Caroline Offit, MS1; Katie L. Fanslau, DNP, RN2; Karen Costello, MSS, LSW, OSWC3; Amy D. Smith, FNP-BC4; Mihir Raval, MD, MPH5; Caron Jacobson, MD, MMSc6; Arnela Kajdic-Tarantino, CTFC7; Peter A. Riedell, MD8; Farrukh T. Awan, MD9; Kate D. Taucher, PharmD, MHA, BCOP10; Allison Harvey, MPH, CHES11; Rifeta Kajdić Hodžić, CHPM1; Ashley Lile, MPS1; Molly Kisiel, MSN, FNP-BC1; Elana Plotkin, CMP-HC1
1Association of Cancer Care Centers; 2Penn Medicine - University of Pennsylvania Health System; 3Cancer Support Community; 4Meredith & Jeannie Ray Cancer Center Ivinson Memorial Hospital; 5New York Oncology Hematology; 6Dana-Farber Cancer Institute; 7St. Luke’s Cancer Institute; 8University of Chicago Medical Center, Association of American Cancer Institutes; 9UT Southwestern Medical Center; 10UCHealth, Advanced Practitioner Society for Hematology and Oncology; 11Rhizome, LLC
Background: Timely patient identification and referral for CAR T-cell therapy (CAR-T) are critical.1,2 Barriers to accessing CAR-T and the high percentage of eligible patients not receiving it are well documented.3,4 Less understood are strategies to maintain relationships between referring programs and treatment centers and implementing timely patient identification, both improving patient outcomes.
Objective: To qualitatively explore and document best practices, perceptions, access to, and gaps in service related to CAR-T with a goal to identify ways in which cancer programs can improve timely patient identification, referral, and multidisciplinary care coordination between referring programs and authorized treatment centers.
Methods: To understand experiences, practices, and needs related to CAR-T patient identification and multidisciplinary care coordination, the Association of Cancer Care Centers convened an expert advisory committee and patient advocacy partners to guide the development of 4 virtual focus groups between September and November 2023. One focus group included CAR-T recipients/caregivers (n=7). The remaining focus groups and interviews included multidisciplinary healthcare professionals (HCPs; n=23) who work at or refer patients to CAR-T centers. HCPs represented included administrators or practice managers (n=4), advanced practice providers (n=6), hematologist/oncologists (n=4), nurse/nurse navigators (n=7), and social workers (n=3). Data collected were stratified by participant type (patients/caregivers or HCPs) and analyzed using a rigorous and accelerated data reduction technique.
Results: All HCP participants emphasized the value of building strong, multidisciplinary relationships between treatment centers and referring providers to improve CAR-T patient experiences/outcomes. HCPs pointed to the value of resources, such as outreach letter templates for community physicians, communication tool kits for CAR-T centers, and interdisciplinary education opportunities to build referral relationships.
HCPs stressed the importance of fostering transparent and trusting relationships with referring providers to optimize treatment outcomes. Electronic health records were cited as an important facilitator for data sharing/ communication throughout and following treatment; participants also emphasized the importance of building personal relationships to improve timely communication. Multiple HCPs noted that providers with positive referral experiences are more likely to refer again, leading to a more seamless process.
Regarding barriers to timely referral, participants noted that financial authorization processes varied significantly by center, impacting patient eligibility determination. Patients/ caregivers (n=4) with access to navigators/financial advocates noted improved access to timely care and reduced financial burden.
Conclusion: These findings highlight opportunities to build capacity and infrastructure to support a multidisciplinary approach to care aimed at increasing early patient identification and optimizing continuity of care across sites. This could be achieved by formalizing organizational relationships to ensure sustained continuity of care, standardizing bidirectional communication/education processes, testing navigation models across the CAR-T care continuum, and providing comprehensive education for clinicians at local and national levels about early patient identification and the short-term, long-term, and late effects of CAR-T. In addition, the results underscore the need for systemic solutions to assist patients and caregivers in navigating financial barriers to care.
Suzanne Wilson, DBA, BSN, RN-ACM; Fallon Benavides, DNP, RN-ACM
MD Anderson Cancer Center, Houston, TX
Background: MD Anderson Cancer Center functioned as a traditional inpatient case management model to address discharge planning services for patients. Acknowledging that oncology patients require a more comprehensive approach, the Case Management Department embarked on a mission to transform from a discharge planning model to a patient navigation model.
Objective: Utilizing identified metrics to show the value of transforming from a discharge planning model to a case management navigation model.
Methods: The new model is designed to facilitate the coordination and management of a patient’s care during their hospital stay, ensuring that they receive the necessary support and resources to optimize their health outcomes that span to the outpatient setting. Key elements needed to establish the new navigation model included establishing an adequate staffing plan, aligning with outpatient oncology nurse navigation, identification of key metrics, establishing a timeline and workflows, and optimizing the use of technology.
Implementation of this model involved development of key metrics for monitoring. These metrics included patient satisfaction, readmission rates, postdischarge alerts, and others. In addition, an important factor in the establishment of this new program was to develop education and training for current and new staff on the difference between the traditional case management model and the new navigation model.
Results: Postimplementation metric results have shown a tremendous improvement in many of our areas. Patient satisfaction using HCAHPS scores have shown the biggest improvement. In the first quarter of the pilot units, there was a 28-point average increase in the “Care Transitions” HCAHPS score, and the highest increase on one unit was 53 points. For the “Discharge Information” domain of HCAHPS, the average increase was 5 points, with the highest being a 19-point increase on one unit. Seven-day readmission rates have decreased an average of 2% or remained at baseline for the first 2 service lines on the pilot units. Postdischarge alerts are sent to every patient at discharged and ask the patient if they need any additional help. These alerts have decreased an average of 24% on the pilot units, meaning that patients feel as if their needs were met prior to discharge.
Conclusion: Changing from a traditional case management model to an inpatient navigation program was a big undertaking at this large oncology hospital, but it has proved to be a worthwhile endeavor. There has been an increase in patient satisfaction by providing an inpatient concierge service. Additionally, the reduction in readmission rates has shown an increase in quality of care by addressing barriers and ensuring a smooth handoff between the inpatient and outpatient navigation teams.
George Washington University School of Medicine and Health Sciences. Oncology Patient Navigator Training: The Fundamentals. 2023. Accessed July 18, 2023. https://cme.smhs.gwu.edu/gw-cancer-center-/content/oncology-patient-navigator-training-fundamentals#group-tabs-node-course-default1
Miller E, Sheaffer H. Academic nurse navigation: unique aspects and strategies for success. Clin J Oncol Nurs. 2020;24:579-581.
Patient navigator in cancer care—a specialized oncology nurse role that contributes to high-quality, person-centred care experiences and clinical efficiencies. Can Oncol Nurs J. 2020;30:227-228.
Smith GL, Banegas MP, Acquati C, et al. Navigating financial toxicity in patients with cancer: a multidisciplinary management approach. CA Cancer J Clin. 2022;72:437-453.
Tipton K, Leas BF, Mull NK, et al. Interventions to Decrease Hospital Length of Stay. Agency for Healthcare Research and Quality (US); Introduction. Accessed July 18, 2023. www.ncbi.nlm.nih.gov/books/NBK574438/
Emily Copus, MSW, OPN-CG; Caleb Evington, LCSW; Abbie Mauney, CHES; Carla Strom, MLA
Office of Cancer Health Equity, Atrium Health Wake Forest Baptist Comprehensive Cancer Center
Background: AYAs are patients between 15 and 39 years of age diagnosed with cancer with unique barriers to care as it relates to age-related needs.1 Our Population Health Navigation program addresses the inequities underserved populations, including AYAs, often face during cancer.2 Tailored patient navigation for AYAs includes oncofertility comeducation and support with referrals.
Objective: To understand the impact of navigation on increasing access to education on and referrals to oncofertility services in AYAs with cancer to improve specialized support of population-specific needs across the adult and pediatric oncology clinics.
Methods: The AYA navigator provides specialized support, including several aspects of oncofertility, such as empowering patients with the knowledge of reproductive options and family planning following a diagnosis to ensure seamless collaboration with the reproductive endocrinology clinic.3 To assess the impact of the new role on supporting oncofertility needs, data captured by the AYA navigator in Epic/Healthy Planet were abstracted retrospectively from July 27, 2022, to February 29, 2024, for analysis. Rates of referral to reproductive endocrinology were then compared with data from 2021 prior to the initiation of the navigation role, also obtained from Epic. Data are reported in the aggregate.
Results: In this cohort (N=152), the most populous group was patients in their 30s (50% aged 30-39 years), with a mean age of 28 years, and more likely to be male (55%). Patients’ race and ethnicity varied, with 64% identifying as White/Caucasian, 18% as Black/African American, 3% as Asian American/Pacific Islander, and 12% as Hispanic/ Latine. The most common cancers were lymphoma (20%), leukemia (19%), breast (16%), and sarcoma (7%). The most common patient barriers documented by the navigator were psychosocial needs (56%), financial and/or insurance concerns (53%), and treatment logistics, such as transportation, lodging, etc (36%). One-fourth of patients (25%) reported a concern or need related to intimacy or fertility, and 26% were educated on fertility preservation and family planning by the navigator. AYA referrals to reproductive endocrinology from 2021 (prior to navigation) to 2023 increased from 2% to 9%, respectively.
Conclusion: AYAs are the most underserved age group in oncology, and to achieve cancer health equity, a greater focus needs to be placed on their unique needs.4 Emphasis on supporting AYA-specific needs through navigation, particularly oncofertility, is essential to providing patient-centered care. Highlighting AYA needs through the lens of navigation increases awareness of their individualized challenges when treating this population, as demonstrated through the oncofertility-related data. These initial data indicate AYA-tailored navigation as a potential viable solution to expand oncofertility support across the multidisciplinary care team to ensure consistency and guidance throughout the continuum of care.
Jennifer Rynning, MPH; Alicia Annamalay, PhD; Meghan Paynter, PhD; Bryan Murphy-Eustis, MBA, MPH; Pat Garcia-Gonzalez, MSc
The Max Foundation, Seattle, WA
Background: Cancer patients from underserved communities in the United States often face significant barriers to accessing quality healthcare, leading to disparities in cancer outcomes. Patient navigation is an evidence-based intervention aimed at eliminating health disparities and improving health equity. The Max Foundation recently launched Max GPS, a patient navigation program.
Objective: Max GPS aims to provide free and confidential support to individuals living with cancer, along with their families and caregivers, by guiding them through the complex healthcare system to ensure they receive timely, coordinated, and culturally appropriate care, targeting medically underserved and underrepresented communities.
Methods: Preimplementation activities included: (1) conducting a patient needs assessment; (2) networking with patient organizations, community health centers, and organizations providing resources; (3) developing the program scope; (4) building a resource library; (5) recruiting a patient navigator; (6) developing program materials; (7) devising a communication and outreach strategy; (8) fundraising; and (9) developing a technology platform for patient tracking and reporting. The program was implemented in July 2023 through the launch of an online contact form and email distributed to patient organizations, community health centers, and other stakeholders and promoted via a press release. Individuals who requested support from Max GPS completed an intake form that would provide the patient navigator with additional information to streamline care coordination.
Results: From July 2023 to March 2024, Max GPS supported 139 individual patients, families, and caregivers through 226 total interactions. Among the 139 individuals supported, 128 (92%) were from 23 states in the United States, and 11 (8%) were from outside the United States. Of the patients who reported demographic information, 43 (57%) were female, and the average age was 51 years. Fifty-two (93%) were from low-income households (less than $30,000 per year). The most frequently reported diagnosis was blood cancer (39%), followed by multiple myeloma (17%) and lymphoma (15%). The most requested support services were financial assistance (53%), transportation and lodging (13%), general information (9%), and treatment access (8%). Support provided by the program’s patient navigator included connecting patients with resources, coordinating care, and offering emotional support. The average number of interactions per patient was 1.6, primarily through phone calls and emails.
Conclusion: The program implementation activities were key to early success of the program, as evidenced by the number of individuals supported. Collecting feedback from individuals supported in the future can help evaluate if the program effectively leads to improved patient outcomes and satisfaction. Max GPS provides a viable patient navigation model for reducing health disparities in cancer care.
Jeanine Lynch, RN, BSN, OCN, CBCN
University of Vermont Health Network – Champlain Valley Physicians Hospital, Plattsburgh, NY
Background: In 2017, care coordination at a rural healthcare system included patient diagnosis disclosure by telephone and the patient being responsible for self-referral to surgery. Multidisciplinary care coordination (MCC) is essential in influencing delivery of cancer care services.1 Therefore, a multidisciplinary team approach for coordination of care was developed to include navigation, medical oncology, and surgery to improve delivery of care and surgical retention.
Objective: To enhance the MCC model by studying the impact of distress scores and surgical retention with early navigation intervention and coordination of medical oncology consults prior to surgery.
Methods: A previous study on early navigation intervention and distress score was completed at this rural healthcare system. The study revealed decreased distress levels with early navigation intervention (preintervention distress score of M=7.44, SD=2.68, vs postintervention distress of M=2.94, SD=1.86), with increased patient retention from 60% to 96%.2 A follow-up study with convenience sampling (N=10) was conducted to study the impact of distress scores and surgical retention on newly diagnosed breast cancer patients (mean age, 56.3 years) with coordination of medical oncology consults prior to surgery from October 1, 2020, to December 1, 2020. Distress level data were collected prior to and at conclusion of the medical oncology consult using the NCCN Distress Thermometer. Multiple choice and open-ended surveys were provided to out-migrated patients to identify themes and future initiatives for patient retention.
Results: After a preliminary 3-month study, a regression of distress scores was seen with the MCC model (Pre- 5.1 vs Post- 2.7) with early referral to medical oncology by navigation. An increase in surgical retention was noted at 90% versus 60% with coordination of medical oncology consult by navigation prior to surgery versus self-referral. An out-migration survey was mailed to patients (N=20), with a response rate of 43.4%. The identified themes were patient reassurance in knowledge of multidisciplinary cancer team members at the beginning of diagnosis, patient-centric comprehensive care, and psychosocial support.
Conclusion: Although limited, evidence positively supports early care coordination of medical oncology and surgical consults by navigator on distress assessment score and patient retention. Subsequent research is needed to explore sustainability of the MCC model process considering staffing and medical oncology shortage.
Candace Bashaw, MSN, RN, OCN; Kris Blackley, MSN, RN, BBA, OCN; Jill Hyson, MSN, NP-C, AOCNP; Emily Ann-Marie Copus, MSW, OPN-CG; Carla Strom, MLA; Laura Kabrich, MSN, RN, BA Psych, ACM; Laura Hayes, MSN, RN, OCN
Atrium Health Levine Cancer, Concord, NC
Background: Utilization of an acuity scale in oncology patient navigation plays a pivotal role in understanding the complexity of the patients’ needs and the amount of navigation that may be required. Navigation programs often utilize acuity scoring to balance caseloads and to justify additional navigation positions.
Objective: To implement a comprehensive and objective acuity grading system across a large, multisite learning health system with varied types of navigators.
Methods: Representatives from Levine Cancer and Wake Forest Baptist (WFB) met to compare current acuity scoring systems. Both teams agreed they desired to develop a comprehensive acuity scoring system that removed subjectivity and focused on specific factors that result in a more accurate acuity level, building upon the current WFB acuity tool. Specific patient characteristics and barriers were selected and weighted based on the severity/complexity. Patient characteristics focused on symptoms, treatment, and other comorbidities. Barriers chosen emphasized insurance, support, financial status, and access to care. Each characteristic/barrier was assigned a weight between 0 and 3 depending on its ability to impact a patient’s overall ability to receive recommended care. The total score is calculated by the electronic medical record and assigns an acuity rating of no navigation needed, low, medium, or high acuity.
Results: The acuity scale flowsheet, within the integrated documentation, has a comprehensive list of specific patient characteristics and barriers that determine a patient’s overall acuity level. Navigators can increase the score if there are additional factors not captured with the flowsheet. The rating of no navigation, low, medium, and high acuity is easier for other members of the healthcare team to understand and helps navigators determine how much proactive navigation the patient will require. Guidelines recommend navigators reassess acuity scores throughout the continuum and at each change of treatment modality to ensure the rating is still accurate.
Conclusion: Development of the acuity scale has created more consistency within navigation programs across the Southeast region when determining a patient’s overall acuity level. Subjectivity in determining a patient’s acuity level is limited by creating a scale that allows navigators to select specific patient characteristics and barriers. This has also helped to standardize how navigation is now delivered across the institution. Future plans include ongoing evaluation of the scale and continued evolution beyond the initial implementation period.
Jo Gonzalez, MSN, RN, NE-BC; Tarin Foley, BSN, RN
Mayo Clinic Arizona, Phoenix, AZ
Background: At Mayo Clinic Arizona, the existing workflow for the oncology nurse navigator (ONN) revolves around managing the intake process for all referrals. The ONN’s responsibilities encompass triaging the patients for consultation, obtaining pertinent medical records, and scheduling appropriate multidisciplinary consultation appointments. Presently, each ONN handles a substantial volume of referrals, ranging from 80 to 130 per month.
Given the high volume of referrals, the ONNs face challenges in providing essential touchpoints and addressing barriers to care throughout the entirety of the patient’s cancer treatment journey, as advocated by both the Academy of Oncology Nurse & Patient Navigators and the Mayo Clinic Cancer Center.
Objective: In response to this identified gap, a pilot program was conceived to investigate whether transitioning the responsibility of referral intake from the ONNs to medical assistants (MAs) could lead to improvements in patient outcomes, satisfaction levels, and healthcare team experiences.
Methods: A 6-month pilot in the head, neck and thoracic (HNT) disease group was initiated, utilizing a descriptive design. The intake process was transferred from ONNs to MAs, enabling ONNs to concentrate on pivotal touchpoints throughout patients’ cancer care.
During the pilot, the ONN actively recruited 131 patients needing complex care. They included patients with head and neck or metastatic lung cancer and those encountering known barriers to care. A comprehensive process map was devised for the ONN, delineating scheduled touchpoints with patients at critical junctures during their treatment. Through this approach, the ONN effectively addressed barriers, delivered necessary interventions, and guided patients through their care continuum. In addition, a patient satisfaction survey was disseminated to all patients who received multiple touchpoints from the ONN.
Results: The ONN navigated 131 patients, while maintaining a continuous volume of 73 patients per month on average. The ONN provided patients with 434 touchpoints, 701 interventions, addressed 605 barriers to care, placed 121 referrals to revenue-generating services, averaged 3.3 touchpoints per patient, and addressed on average 2.2 more barriers to care per patient.
Each patient in the pilot was provided a satisfaction survey. Patients scored either agree or strongly agree with an average of 4.6 on a 5-point Likert scale (1-5) that this service was beneficial. In addition, the 2 physicians in HNT practice noted an increase in patient satisfaction scores. In the category of concern for questions/worries, an increase was seen in satisfaction from 70.8 to 81.6 for the head/neck provider, while the lung provider saw an increase from 89.9 to 91.2.
Challenges encountered during the pilot encompassed patients who were nonresponsive to phone communication attempts for essential assessments and crucial touchpoints. Additionally, some patients transferred care, resulting in their departure from the pilot program.
Conclusion: The success of the pilot was demonstrated through a multifaceted analysis that showed enhanced patient outcomes, improved levels of patient and physician satisfaction, and an increase in return on investment. These pivotal metrics showed that the pilot yielded tangible benefits across multiple components.
Kimberly Demirhan, MBA, BSN, RN1; Jacqueline Dibble, FNP-BC, APRN2; Hilda Haynes-Lewis, PhD, ANP-BC, AOCNP3; Steven Francis Powell, MD4; Beth Michelle Beadle, MD5; Tammara L. Watts, MD, PhD, FACS6; Jessica H. Maxwell7; Linda Hutkin-Slade, MSW, LCSW, OSW-C8; Angie Rush9; Eileen Sexton9; Molly Kisiel, MSN, FNP-BC1; Elana Plotkin, CMP-HC1
1Association of Cancer Care Centers; 2Yale New Haven Hospital; 3Montefiore Medical Center/Albert Einstein College of Medicine; 4Sanford Cancer Center; 5Stanford University; 6Duke University Medical Center; 7Pittsburgh Veterans Affairs Medical Center; 8Sharp Grossmont Hospital; 9Head and Neck Cancer Alliance
Background: Head and neck cancer (HNC) is a complex disease that requires multidisciplinary care, which poses significant challenges for both patients and healthcare providers. Although evidence-based guidelines exist, achieving optimal HNC care faces many barriers. This mixed-methods study explores the perceived barriers by patients and clinicians to optimal HNC care, with a focus on the need for navigation services and care coordination for multimodal treatments.
Objective: The Association of Cancer Care Centers (ACCC) collaborated with the Head and Neck Cancer Alliance and the American Society for Radiation Oncology, along with an expert steering committee of multidisciplinary roles representing diverse cancer care centers, to evaluate the current landscape of HNC care delivery and understand actual or perceived barriers to delivering optimal care to patients with HNC.
Methods: Using an explanatory sequential design, ACCC conducted patient (n=247) and provider (n=206) surveys, a patient and caregiver focus group, and 3 multidisciplinary care team focus groups to capture barriers to optimal HNC care. ACCC then convened a roundtable of 24 key stakeholders of the multidisciplinary HNC care team to discuss findings and propose actionable solutions.
Results: While barriers identified within the study were multifactorial, key themes centered on the importance of care coordination, the need for navigation services, and more comprehensive patient education and support. Survey highlights include:
The availability of dedicated HNC navigation services varied based on center size and location:
Clinicians identified key areas that needed improvement to provide more effective care: financial resources (62%), dedicated navigation (45%), and coordination across members of the care team (45%).
The patient focus group identified that programs with navigators, including those with varied clinical backgrounds, saw a higher level of patient satisfaction and increased understanding of care plans.
Conclusion: This study revealed insights into the delivery of optimal care in HNC in the United States, including being a high-volume center, and having dedicated HNC nurse navigators and multidisciplinary meetings for care coordination. Multifactorial barriers to optimal HNC care were also identified and will be used to inform future educational programming and the development of interventions to improve care.
Lisa Philipp, MSN, RN, OCN; Alexandra Elyse Velozo, BSN, RN, CCM; Aja M. Scott, MS, PMP, CRCR; Patricia Falconer, MBA; Joseph Pizzolato, MD, MBA
Cancer Insights, Bedford Hills, NY
Background: Due to advances in screening and treatment, men diagnosed with prostate cancer often need long-term follow-up, sometimes over decades. There is no current comprehensive technology that supports the identification, monitoring, and tracking of prostate cancer patients. Dana-Farber/Brigham Cancer Center (DF/BCC) and Cancer Insights, with a grant from the National Cancer Institute (NCI), have developed and tested the use of VIPCare, an AI-based clinical triage tool to identify and monitor prostate cancer patients during the care journey.
Objective: To support nursing navigation and minimize the burden of identifying, monitoring, and tracking prostate cancer patients with the use of an AI-based technology (VIPCare).
Methods: Clinical guidelines, literature, and expert interviews were used to create a detailed map of the prostate cancer care journey from diagnosis through posttreatment surveillance/ survivorship. Markov decision modeling was used to model the prostate cancer journey stages and transitions.
Internal review board approval was granted to study 1000 historical patients diagnosed and treated for prostate cancer at DF/BCC from 2016 to the present. Patients had to have at least 2 clinical visits at DF/BCC during the study period. A limited dataset is being abstracted from patient records that includes age at diagnosis, tumor characteristics, clinical monitoring (labs, imaging), and treatment history. Data for an initial 20 patients were loaded to the Cancer Insights platform, and the care pathway algorithms were used to map their care journeys. Manual clinical review of patients in VIPCare was used to assess the system’s accuracy in care journey mapping and the VIPCare interactive interface.
Results: The system was able to correctly map the care journeys (diagnosis, active surveillance, active treatment, posttreatment surveillance, metastatic) of the 20 patients with minor adjustments to the algorithms. The user interface is intuitive with drill-down capabilities to view original source data. When integrated into the electronic medical record (EMR), the system will be able to continuously monitor the patient records for overdue tests, missed follow-ups, and test values that warrant additional follow-up. The tool will be able to identify and monitor prostate cancer patients in both active surveillance and posttreatment surveillance.
Conclusion: This NCI-funded study is still in progress, but preliminary results with the initial 20 patients suggest that VIPCare supports the identification, monitoring, and tracking of prostate cancer patients, relieving care teams of the manual administrative burden and the worry that patients have been missed or lost to follow-up. Configuration of the system for other cancers and expansion to survivorship is underway.
As the population of cancer survivors increases, technologies are needed that can assist in managing patients in follow-up according to published guidelines and institutional practices to lower the clinical care burden. System requirements include seamless EMR and clinical workflow integration, reliable and accurate tracking, and transparent processes. VIPCare is delivering in each of these areas.
Sharon Gentry, MSN, RN, HON-ONN-CG, AOCN, CBCN
Academy of Oncology Nurse & Patient Navigators
Background: A core responsibility of a nurse navigator is advocacy in tumor board participation. This supportive intervention in care coordination is cited in the Oncology Navigation Standards of Professional Practice.1 Previously, AONN+ surveyed members on navigation activities around tumor board participation and published the results in the Team-Based Oncology Care book.2
Objective: In 2023, the AONN+ re-explored the role of navigation from case preparation through follow-up to create a holistic picture of navigation and tumor board activity.
Methods: In the fall of 2023, AONN+ asked its members to reply to the same 14-question survey titled Multidisciplinary Tumor Board Questionnaire that was previously used in the spring of 2017. The time of completion was 20 to 30 minutes depending on whether the participant opted to share stories of successes or learning experiences related to their role and the multidisciplinary tumor board. The survey awareness was released in the quarterly Local Navigation Newsletter, the monthly Navigation & Survivorship Newsletter, in AONN+ committee meetings, and ran on the AONN+ website carousel from October 2023 to January 2024. The platform used was SurveyMonkey. The data were captured in a PDF file as a summary and in an Excel document to reflect individual responses.
Results: Of 123 navigators who responded, 95% were nurses. Most (54%) worked at a community hospital or an academic center (32%). Breast, lung, and colorectal were the largest disease-specific responders, but representation for all tumor types and general tumor board were selected. The top navigation tasks prior to the discussion were case identification and awareness of case materials and diagnostics being available. A change from 2017 was fewer clerical tasks, such as physical meeting preparation. Over 70% listened/ documented to understand the plan to educate the patient on their treatment and advocated by presenting unique information on patients during the tumor board. After the tumor board, 2 main roles were communicating recommendations to the team and making sure the patient had appropriate follow-up appointments. After a patient heard the tumor board outcome, navigators reiterated upcoming therapy, conducted necessary teaching, and assessed for other psychosocial needs.
Conclusions: The navigator participates in the tumor board within their professional standards. Being a team member early in the care of the patient allows the navigator to proactively recognize the need for a tumor board consult. Understanding the patient’s unique circumstances prior to the presentation allows the navigator to champion the unique needs of each patient. Attentively participating and listening during the case presentation promotes adherence to planned treatment by implementing appropriate patient education and reinforcement as well as anticipating future patient needs. Follow-up allows the navigator to support patients during transitions of care and be proactive regarding future issues related to treatment goals. In the future, the role of patient navigators and social worker navigators needs to be explored to have a richer understanding in their role around tumor boards.
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