Interview with the Innovators

Navigating Lung Cancer Patients at Fox Chase Cancer Center

August 2018 Vol 9, No 8 —August 14, 2018

An Interview with Maria Kadlec, BSN, RN; Caryn M. Vadseth, BSN, RN, OCN; and Mary Pat Winterhalter, MS, BSN, RN, NE-BC

Ms Kadlec is Oncology Nurse Navigator specializing in sarcoma and thoracic cancers at Fox Chase Cancer Center, Philadelphia, PA.

Ms Vadseth is Oncology Navigation Nurse Manager at the Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA.

Ms Winterhalter is Director of Nurse Navigation at Fox Chase Cancer Center, Philadelphia, PA.

At Fox Chase, nurse navigators are clinically trained specialists who provide support to patients even before their first appointment. Their goal?

To connect patients to the appropriate cancer care team, expedite care when possible, answer clinical questions about a patient's diagnosis leading up to their first appointment, discuss treatment options, and coordinate medical administrative tasks to facilitate a smooth transition into treatment at Fox Chase.

In addition, nurse navigators educate patients and families about support services offered at the center to ease anxiety surrounding a diagnosis.

Sound like a lot? It is. But with coordination and an expert grasp of the system and its resources, nurse navigators at Fox Chase are reaching and exceeding their program goals of removing barriers to care and improving outcomes, and none more so than the lung cancer navigation group. Not only are these navigators an excellent resource for their patients, they are also providing community resources to raise awareness of lung cancer as well as increase early diagnoses and interventions.

To learn more about this lung cancer navigation program, the publisher of JONS met with Maria Kadlec, BSN, RN, and Mary Pat Winterhalter, MS, BSN, RN, NE-BC, of Fox Chase Cancer Center, and Caryn M. Vadseth, BSN, RN, OCN, of the Sidney Kimmel Cancer Center at Thomas Jefferson University, formally of Fox Chase, to discuss the initiation of the navigation program at Fox Chase and the ways in which patient advocacy and community outreach have made the navigation program a success.

JONS  Good morning and thank you for taking the time to talk with us about the navigation program for lung cancer at Fox Chase. To begin, please discuss the decision to introduce the program and how it evolved.

Ms Vadseth  Fox Chase began its program in 2010. At that time, we were fortunate to have a manager who came from a hospital with a navigation program. She introduced the concept of navigation to Fox Chase. As the director of the women's cancer center, she began a pilot navigation program in breast cancer with 2 navigators.

A gap analysis was conducted and revealed that timely patient access to care was an issue. The program began with goals to decrease the time from first call to first appointment, from first appointment to diagnosis, and first call to start of treatment. To address this issue, the navigators began handling the initial incoming calls from new patients.

Fox Chase realized positive results very quickly after initiating the program and proceeded to expand the program and hire additional navigators.

The administration and doctors liked that patients were speaking with nurse navigators from the first point of contact and receiving valuable information and instruction over the phone. Patients liked having someone in a clinical role available to them from the very beginning providing education and care coordination even before the first appointment occurred. Being this kind of advocate for the patient makes for a more fruitful first appointment.

Ms Winterhalter  Yes, the initiation of our navigation program was part of our effort to map, support, and advocate every cancer patient's journey by leveraging caring and tenured nurses to achieve the best possible outcomes.

JONS  Can you talk about the return on investment of your navigation program?

Ms Vadseth  Fox Chase is unique because it is a tertiary cancer center—meaning, cancer treatment is all they do. There are no primary care doctors or an emergency department. When the navigation program started, we relied heavily on that gap analysis to see where the barriers to care existed. And, as I mentioned, timely access to care was the primary issue.

Our navigation program was born out of the need to overcome that barrier to patient access. Now there are over a dozen navigators within the Fox Chase system assigned to specific disease states.

As far as return on investment, Fox Chase is realizing the benefits of having navigators increase access to care and moving patients through the system more efficiently, which added to patient satisfaction. And we were able to show that patients stayed at our center, thus increasing downstream revenue.

JONS  How is Fox Chase addressing health disparities and community needs?

Ms Vadseth   Fox Chase has a health disparities division as part of the community outreach program. That program uses lay navigators to promote free cancer screenings in the community.

Ms Kadlec   Yes, we have a mobile screening unit that conducts mammograms as well as skin and prostate cancer screenings out in the community. The lay navigators on the mobile screening unit can work with the patients in whom cancer is found to get them into our system.

They can also provide assistance in financial navigation, such as helping patients without insurance figure out insurance options.

JONS  What types of prevention programs does Fox Chase promote?

Ms Vadseth   In the spring we host a patient awareness day—it's a patient education fair with all the different departments and programs at Fox Chase represented. This event is on our campus and open to the entire community. We host a table for lung cancer screening and tobacco treatment to answer patient questions and enroll them in these 2 programs.

For the past 5 years, our team has organized a lung cancer awareness day in November, Lung Cancer Awareness Month. We host an evening program where we have speakers from different disciplines, such as thoracic surgeons, medical oncologists, or pulmonologists. We also invite a patient to speak about his or her experience. Attendees also have access to education materials, including general information about the disease and advocacy groups, and recently we've invited pharmaceutical companies to attend as well.

Ms Winterhalter  The Temple Lung Center and Fox Chase have come together to offer lung cancer screenings. We offer a personalized experience for lung cancer screening where in a single-day appointment, our lung cancer screening specialist will guide a patient through the process, coordinate care, and answer all their questions. They will receive a low-dose CT scan as well as the results and will have the opportunity to discuss their results. Based on the results, the patient is then scheduled for an annual low-dose CT scan or additional workup of an abnormal finding.

JONS  What can you tell us about your tobacco treatment support group?

Ms Kadlec  Our tobacco treatment program is run by 2 nurse practitioners specializing in lung cancer. One is a pulmonology nurse practitioner, one is a lung medical oncology nurse practitioner. One of the goals within our navigation program is to address our patients' need for a tobacco treatment referral at our first touch point. We want to ascertain if the patient is ready to quit and what, if anything, they have tried in the past. If appropriate, we refer them to the tobacco treatment program. In the program, they will meet with a nurse practitioner, and she'll go over the medications and strategies for quitting.

JONS  How can navigators help patients achieve a sense of empowerment?

Ms Kadlec   It begins on that very first phone call. Many times, one of the first questions I receive is whether they should seek a second opinion. I talk with patients and encourage them that a second or even a third opinion is an option if they would like to do that. They have to be comfortable with their doctor and the treatment they're going to receive.

Ms Vadseth  I always tell patients that they know their body the best. We're here to help them, but they have to be the first advocate for themselves. To me, empowerment is arming the patient with knowledge and information about their disease—and the support that we'll get through this together. I encourage patients to tell us when they're not feeling well, or what doesn't sit well with them, and to ask questions of me and their doctor.

JONS  How do advocacy groups add to patient empowerment?

Ms Vadseth   There are quite a few advocacy groups out there for lung cancer patients, such as the Lung Cancer Research Foundation, the Lung Cancer Alliance, the Bonnie J. Addario Lung Cancer Foundation, and the LUNGevity Foundation. We're all unique learners, and these groups have different programs that suit different individuals. There are phone buddy programs, so if you want to talk to someone who has stage IV lung cancer and is a female, they'll try to match you up with someone over the telephone. Other people may prefer web-based information, so I advise them to go to reputable sites such as the National Cancer Institute, the American Cancer Society, or one of the aforementioned advocacy groups. Once on these sites, they can request written information, or we will supply this to them. Or, if too much information is too intimidating or too overwhelming, I encourage them to stay off the Internet.

JONS  Do you have a fairly diverse population at Fox Chase? How does patient diversity impact your job?

Ms Kadlec  We do have a diverse patient population. Communication can become an issue with non-English–speaking patients. We ensure that we have an interpreter for these patients. It takes some extra steps to have an interpreter on the phone with me and the patient, or in person at our appointments, but it is best for the patient and for us to really get the full picture.

It's important to note that the interpreters we use are trained in medical terminology. This is much preferred to relying on a bilingual family member.

JONS  Do you have any advice for new navigators?

Ms Kadlec  It's important to have your professional support system in place to execute your job effectively and efficiently. You don't have to reinvent the wheel. Use your resources.

Ms Vadseth  Remember, patients are experiencing this new world with new terminology. Explain things in a way that a patient can understand. Patients want a listening ear, some compassion, and support. Be that anchor for them during this new journey.

JONS  What's next for the navigation program at Fox Chase?

Ms Winterhalter  We anticipate expanding the role of our navigators. Our goal is to offer patients more navigation resources and move the nurse navigator further into the patient's continuum of care. We will continue to evaluate the role of the nurse navigator to ensure they are practicing at the top of their license.

JONS  What tactics will you employ to assist in the growth of the navigation program?

Ms Winterhalter  We recently completed patient surveys, provider surveys, and examined "best in class" navigation programs. This exercise revealed an over­arching theme that patients desire increased coordination of care.

To increase our ability to coordinate care, we plan to build out a comprehensive medical record program to assist the navigators in gathering past medical records. This will allow information to be efficiently placed in the patient's electronic medical record to facilitate a comprehensive new patient appointment here at Fox Chase.

We also have placed 6 transitional care nurse navigators in the inpatient environment to facilitate safe transitions from the hospital to outpatient services. These transitional care nurse navigators call patients after discharge to make sure the patient is safe and aware of all follow-up appointments and previously arranged outpatient services being delivered by post-acute providers.

JONS  Thank you all very much for your time today, and best wishes for continued success of your program.

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