Reflections: Findings and Insights From the 2024 AONN+ Survey

Membership surveys help organizations understand their members’ needs and preferences and, most importantly, show members that their input is valued, and the organization is listening to them. The appraisal can lead to improved member satisfaction by understanding what their members like and dislike, as well as identify ways to improve member loyalty and engagement. The survey does provide organizations with appreciated information that can help them make decisions about their programs, operations, and staff priorities.

Membership surveys help organizations understand their members’ needs and preferences and, most importantly, show members that their input is valued, and the organization is listening to them.

The Academy of Oncology Nurse & Patient Navigators (AONN+) is continuously working to listen to its membership, and one avenue is through a membership survey every 2 years. The internal team creates a comprehensive survey that helps to identify who we are as an organization, what professional resources are working for the membership, areas where improvement is suggested, and key topics navigators are facing in today’s healthcare landscape.

In 2024, an online survey consisting of 43 open-ended and multiple-choice questions with an “other” option that enabled the user to enter their custom answer apart from the multiple choices provided was released by AONN+. The 20-minute survey was open for 2 months. Survey access was emailed to individual members as well as distributed through the local navigator networks, the Oncology Navigation & Survivorship News, and the AONN+ website and social media outlets.

The response rate was low with 174 participants. Reasons why only a small percentage of membership submitted information could be attributed to not having a tangible incentive, such as a financial reward or gift card, or having no desire to participate. The timing of the fall release could have been in conflict with work, home, and holiday events. The online channel may not have been readily accessible or preferred by the navigator, or survey fatigue may have created hesitancy in participation. The low response rate makes it difficult to generalize findings to the broader membership population. Despite the limited response, AONN+ will use the feedback from those who were interested in sharing their voice to identify ways to better serve with professional benefits.

Most of the respondents were from the South and mid-Atlantic areas followed by the Central states. Practice settings ranged from community hospital (35%), academic institution (26%), and community teaching (8%). Fifty-six percent of the responders were nurse navigators, 19% were patient navigators, 17% were a navigation director or administrator, with the remaining in an advanced practice or education role. Forty-five percent had a bachelor’s degree, 34% a master level of education, and 14% had an associate degree. Many respondents were certified, with 54% citing either Oncology Certified Nurse (OCN), Oncology Nurse Navigator–Certified Generalist (ONN-CG), or Oncology Patient Navigator–Certified Generalist (OPN-CG) as part of their title.

The work status reflected that 87% were full-time and 13% were part-time. The focus of this group was on the adult population (98%), with most managing patients with both solid and liquid tumors. Just 2% navigated hematology patients only. The “site of navigation” was reflective of the 2022 membership survey with more navigators having a multidisease-site focus versus a single-disease concentration. When asked about patient cases, breast, colorectal, lung, and gynecological were the top selections. The questions about how long they have been in their role as a navigator and how many years they have been a professional navigator showed identical answers, with most practicing more than 10 years (34%), followed by 3 to 5 years (26%), less than 2 years (23%), and 6 to 9 years (17%). This is consistent with past surveys in which there was a large incoming number just beginning the profession. With the evolution of navigation, there was an increase in the percentage with more than 10 years’ experience.

More than half of the respondents worked in a practice with 1 to 5 employed navigators. Interestingly, 11 to 15 and more than 21 were the next highest selections. This is an increase in employed navigators from the 2022 survey that showed most practices employed 1 to 5 or 6 to 10 positions. It is too early to see how the Centers for Medicare & Medicaid Services (CMS) reimbursement for navigators influences hiring patterns. It is possible that the loss of staff from the COVID pandemic and the aging of oncology health professionals influenced administrative oversight to recognize the value of patient navigators with direct knowledge of the community and its resources. Also recognized was the use by clinically licensed navigators of their clinical skills to improve efficiency and adherence to care by ensuring that individualized care is coordinated among members of the team.

Many commented only on the total number they managed per year and not the number of new cases. The responses ranged from as low as 40 to as high as 1500, with the average between 250 to 400.

Eighty-eight percent of responding navigators engage with the patient at the time of diagnosis. An open-ended question had the participants describe their annual caseload. Many commented only on the total number they managed per year and not the number of new cases. The responses ranged from as low as 40 to as high as 1500, with the average between 250 to 400. These professionals are upholding the Oncology Navigation Standards of Professional Practice on Interdisciplinary and Interorganizational Collaboration as they collaborate with patients, caregivers, and varied members of the healthcare team every week. Outside referrals with genetics, dietary, physical therapy, clinical trials, and pathologist were noted by the survey takers. The response to the question about handing off patient-specific information among healthcare professionals at transition points was split almost 50/50. Some do not have a set process, but others use electronic health records (EHRs), weekly team meetings, face-to-face conversations, and staff messaging via computer.

This is the second survey in which salary information was gathered. Over 65% make $80,000 to $90,000 a year. This is up from the survey taken 2 years ago that had 62% of the navigators making $70,001 to $80,000 a year. This survey also asked about salary benefits, and 88% of the navigators have health insurance, paid time off, and a retirement plan and packages. Fifty-five percent have family benefits, and 11% have childcare. Navigators have consistently showed value in their crucial roles by helping people access and navigate the complexities of the healthcare system, particularly those in underserved communities. This includes assisting with insurance enrollment, finding appropriate healthcare providers, and coordinating care. Navigators can help patients better manage their conditions, adhere to treatment plans, and improve their overall health outcomes. In essence, the increased emphasis on patient navigation and the recognition of its impact on improving healthcare access and outcomes could be driving factors to support increased compensation for navigators.

The threads of employment, compensation, and caseload were reflected in the question of what topics the membership would like to receive more information about. Metrics, financial support, reimbursement, and sustainability were the top-ranking choices. Professional development was also a popular request and was inclusive of standards in a navigation program, team empowerment with a networking focus, sharing best practices on how navigators work in various systems (referral process), and self-care by understanding compassion fatigue. Clinical trials were not a popular choice by the respondents, and further exploration showed that only 22% from this survey were directly involved in clinical trial education or recruitment. But 80% stated they were comfortable talking to patients about clinical trials and had support to be active with the facility’s clinical trials team. Clinical Trial Education for the Navigator is a 2024 AONN+ resource that focused on helping all navigators understand clinical trial protocols, accrual, and retention best practices. The ranking of resources that have been impactful for AONN+ membership is shown in the Figure.

The top preferred learning options remain in-person, live/virtual webinars, and recorded/on-demand content. Online communities, such as local navigator networks and roundtable/small group discussions, were suggested as venues for education. As the professional organization works to create information for the navigation population, the majority of survey takers confirmed that their institution does not accept product-specific materials. For those who engage in social media, Facebook and Instagram were popular avenues. The AONN+ Facebook page is consistently active with questions ranging from building a navigation program, using EHRs and/or linking oncology navigation software that “talks” to the EHR, questions on best practices for screening or treatment pathways, and billing for services.

Based on this survey, most navigators are not implementing the CMS Principal Illness Navigation Reimbursement. Only 45% were exploring the idea or starting to implement:

• “Still in planning. Working on improving documentation first.”
• “Still in exploration & discovery; evaluating structural and organizational barriers, added financial impact to patient, scope of coverage across plans and payers.”
• “Leadership working out the logistics.”
• “Piloting at some sites this month. Expected to roll out network-wide early 2025.”
• “We are hardwiring EHR-driven orders, charge triggers, etc to facilitate efficient billing.”

The main points for not implementing at this time were focused on system-level decisions, not having a champion administrator to support the request, lack of manpower or resources, especially since the IT aspect and programs were comfortable with downstream revenue captured by preventing out-migration of patients and attracting new patients to the system.

It was exciting to see that 80% to 90% of this group was familiar with the Oncology Navigation Standards of Practice and were applying them to their practice and navigation program. Many navigators commented on using them in their daily routine of care and interaction with patients, as well as working within the healthcare team. Others commented on building their professional practice:

• “We’ve been using standardized definitions of various role responsibilities. We are working toward a standard documentation to eventually reach all the standards.”
• “We used it to guide role delineation, to develop position descriptions, to train our newly onboarded navigators, and to justify our roles with administration and providers.”
• “Built into our job descriptions”
• “As a justification to some of our key performance indicators.”
• “Using them to formulate job descriptions, guide professional practice, ensure equality among navigation group, promote navigation benefit to providers and administration.”
• “Built our curriculum around them.”

AONN+ was appreciative of the thoughts around the discussion board, certification exams, and annual conference. Most navigators have not discovered the discussion board that presents a new space to discuss all things navigation. They remain very interested in certification and enjoy the pre-conference workshops and activities around the educational sessions:

• “Annual conference is excellent, please continue to offer it in-person!”
• “I gleaned a lot from just being present and listening.”
• “The conference was incredible. It was my first time being here, and I can truly say that I learned a lot and met incredible people.”
• “I thoroughly enjoyed every session I attended. Amazing!”

The survey ended with an opportunity to share open thoughts with the AONN+ leadership. The comments on heartfelt appreciation for this community and the expressed devotion to be a part of the oncology profession will be shared with the leadership. Also, the comments on concerns or opportunities for improvement will be discussed, as AONN+ can take the insights about the members’ wants, needs, desires, and engagement level to make more strategic changes for improvement. The information gained will allow the organization to contemplate and implement worthwhile improvements.

AONN+ is appreciative of those taking the time to complete the 2024 survey, and we are grateful for their honest information and thoughtful suggestions. Your voice is invaluable, and your opinion matters. Thank you for shaping the professional organization’s future.