Sabrena A. Fulkerson, BSN, RN; Kristal Vaughan, RN; Deborah Carey, CSW, OSW-C
University of Kentucky Markey Cancer Center, Lexington
Background: The Markey Cancer Center Affiliate Network (MCCAN) facilitates collaboration among 19 hospitals and the University of Kentucky Markey Cancer Center to promote high-quality cancer care across Kentucky. Affiliates must obtain and maintain Commission on Cancer accreditation, which requires addressing barriers to oncology care. Navigation is an evidence-based method for reducing barriers; however, MCCAN affiliates struggle to define the navigator role, implement navigation processes, and measure navigation’s impact in their program.
Objectives: To improve participants’ understanding of the defined role of the navigator and equip them with tools to measure the quality of their program.
Methods: Prospective participants completed a program application and submitted a supervisor’s letter of recommendation before admittance to the program. Navigators from MCCAN sites and community partners enrolled. The program began with a 1-day, in-person event that included an overview of the program, the toolkit, and the standards. The event also contained team-building activities to create community. Finally, ambassadors received 3 individual project assignments—complete a gap analysis using the Standards of Professional Practice1 as a guide; set 2 goals using the SMART format; and choose at least 1 metric from the Navigation Metrics Toolkit2 as a focus.
MCCAN staff assisted the ambassadors in creating a navigation quality dashboard to demonstrate the impact of oncology navigation to facility leadership. Following the initial meeting, the ambassadors were required to attend 6 virtual learning sessions and quarterly Kentucky Oncology Navigation Network meetings. Participation in a navigation- themed journal club was optional. A 6-month postprogram survey was distributed to gather opinions on the program and whether participation had changed the ambassadors’ knowledge or practice.
Results: A total of 21 navigators participated in the navigation ambassadors program. All participants completed the 9-month program, including the 3 individual projects. The completed projects demonstrated an increased understanding of the navigation metrics and standards of practice. Postprogram survey results revealed that all responding participants had changed—or planned to change—their practice. Participants also indicated a stronger grasp of measuring navigation’s impact and the navigators’ roles and responsibilities.
Conclusion: The navigation ambassadors program created a learning community around the professional practice standards and navigation metrics. The ambassadors indicated a willingness to participate in a follow-up program that may focus on navigation billing strategies. Other opportunities for improvement include providing tools and training to increase healthcare administrators’ understanding of oncology navigation as a value-added oncology service.
Kelly Filer, RN, BSN, CCMC
Sidney Kimmel Cancer Center, Philadelphia, PA
Background: The necessity to outline the nurse navigator role and clinical practice nurse in a newly expanded cancer center. Initially in this setting, the nurse’s role was one nurse doing both. With the expansion and hire of clinic nurses, the staff, providers, and patients needed clarity of the role differences.
Objectives: To clearly define the nurse navigator role and the clinical practice nurse role to maximize care team interactions, thus optimizing patient care.
Methods: The nurse navigator developed a plan with the expansion of a new cancer center to offer a definition of navigation and the importance of nurse navigator as a specialized nurse role. The nurse navigator educated the team on what to expect from a navigation nurse versus a clinical practice nurse. The references used for this qualitative research project are based on material derived from multiple resources.
The job descriptions for both the nurse navigator and the clinical practice nurse were obtained. The navigation director’s analysis of nurse role delineation was assessed for relatable data pertaining to role differences. Oncology Navigation Standards of Professional Practice along with the previously mentioned materials were disbursed to the cancer center team and providers for reference.
Additionally, new patients received a copy of the Academy of Oncology Nurse & Patient Navigators’ What is a Navigator and Why Every Patient Needs One with the nurse navigator contact information attached.
Results: Results are pending. The implementation of outlining the nurse navigator role has completed only 1 month (cancer center opened May 2024). This research study will conclude after 4 months of gathering feedback from the medical oncology team and selected patients using a Likertstyle survey at 2 and 4 months. The survey will include questions based on previous lack of understanding the nursing role differences and the current understanding.
The preliminary analysis is favorable in that the medical oncology team, including the providers, are beginning to realize which nurse will manage the specific needs of the patient. The patients seem better informed about which nurse supports them for what need.
Conclusion: The nurse navigator and clinic nurse roles were previously undefined in the medical oncology setting. The nurse navigator capitalized on the opportunity with the expansion of the cancer center to delineate the roles.
Education based on valid resources was provided to the medical oncology team and providers for which nurse is the appropriate source for the requirement of the patient. In addition, patients were given a clear description of what the navigator does for them.
In conclusion, the correct nurse is utilized for the right need of the patient, improving continuity of patient care.
Rifeta Kajdic Hodzic, BA, CHPM1; Christina Mangir, MS2; Jordan Karwedsky, FACCC3; Angie Santiago, BBA, CRCS, FACCC4; Aimee Hoch, MSW, LSW, OSW-C, FACCC5; Lori Schneider, FACCC3; Wendi Waugh, BS, RT(R)(T), CMD, ODS, FACCC6; Emily Hope Carroll, MHA1; Molly Kisiel, MSN, FNP-BC1; Ashley Lile, MPH1; Elana Plotkin, CMP-HC1
1Association of Cancer Care Centers, Rockville, MD; 2Rhizome, Washington, DC; 3Green Bay Oncology, WI; 4Sidney Kimmel Cancer Center, Philadelphia, PA; 5Grand View Health, Sellersville, PA; 6Southern Ohio Medical Center Cancer Center, Portsmouth, OH
Background: The Association of Cancer Care Centers (ACCC) Financial Advocacy (FA) Services Guidelines identify several metrics to evaluate program success, but implementation is variable. Consistent metrics and the ability to clearly communicate impact of financial advocacy services is imperative for program sustainability.1
Objectives: To compile a library of high-impact, high-feasibility metrics that cancer centers can use to measure the success of their financial advocacy/navigation programs and identify barriers and facilitators to implementation.
Methods: An expert committee identified measures to include in the metric library using guidelines and a literature search. These were mapped to the 3 guideline domains (ie, FA services and functions, program management functions, and partner engagement functions) and categorized using the Donabedian model for healthcare measures— structural, process, and outcome.
The library was shared during a semistructured focus group of 40 financial advocates, navigators, and administrators during the ACCC 2023 National Oncology Conference. Attendees participated in a voting exercise to select which measures were most impactful and feasible. Results were tallied and discussed in a follow-up, semistructured virtual focus group of 65 attendees in 2024. The transcript was coded to identify implementation barriers and facilitators, and the metric library updated to incorporate feedback.
Results: The committee identified 26 FA program metrics, including 4 outcome measures, 17 process measures, and 5 structural measures.
Three metrics were prioritized by the focus group as most feasible to implement: unique patients screened for financial distress (process measure); unique new patients who connect with a financial advocate (process measure); and referrals (process measure).
Four metrics were prioritized as most impactful: treatment delays due to coverage (outcome measure); unique new patients who connect with a financial advocate (process measure); overturned appeals or corrected billing errors (process measure); and total funding secured for the cancer program (process measure).
Barriers to implementing metrics include inability to capture data, highly manual processes, and resources needed for electronic health record (EHR) builds. Facilitators include various EHR optimizations (eg, referrals, smart phrases, flow sheets, flags), FA software that provides reports, dedicated staff time for metrics, and communicating results to leadership.
Conclusion: Only one metric was identified as both high impact and high feasibility: unique new patients who connect with a financial advocate. A balance of outcome, process, and structural measures is needed to support quality improvement efforts and communicate the value FA services provide to patients and the cancer center.
Technology, particularly EHR customizations, can support program measurement but require resources to implement. FA programs of all sizes need clear guidance and practical solutions for prioritizing, implementing, tracking, measuring, and communicating the impact of FA services.
The ACCC will use these findings to finalize the metrics library, summarize recommendations, and inform educational efforts.
Debra J. Woo, BSN, RN, OCN; Laura Kabrich, MSN, RN, BA, Psych ACM; Kris Blackley, RN, MSN, BBA, OCN
Levine Cancer Institute, Charlotte, NC
Background: Oncology nurse navigators (ONNs) received Orientation Manuals (OMs) containing printed role-specific policies, orientation check lists, and relevant resource materials necessary to operationalize their role. Creating a physical OM is costly, time-consuming, and lacks the ability to ensure up-to-date materials.1 Utilizing an electronic platform could be a fix.2
Objectives: Describe the impact of converting to an electronic orientation platform including resource materials on utilization, cost reduction, and ONNs’ reported satisfaction with the conversion.
Methods: A process improvement project was implemented in several phases between January 2023 and May 2024 to evaluate the impact of converting printed ONN onboarding and resource information to an electronic notebook by employing the Microsoft OneNote application platform. An analysis was made of time and cost required to compile each physical OM. Throughout 2023, materials were transitioned into an electronic orientation notebook, introducing use of the application in August.
In January 2024, a survey was completed to collect data on the use of the hard copy OM. In early February, the OneNote OM was launched, and a review of the electronic version’s content, highlighting sections and pages, was completed. ONNs were kept informed monthly on updates and additions along with several ways the notebook could be accessed.
Finally, in late May 2024, a survey was distributed to provide feedback on the electronic notebook.
Results: Preconversion survey results indicated only 12% of ONNs used the physical OM frequently, 50% used it occasionally, 15% used it rarely, and 23% used it very rarely or never. Postconversion survey results showed 28% of those who confirmed access to the electronic version did so frequently, 28% occasionally, 22% rarely, and 22% very rarely or never.
The ONNs rated how beneficial the electronic version OM is as an 8.83 (0-10) and 83% would recommend updating the title to ONN Orientation and Resource Notebook as it is used beyond onboarding.
Additionally, 70% versus 30% prefer the electronic over the physical version, and >83% found it organized and convenient and appreciated the centralized information. The estimated department cost per manual was $302, including all materials (95 pages) and time required to update each manual—a potential annual savings of $1200 presuming onboarding of 4 ONNs a year.
Conclusion: Both novice and experienced ONNs report satisfaction with electronic orientation and resource materials versus physical manuals, with a majority favoring the renaming of the OM to reflect its usefulness beyond orientation. Transition to an electronic notebook has proven to be environmentally friendly, unveiling a significant reduction in the use of resources, and has resulted in critical time and cost savings. Updates to the notebook are easy to upload and are immediately available. Increasing ONNs’ comfort level with electronic applications and access could further enhance use of the electronic notebook.
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