The CATCH: In Support of Symptom Management

This article is supported by funding from AstraZeneca.

Sherry Reji, Oncology Nurse Navigator With MD Anderson Cancer Center

In addition to having an incredible work ethic, [Sherry] is easy to work with and eager to learn. She adapts to change and works to advocate for her patients.

—Jacqueline Jenkins, RN, BSN,
Intake Navigator Supervisor GI/CR,
The University of Texas MD
Anderson Cancer Center

A CATCH is a navigation success story where a navigation tactic improved a patient’s situation. The CATCH Initiative, short for Catching & Addressing Threats to Care & Health, tracks and acknowledges positive outcomes of navigation tactics.

THE CATCH OF THE MONTH

Background: Newly diagnosed pancreatic cancer patient found to have hyperbilirubinemia needing immediate medical attention.

The Incident: The oncology nurse navigator received an 83-year-old newly diagnosed pancreatic cancer patient who had minimal health records and no lab reports. The surgical team provided the patient with an appointment date, and the patient was planning to fly in for his first oncology appointment in 2 weeks. The nurse navigator asked him to get a baseline lab, including a liver function panel. When the lab results came back, the navigator noticed that the patient’s bilirubin was significantly elevated at 26.5 mg/dL.

The CATCH (Intervention): After recognizing his elevated bilirubin level, the navigator immediately called the patient to inform him of his lab results. While discussing his hyperbilirubinemia, the patient reported that he had been having severe and worsening itching of his skin. Understanding the patient might need a biliary stent to drain the bilirubin, the navigator explained to the patient the significance and the urgent need to seek medical attention. The patient stated that his local provider had recommended this procedure recently and had scheduled his stent placement in 2 weeks.

The delay was due to the patient recently having had a COVID-19 upper respiratory infection. Needing to complete a mandatory 14-day isolation period per facility policy, he could not have the procedure done sooner. The patient was frustrated because he had arranged his flight schedule and did not want to wait and risk missing his oncology appointment.

After and notifying the patient’s primary care provider of the lab results and listening to the patient, the navigator explained and educated the patient about the risk of hyperbilirubinemia and that it was not safe to travel for his appointment with his current symptoms and lab findings. The navigator explained that the patient would need the biliary stent placed sooner and strongly advised him to seek medical attention at the nearest emergency center. The navigator also informed the oncology surgical team about the patient’s health status.

Outcome: The patient ultimately sought medical attention and underwent an urgent biliary stent placement at another local medical facility within 24 hours. His repeat bilirubin level after stent placement down-trended to 14 mg/dL. The navigator was able to continue to follow up with the patient while he received care at his local facility and then rescheduled his oncology consultation once discharged from the hospital. The patient was very appreciative of the services and advice of his navigator, especially addressing his logistical challenges with traveling to his medical appointments.

The Importance of the CATCH

To address the patient’s multitude of challenges, the navigator implemented assessment skills unique to the navigation role by addressing not only barriers to care and psychosocial concerns but also by addressing the pertinent clinical situation that needed emergent attention. This patient was caught by the navigator before falling through the cracks and was able to have a positive outcome clinically while also feeling supported emotionally. The navigation role continues to validate the importance of guiding a patient throughout the entire cancer continuum and connecting the dots of the multidisciplinary team, which can be crucial to the patient’s cancer journey and overall experience.

Source

• Bellomo C, Christensen D, Strusowski T. Seasoned navigator: a case study on patient advocacy/patient empowerment. Journal of Oncology Navigation & Survivorship. 2016;7(8):31-32.

Tell us about the navigation tactics that improve the lives of your patients!