Background: Oncology navigation is a patient-focused, time-intensive process. Individual patient encounters occur multiple times over an extended period. A primary objective for nurse navigators is to identify and address patient barriers, then customize care delivered to minimize barriers and achieve optimal healthcare outcomes. Mitigating solutions to barriers is challenging and often requires multiple, time-intensive steps. Caseload volumes for nurse navigators are increasing as programs experience recognition and growth. A standardized method to determine navigator caseloads is merited and needs to be acuity-based rather than number-based for management efficacy and practice success.
Objective: To establish a baseline acuity score for oncology patients by utilizing distress scores and barrier numbers, then compare with the total time spent navigating the patient for correlation patterns.
Methods: Retrospectively, navigation documentation on 112 breast cancer patients from 2015 to 2017 was audited to identify patient barriers and distress scores. These numbers were then plotted on the patient navigator acuity scale to establish an acuity level for each patient. Barriers, distress score, and established acuity levels were then compared with the total navigation time logged (per hour) per patient. Correlation was used to determine the relationship between barriers, distress score, acuity level, and the total navigation time. Regression was performed to determine if any variables were predictive of navigation time.
Results: Breast cancer cases increased annually. Overall, barrier number impacted the patient’s acuity score, and the greater the number the higher the acuity. Barriers (0.001) and acuity scores (0.006) demonstrated significant correlation to navigation time. Barriers were also found to be significant predictors (0.023) of navigation time. Average time spent navigating per barrier was 0.7 to 1.0 hour. Distress scores did not show significant correlation or prediction of navigation time. Timing of distress screenings impacted test results, and were found to be inconsistent and predominately completed toward end of treatment. Limitations in the study included utilizing a barrier assessment tool developed for a community outside the study area.
Conclusion: As navigation programs evolve, a standardized method to determine acuity for caseload management is needed to support nurse navigators and ensure ongoing navigation success. Development of barrier assessment tools along with consistent screening practices for distress are warranted. This study highlights the importance of barriers and their impact on acuity and supports the need for continued research in navigation acuity for best practice development.
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