cancer (NSCLC) by different disciplines that constitute MDTs, including oncology nurses and patient navigation, and identify barriers to optimal care delivery.

Methods: Insights of oncology MDT members (ie, oncologists, pathologists, pulmonologists, thoracic surgeons, oncology nurses, patient navigators, pharmacists, and cancer center administrators) from a diverse set of US cancer centers were gathered via a comprehensive, double-blind, web-based, national survey between January 24 and April 25, 2019. Survey questions were customized for MDT disciplines using skip logic and included topics such as NSCLC screening, diagnosis, treatment, and care coordination. Subanalyses examined relationships between NSCLC care delivery practices relevant to oncology nursing and patient navigation and outcomes, such as shared decision-making (SDM), using statistical testing.

Results: The survey included 639/1211 complete responders (response rate, 52.8%) from 160 unique oncology programs across 44 US states. More than half (54.9%, 351/639) were affiliated with programs that could be categorized as “community based.” Of the total respondents, 75 (11.7%) were oncology nurses, nurse navigators, or advanced practice nurses, and 33 (5.2%) were financial advocates, navigators, or social workers who provide financial counseling and support patient access. Across programs, there was a lack of nurse or lay navigators (22.3%, 101/452) to assist patients with NSCLC. Among cancer program types, integrated network cancer programs were significantly more likely to not have a navigator than to have one (7.9% vs 3.1%; P <.05). Most respondents (90.1%, 100/111) reported no formal health literacy assessments in their programs. Presence of navigation services also has a significant impact on SDM. Compared with programs without patient navigators, participants in programs with patient navigators for NSCLC had significantly higher (P <.05) mean scores for the following elements of SDM: (1) explaining SDM (3.29 vs 3.82; P = 0), (2) asking patients if they wish to engage in SDM (3.11 vs 3.55; P = .005), (3) explaining risks/benefits of treatment options (3.52 vs 3.81; P = .025), and (4) use of decision aids to help patients participate in their healthcare decisions (4.02 vs 4.28; P = .033).

Conclusions: These care coordination insights highlight the need for further expansion of patient navigation and may be used to inform efforts to enhance high-quality, patient-centered NSCLC care. Specific areas for improvement include increasing health literacy assessment use; improving patient education and engagement through the use of patient navigators, thus reducing the burden on other providers; and continued integration of navigation services within lung cancer MDTs.

Disclosure: This study was funded by AstraZeneca.


Desveaux L, McBrien K, Barnieh L, Ivers NM. Mapping variation in intervention design: a systematic review to develop a program theory for patient navigator programs. Syst Rev. 2019;8:8.

Freeman HP. The origin, evolution, and principles of patient navigation. Cancer Epidemiol Biomarkers Prev. 2012;21:1614-1617.

Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer. 2011;117(15 Suppl):3539-3542.

Freund KM. Implementation of evidence-based patient navigation programs. Acta Oncol. 2017;56:123-127.

Gorin SS, Haggstrom D, Han PK, et al. Cancer care coordination: a systematic review and meta-analysis of over 30 years of empirical studies. Ann Behav Med. 2017;51:532-546.

Hunnibell LS, Rose MG, Connery DM, et al. Using nurse navigation to improve timeliness of lung cancer care at a veterans hospital. Clin J Oncol Nurs. 2012;16:29-36.

Kehl KL, Landrum MB, Arora NK, et al. Association of actual and preferred decision roles with patient-reported quality of care: shared decision making in cancer care. JAMA Oncol. 2015;1:50-58.

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.

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Last modified: May 7, 2021

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