Background: A navigator’s interventions with a patient throughout treatment include disease-specific education packet, referrals to specialists, resources and supportive care team members, providing timely appointments, presentation at Breast Tumor Board, chemotherapy education, and performing a treatment summary. The creators of this tool wanted a design that is easy to use, can be used by licensed or nonlicensed navigators, would work throughout the continuum of care, and would acknowledge the main workflow of the navigator. The tool should consider workflow, be designed with the ability to track the value of the navigator as an intervention, and quantify the relationship with distress and barriers to treatment.
The Patient Navigator Acuity Monograph (PNAM) facilitates the navigator’s ability to prioritize and document work through a systematic and flexible approach of identifying distress and providing resources to help overcome treatment barriers.1 The navigator’s time commitment is devoted to identifying barriers, referring to resources, and acknowledging a patient’s self-identified level of distress from the situation. PNAM provides a cohesive and universal language for communicating the number of barriers and the degree of distress. Ideally, patients’ scores will decrease as they progress through treatment.
Objective: Identify a tool (PNAM) that will predict, quantify, and account for a navigator’s productivity.
Methods: Using the PNAM, the navigator will identify the patient’s baseline acuity at diagnosis. This tool is adaptive in nature, acknowledging the resilience of the patient to the acute changes in their needs and distress, which is reflected in the PNAM score. When a navigator initially meets with a patient, they conduct a needs assessment and have the patient fill out their distress score. The number of barriers identified and the distress score the patient reports are combined to identify the patient’s acuity using the PNAM. In doing a needs assessment, when the navigator identifies a barrier, that barrier is attached to a resource. This allows the navigator to make the appropriate referral for the identified barrier.
Distress, barriers, and acuity are measured at every unique encounter, including diagnosis and when the patient has a treatment summary. Optimally, the score will show acuity decreasing over time, demonstrating the success of the navigator in decreasing the patients’ stress and anxiety and increasing the ability to overcome barriers.
Results: A cross-sectional sampling was performed of 6 patients who had completed treatment. The results showed an average improvement in barriers at -15%. The average improvement in the NCCN Distress Thermometer score was 61%, and the average improvement in the PNAM was 23%.
Conclusions: The final results measuring distress and number of barriers as independent variables reflect the effectiveness of navigators intervening and engaging resources and supportive care team members. The barriers were at -15% because the original needs assessment tool was not used on some of the patients; this will be corrected in the future to obtain an accurate account of patient barriers at baseline and completion of treatment. The authors will continue to collect data as more breast cancer patients complete treatment, which will impact final results.
- Patient Navigator Acuity Tool. National Consortium of Breast Centers, Inc. Breast Center Bulletin No. 175. September 2015.