The Impact of Patient Navigation with Gastrointestinal and Hepatopancreatobiliary Cancer Patients

November 2020 Vol 11, No 11
Michele M. Hubert Fiscus, MSN, RN
Cancer Conference Director
Great Lakes Cancer Center
Buffalo, NY

Background: A professional steering committee for Great Lakes Health Hospital System identified the need to coordinate and integrate an organized oncology service line and attain Commission on Cancer accreditation. An important part of its success was the implementation of a patient navigation program. Early on, the team identified a delay in the time from the onset of diagnostic testing to initial treatment, which made the need for a nurse navigator imperative. The first disease site to begin a navigation trial was hepatopancreatobiliary and gastrointestinal (HPB/GI) cancers. Led by their Clinical Performance Group, a 40-day benchmark was identified, and goals were set.

Objectives: The objective of this project was to show how a navigation program will improve the time from an initial tissue biopsy to the initiation of oncology treatment to 23 days.

Methods: A quasi-experimental applied research design was used. This methodology allowed the author to determine if patient navigation changed the timeliness of accessing oncology care for this specific population. The sampling criteria included patients diagnosed with an HPB/GI cancer. A baseline was obtained from 27 random patients diagnosed with an HPB/GI cancer within 6 months before the introduction of the navigation pilot. A retrospective review of 76 nonrandom patients with abnormal findings were included in the postnavigation sample. Data were collected through retrospective chart reviews. An outcomes database provided the patient’s date of biopsy and topography. The electronic medical record was used to identify the following dates: biopsy performed, biopsy report, initial surgical oncology, medical oncology, office consults, initiation of treatment, and the pathologist. A Servant Leadership model was used in the development of the navigation program.

Results: A quantitative data analysis was conducted. Although the goals were not met, the results support the goal. Multiple factors may have affected the patient’s time to initial treatment. Some of the issues identified in this project also impacted the time from medical oncology consult to treatment. The most common reasons made known included the need for an additional biopsy, an extended hospital stay, discharge to a rehabilitation facility, need for further testing, and insurance denials requiring appeals or change in the treatment plan. Through inserting a nurse navigator into the workflow for newly diagnosed HPB/GI cancer patients, an overall improvement was noted in the time from biopsy to initial treatment by almost 10%. The most significant improvement (60%) was observed in the time from the biopsy to initial medical consultation.

Conclusions: Although the limitations identified during this project may have affected the communication capabilities between the oncology providers and nurse navigators, including a patient navigation program in the care of the oncology patient led to an improvement in the time from biopsy to initial treatment. This project was performed on HPB/GI cancer patients who primarily received navigation from 1 specific navigator. Referrals were received on patients who primarily underwent their initial biopsy at Buffalo General Medical Center. Repeating the project using data for all patients with an HPB/GI cancer diagnosis may provide additional insight into other outcomes and barriers of care.

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