Implementing a Barrier Assessment Tool to Guide Oral Oncology Nurse Navigator Interventions

November 2018 Vol 9, NO 11
Nikki Barkett, RN, BSN
University of Arizona Cancer Center
Beth High, MSN, RN, OCN, CBCN, CN-BN
University of Arizona Cancer Center

Background: As oncology programs demonstrate positive patient outcomes associated with oncology nurse navigation, new specialized permutations of the role are being developed to address distinct gaps in care. One such permutation is the oral antineoplastic nurse navigator (OANN), whose focus is patient adherence to oral oncolytic medications. The literature supports the role of the OANN to provide education, help patients comply with oral therapy treatments, and to monitor side effects.1 It is also well documented that a primary function of any navigator is to assess for and resolve patient barriers to care as a patient outcome metric.2 Patients who have been prescribed oral agents face a variety of barriers that may prevent them from complying with the treatment plan.3 An oral oncolytic barrier assessment tool may help the OANN to better understand the patient-specific reason for noncompliance and assist the OANN to offer meaningful interventions. The Oncology Nursing Society Oral Adherence Toolkit4 provides guidance on the need to assess for factors influencing adherence but does not provide a specific tool. At the University of Arizona Cancer Center (UACC), a significant opportunity existed regarding patient adherence to oral antineoplastic drugs, but there were few data available for analysis.

Objectives: Design and implement an oral oncolytic barrier assessment tool and begin a quality improvement project to collect data on patient oral adherence.

Methods: A multidisciplinary team at UACC, including a newly hired OANN, was formed to tackle the problem of oral adherence. After an extensive literature review, an assessment tool to elicit actual and potential barriers to care was created. The oral adherence–specific tool assesses for physical barriers such as difficulties with swallowing medications and opening medication containers. Other assessment questions address issues such as health literacy, visual impairment, memory challenges, and financial concerns. Once the tool was approved by the committee, the OANN began meeting with patients and conducting assessments. Appropriate and individualized interventions for identified barriers were initiated. An institutionally developed follow-up protocol was implemented to evaluate the success of the interventions. The OANN tracked patient adherence factors such as barriers, interventions, adverse reactions, and compliance for every referred patient. The data will be used to analyze the utility and effectiveness of the tool at quarterly intervals. Improvements will be made to the tool and process as needed.

Results: At the time of this writing, a newly created barrier assessment tool has been implemented for only a few weeks at UACC. The OANN is conducting a quality study using the Plan, Do, Study, Act cycle to drive continuous improvement in the barrier assessment and resolution process. Data are being collected and results will be reported in subsequent writings.

Conclusion/Implications: As a subspecialty, OANNs can play an important part toward improving patient adherence, but there is a need for specific tools to support the role. An adherence-specific barrier assessment tool can help these navigators conduct succinct and focused patient interviews leading to more patient-specific interventions.


  1. Anderson MK, Reff MJ, McMahon RS, Walters DR. The role of the oral oncology nurse navigator. Oncology Issues. 2017;32:26-30.
  2. Johnston D, Strusowski T, Sein E. AONN+ national evidence-based oncology navigation metrics quality study: demonstrate value and sustainability of navigation programs. Journal of Oncology Navigation & Survivorship. 2018;9(3):120-122.
  3. Pagan J. Oral Cancer Medications: New Paradigm Brings New Challenges. Oncology Nurse Advisor. June 17, 2017.
  4. Oncology Nursing Society. ONS Oral Adherence Toolkit. 2016.
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Last modified: December 17, 2018

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