Background: Nurse navigators play a vital role in promoting quality oncology care to all patients. However, numerous barriers to care have been reported that cause delays in care management and compromise overall health outcomes.1 One issue impacting the outcome of survivorship and quality of life is timeliness to care.2 On April 1, 2018, Ocala Health System transitioned from a general navigation model to a tumor site–specific model with the addition of a certified breast navigator with the belief that a site-specific navigator will more effectively prepare patients for care through education and more effectively remove barriers specific to breast cancer patients. A quarterly breast-specific workgroup, including surgeons, oncologists, navigators, director of imaging services, hospital administration, and pathologists, was introduced and provided an opportunity to more effectively address the needs of breast cancer patients by leveraging multidisciplinary expertise and improving coordination of care.
Objectives: To examine the impact of moving from a model of general navigation to tumor site–specific navigation. Timeliness of care will be assessed by analyzing time from diagnosis to first treatment.
Methods: Sarah Cannon navigators will use proprietary software and an ad hoc reporting system from January 1, 2018, through December 31, 2020. Average days to treatment will be evaluated on a monthly and annual basis for comparison of the timeliness to care under a general navigation model versus a tumor site–specific navigation model. We will confirm an improvement in timeliness to care from diagnosis to first treatment by analyzing data over the program’s first 2 years compared with the 3 months prior to implementation.
Results: The average time from diagnosis to first treatment for 2018 was 25 days. In 2019, after initiation of a tumor site–specific program, the average time from diagnosis to first treatment decreased to 21 days. In 2020, the average time from diagnosis to first treatment was 17 days. By having a navigator focus specifically on patients with breast cancer, multiple benefits were recognized. Professional relationships with key stakeholders were fostered. Relationships between the nurse navigator and mammography coordinator were enhanced prompting more timely communication of positive pathology, which resulted in expedited care plans for patients. By allowing the navigator to focus on a site-specific tumor they were able to identify additional community-based resources for patients with breast cancer, including wigs, postsurgical camisoles, mastectomy bras, and port pillows. Discussions held with breast-specific providers at a breast workgroup resulted in the addition of breast MRI, 3D mammography, stereotactic biopsies, and expedited pathology resulting in more timely care.
Tumor site–specific navigation also encouraged the navigator to obtain certification specifically designated for breast care nurses demonstrating increased knowledge resulting in enhanced patient education.
Conclusion: At Ocala Health System, implementation of a site-specific navigator along with a quarterly multidisciplinary breast workgroup was associated with the improvement of timeliness to care by an average of 8 days. This improvement validates the importance of tumor site–specific navigation, along with engagement of key stakeholders, in reducing delays in care within this health system.
- Simon D, Rassi Y. Removing the barriers to care for breast cancer patients: improving timeliness to care. Journal of Oncology Navigation & Survivorship. 2020;11(12):481-484.
- Basu M, Linebarger J, Grabram SGA, et al. The effect of nurse navigation on timeless of breast cancer care at an academic comprehensive cancer center. Cancer. 2013;119:2524-2531.