Background: The current approach to cancer care in South Africa is known to be fragmented, uncoordinated, and often unsupportive of individual patient needs. With the growing incidence of cancer in this country, Netcare Pty Ltd, a private hospital group in South Africa, embarked on a pilot study to improve its cancer service delivery by creating a holistic cancer care system that nurtures the patient throughout the cancer care continuum, focusing on patient-centered health and care. Nurse navigation was identified as a critical component in ensuring a smooth transition of patients being treated for cancer at our hospitals. After a rigorous literature review on the topic, Netcare embarked on piloting nurse navigation at 15 hospitals known for their high cancer admission rates within the group while measuring feasibility and acceptability of the program to stakeholders, including oncology patients and their families cared for within the Netcare Group.
Objective: To describe a pilot navigation program designed to improve the care coordination of oncology patients.
Methods: A navigation induction program, including a comprehensive tool kit and evaluation document, was developed focusing on navigator competence and field readiness. Key performance indicators were adapted from AONN+ measures against which ongoing navigator performance has been measured. Internal and external stakeholder engagements were identified as critical success factors for navigation. Six oncology-trained professional nurses were employed as clinical nurse navigators and allocated to specific regions on completion of induction training. They were offered continuous support by way of biyearly navigator forums, biweekly teleconferences, and membership to AONN+.
Various data-capturing tools were developed to track success measures, patient and stakeholder engagements, and satisfaction. Input data were converted into visual dashboards that enable easy interpretation and analysis. These interactive dashboards were used to track navigation activity and understand pilot trends.
Results: During the 9-month pilot period, 398 patients were navigated at identified Netcare hospitals, mainly through doctor or patient self-referral. Patients have indicated a high level of satisfaction from both the surveys conducted and letters and testimonials received. A similar trend is noted with the physicians. Six of the 7 key pilot success measures were exceeded; however, the desired benchmark for percentage of navigation time spent navigating patients was set at 60%, and although it was not achieved during the pilot, the data showed a clear upward trend. Despite the immense amount of knowledge gained through the data, a conclusive navigator caseload could not be developed due to the many factors that influence patient acuity.
Conclusion: The bulk of the expectations set at the start of the pilot were met, and the pilot can be considered successful. It is clear that most patients were referred during the treatment stage of their cancer journey. However, it is postulated that as the navigation concept matures, referrals to navigation will start at an earlier stage within the cancer care continuum, thus maximizing the benefit for patients. Benchmark key success measures will be refined as more data are gathered.