Those in attendance at the AONN second annual meeting had the opportunity to attend breakout sessions focused on navigation strategies in the following subject areas: breast cancer, lung cancer, gastrointestinal (GI) cancer, prostate cancer, multi-tumor types, as well as the management of a navigation program. It is our pleasure to offer the following summaries and takehome points from each session.
Breast Cancer Navigation: 5 Steps to Better Navigation
Sue Bowman, RN, OCN, CBCN, MSW
Leesa Mattingly, RN, OCN
The breast cancer session focused on the use of the Nursing Process to guide navigation for people with breast cancer. A review of the Nursing Process theory was aligned to navigation using As sessment, Nursing Diagnosis, Creating a Plan of Care, Im plementing the Plan, and Evaluating the Plan. Practical application of the Nursing Process was described in relation to the steps of comprehensive navigation such as preparing for an initial assessment, building a rapport with the patient, and engaging the patient in their care. Promotion of a team approach and use of available resources for holistic care include the patient, physicians, and supportive services and was delineated. Developing logical ways to identify individual barriers and barrier resolution was discussed. The 2012 ACoS CoC Standards were reviewed in relation to the navigation, psychosocial assessment, and survivorship standard requirements. The Nursing Process was applied to developing individualized survivor programs in a way that participants could identify a need in their community and use that as a focus for their program. Interactive activities like Barrier Balls and Case Study kept the audience entertained and thinking in terms of practical tools and patient intervention.
- Patient navigation is exemplified by the Nursing Process theory
- All aspects of the navigation process can be addressed by applying the Nursing Process theory
- Navigation teams can be assembled with readily available resources, whether a concrete or virtual design
- ACoS CoC accreditation standards can be incorporated into any navigation program
- To be successful, survivorship programs are designed around patient need
Lung Cancer Navigation
Pamela Matten, RN, BNS, OCN
As one of the most lethal cancers in the world, lung cancer presents numerous challenges in diagnosis and management. New evidence from the National Lung Screening Trial indicates that screening with low-dose CT may provide opportunity to detect lung cancer at earlier stages. This breakout session highlighted the role of the thoracic oncology nurse navigator in prevention and screening, and the importance of early detection of cancer with regard to diagnosis and treatment options. One of the multifaceted roles of the nurse navigator includes coordinating a multidisciplinary conference and clinic, putting all diseasespecific specialists together at one time and place to decide on a comprehensive treatment plan. Nursing navigation serves to expedite the pathway from suspicion to diagnosis and diagnosis to treatment on through to survivorship and/or palliative care, while collaborating with involved clinicians, keeping the patient and family at the helm of decision making. Case study presentations typified how the thoracic oncology nurse navigator weaves his/her role throughout thecontinuum of care, collaborating among clinicians and points of patient contact, providing support and education, and monitoring patients for side effects and effectiveness of therapies. In closing, the breakout session included a glimpse at the development of new frontiers in the treatment of lung cancer with respect to novel targeted agents and the use of molecular biomarkers.
The role of the thoracic nurse navigator:
- Impacts prevention through education about tobacco cessation and intervention for early detection of lung nodules through low-dose CT screening programs
- Expedites the pathway from suspicious finding to diagnosis and treatment
- Coordinates care to reduce duplication of services while collaborating with disease-specific clinicians
- Serves as a vital one-point-of-contact link to support services, education, and resources
- Provides leadership and mentoring by translating into practice the expanding arena of novel treatments for lung cancer
GI Cancer Navigation
Coralyn Martinez, MSN, RN, OCN
Nicole Messier, RN, BSN
The goal of the GI cancer navigation break out session was to provide an in teractive forum for navigators to discuss current successes and ob stacles in developing and main taining a successful GI navigation program. An over view of 2 GI multi disciplinary programs was provided followed by small group breakout discussion. The small group discussion focused on types of navigation, developing focused navigation and programmatic goals, documentation, referral patterns, re sources, and measuring success.
- Develop a consistent process – Consistency is the key to success; development of a standard job description with clarification of the role and a reproducible navigation model is the starting point
- Provide clear communication to patients and providers – Verbally and in writing, everyone needs to be in the know regarding the plan and any changes that may come about
- Be alert to red flags – Identifying and re - moving barriers to care will facilitate timely service
- Use quality standards and guidelines – Using best practice standards, such as NCCN guidelines, ensures appropriate and quality staging and treatment
- Measure your success – The use of data bases and QA projects can help prove and justify the importance, need, and value of your role as a nurse navigator as well as your program
Prostate Cancer Navigation
Frank delaRama, RN, MSN, AOCNS
The prostate cancer navigator breakout session fo cused on 2 main areas: (1) program development/maintenance, and (2) shared decision making and role of the navigator. Through sharing the story of the development of the pro state cancer care program at Palo Alto Medical Foundation, many strategies and ideas were identified that can help grow and maintain a program of excellence, with the navigator leading the way.
- The tasks of the prostate cancer nurse navigator can be divided into 5 fundamental themes:
- Helping physicians and other healthcare providers
- Helping patients directly with support and advice
- Helping the population (eg, community awareness of prostate cancer)
- Outcome measurement
- Creating avenues for patients to give back (eg, buddy programs, philanthropy)
Multi-Tumor Type Navigation
Shanna Gillming, RN
Jay R. Swanson, RN, BSN, OCN
The goal of our breakout session was to have an open discussion regarding concerns with multi-tumor site navigation, identify potential best practices, and review some case studies highlighting the strengths and difficulties of multi-tumor site navigation. We wanted to have an open discussion with each navigator involved.
- Multi-tumor site navigation does have its own benefits, and multi-tumor site navigation is the ideal situation for certain institutions
- Multi-tumor site navigation also has some downsides
- It is helpful to network with other multitumor site navigators to share resources
- We would like to explore the idea of a community within AONN for multi-tumor site navigators to network
Managing a Navigation Program: The Role of Administrators
Phyllis DeAntonio, RN, MSN, FAAMA
Marie DeStefano, RN, MSN, FAAMA
Patient navigation is all the buzz in healthcare today. Every patient with an abnormal finding, whether malignant or not, wants a nurse navigator to guide them through this complex business we call health care. Navigation is as different and unique as the institution where the care is delivered, including the title of the navigator. In some institutions they are known as “nurse navigators,” and in others, “patient navigators.” They have been called “patient care coordinators,” “case managers,” and “patient care navigators.” Regardless of their title, the role remains the same. The purpose of the navigator is to assist the patients in receiving prompt quality care during this challenging time in their life in order to achieve the best outcome. While the overall goals are better patient outcomes, in an environment where justification of new positions is a constant challenge, it is important to gain support from administration for the ongoing success and funding of this position.
Some key points from an administrative view to remember about nursing navigation are:
- Evaluate the gaps in your system for better utilization of the navigator
- Establish relationships with referring physicians
- Establish a point of contact for the patient, whether imaging, physician referrals, selfreferrals, or pathology
- Remember, a navigator does not work in isolation but is part of the team approach
- Establish volume baselines for ongoing monitoring of out-migration and the ability to maintain patients
- Report statistics to administration on a timely basis for ongoing justification of position
- Report patient satisfaction; satisfied patients are the best marketers for the institution
- Set realistic goals for patient volumes