The Importance of Nurse Navigation in Lung Cancer Screening

November 2018 Vol 9, NO 11
Stephanie M. Hoopes, BSN, RN, OCN, ONN-CG
Prisma Health Upstate Center for Integrative Oncology and Survivorship
Greenville, SC
Gina Franco, MSN, ANP-C
Center for Integrative Oncology and Survivorship
Jo Weathers, RN, BSN, OCN, CBCN
Center for Integrative Oncology and Survivorship
Pamela Cloys, MSN, ANP-C
Prisma Health, Greenville, SC
LeAnn Perkins, FNP-BC, DipACLM
Prisma Health Upstate Center for Integrative Oncology and Survivorship
Greenville, SC
Mark A O'Rourke, MD
Center for Integrative Oncology and Survivorship
Patricia Leighton, MSN Ed, OCN, ONN-CG
Center for Integrative Oncology & Survivorship

Background: Lung cancer is the leading cause of cancerrelated death for men and women in the United States.1 An early detection of lung cancer was shown to directly correlate to lower mortality by the National Lung Screening Trial (NLST) results. The NLST showed a 20% decrease in mortality in those patients who had a low-dose CT (LDCT) scan of their chest compared with those who only had a chest x-ray. In 2015, Greenville Health System (GHS) created a multidisciplinary Lung Cancer Screening (LCS) program with the Center for Integrative Oncology and Survivorship (CIOS) as 1 of 2 portals of entry to provide a shared decision-making screening visit the Centers for Medicare & Medicare Services required. The nurse navigator is an invaluable part of the interdisciplinary team for the patients within the LCS program.

Objective: Nurse navigation was implemented within the LCS program at CIOS to increase initial screening, navigate patients through the process, provide the necessary education to patients and staff, and record and report data.

Methods: The multidisciplinary approach to LCS at GHS includes staff radiology, pulmonology, thoracic surgery, and CIOS. Primary care and specialists refer eligible patients to LCS, and their screening visit is provided by either CIOS or pulmonology. Patients then receive their LDCT at accredited radiology centers within the system. CIOS is a Screening Center of Excellence from the Lung Cancer Alliance. The data received from the LCS visits at CIOS are entered into REDCaps database to follow compliance. The nurse navigator at CIOS is a constant throughout the multidisciplinary process.

Results: LCS is one of many responsibilities of the nurse navigator at CIOS and takes approximately 25% of their time. The coordination of care the navigator provides at CIOS allows appropriate patients to be screened, educated, receive timely results, and get appropriate referrals to other disciplines as needed.

Conclusions: The LCS program has grown and thrived at CIOS with the support of the nurse navigator. Numerous disciplines within the health system, including primary care, financial counseling, and radiology, depend on the navigator for questions and support. The patient also can depend on the navigator for education within the shared decision-making visit about screening, risks and benefits, and smoking cessation and beyond with result phone calls, information on incidental findings, and referrals to appropriate specialists. The navigator, alongside the nurse practitioner, works with the multidisciplinary team to ensure continuity of care within the 2 departments providing screening visits. Discussions on how to expand the program and have navigation for LCS in outlying areas of the health system are already underway. Although some barriers exist, the LCS program is an innovative approach to preventive health measures, including consistent monitoring, adherence, and promotion of screening. It allows for patient tracking, early detection, and standardization of follow-up care for patients within the department and other specialties.


  1. American Cancer Society. Lung Cancer Prevention and Early Detection. 2018.
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