Category VII: Operations Management, Organizational Development, Health Economics

October 2022 Vol 13, No 10 —November 7, 2022

G1 Acuity Grading Can Improve Navigation Operations

Kris Blackley, MSN, BBA, OCN; Bei Hu, MD; Danielle Boselli, MS; James T. Symanowski, PhD; Laura Kabrich, BSN, OCN

Levine Cancer Institute, Charlotte, NC

Background: The Levine Cancer Institute (LCI) navigation program needed to manage limited resources in a large multifacility cancer center with high patient volume. In some areas, navigator volumes were as high as 250 patients per navigator, while other areas had lower volumes but required intensive navigation and could not be assessed solely by the number of patient visits. The acuity grading tool (AGT) was created to help with the operational efficiency of the navigation team and to assess workload, using another metric in addition to patient volume.

Objectives: The goal of this retrospective review was to determine if the AGT accurately reflects the work effort, the barriers facing patients, and the intensity of navigation required for individual patients receiving cancer treatment. The objective of acuity grading is 2-fold: To quantify the work effort required per patient and to help the navigators prioritize their limited time by utilizing the level of acuity grading score.

Methods: The AGT is based on a scale from 1 to 4, with 1 being the lowest acuity having few needs, and 4 being the highest acuity having multiple barriers that require regular monitoring to ensure treatment compliance. The grading is subjective, but guidance is provided for the types of barriers that qualify for each level of acuity, and routine chart auditing is conducted for quality.

We evaluated the AGT using a retrospective study evaluating differences of White versus minority patients with aggressive B-cell lymphoma treated at LCI (Cancer, 0, 1-7). We used the navigation database to assess acuity grading scores (high intensity [score of 3 or 4] vs low intensity [score of 1 or 2]), the types of barriers that patients faced, and time spent navigating these patients.

Results: 204 total patients were included for analysis, of whom 85% (n = 174) were navigated. There was only a small difference between minorities and Whites accessing navigation services (81% vs 87%; P = .35), but minorities had more high-intensity navigation (42% vs 21%; P = .01). It was also noted that minorities faced a higher number of barriers, including compliance concerns (18% vs 7%; P = .04), insurance questions (29% vs 8%; P = .002), financial concerns (37% vs 18%; P = .02), and transportation concerns (16% vs 2%; P = .004). The high-intensity encounters also took up significantly more time for the navigators compared with low-intensity encounters (median, 135 vs 60 minutes; P <.001).

Conclusion: The AGT reflects the work effort of navigators in this retrospective study. High-intensity encounters required more time and addressed more barriers to patient care. Based on this specific study, the navigation AGT was an accurate tool to assist in the management of program operations and patient care, and further studies evaluating this tool in all cancer types are needed.

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G2 A Quality Improvement Project to Reduce Hospital Readmissions in the Oncology Patient Population

Laura Alfonso, RN, MSN, OCN

UCLA Santa Monica Medical Center, Santa Monica, CA

Background: Hospital readmissions negatively impact healthcare organizations and patients alike. Readmissions are costly, resulting in financial losses for organizations while also causing poor patient experiences. Oncology patients are associated with higher readmission rates due to the complexities of their disease. They face high symptom burden as a result of their cancer and treatment, such as pain, nausea, vomiting, and fatigue. In an effort to address this issue, the readmissions reduction steering committee implemented a system-wide screening tool—Better Outcomes by Optimizing Safe Transition (BOOST). BOOST prompts nurses to identify if patients meet any of the 8 predetermined high-risk readmission categories as part of their daily assessment. Utilizing the BOOST tool may prove effective in identifying oncology patients at high risk for readmission, leading to the development of clinical pathways.

Objective: Conduct analysis of readmission data as they relate to BOOST to create a foundation for the development of a clinical pathway to reduce oncology-related readmissions.

Methods: Using the BOOST screening tool, baseline data were collected on the 30-day readmission rate of patients on the solid tumor oncology unit for 4 months. An interdisciplinary workgroup evaluated the data to develop a clinical pathway for the oncology diagnosis to enhance patient care and ensure a safe discharge and posthospital care.


  1. Data were collected for 16 weeks
  2. Fifty-two patients were identified by the BOOST tool. Fourteen of those patients were assigned to the overflow hospitalist service
  3. Thirty-eight oncology patients were found to be readmitted within 30 days of discharge through the BOOST tool
  4. Most common BOOST elements were problems with medications, physical limitations, poor health literacy, and palliative care
  5. Most common primary oncology diagnosed with highest readmission rate: colorectal, hematologic malignancies, liver, and breast
  6. Varied readmission diagnoses and reasons for readmission

Conclusion: Per BOOST, the oncology diagnosis with the highest readmission rate is colorectal cancer, and the highest contributing BOOST element is problems with medication. Despite this, an in-depth chart review revealed that symptom management and unclear goals of care are the main contributing factors for readmission. A plan is needed to create a clinical pathway for colorectal oncology patients addressing palliative care needs to reduce readmissions.

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G3 Cost-Effectiveness of Multicancer Early Detection Testing in Subgroups with Smoking History or Obesity

Ali Tafazzoli*1; Alissa Shaul2; Weicheng Ye2; Ameya Chavan2; Karen C. Chung1; Anuraag R. Kansal1; Mark Fendrick3

1GRAIL LLC, a subsidiary of Illumina Inc., Menlo Park, CA†; 2Evidera, Bethesda, MD; 3Department of Internal Medicine, Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI

Background: Cancer is a leading cause of death globally, with higher incidence and mortality rates in patients with obesity or a history of smoking. Cancer screening is associated with a reduction in mortality, and recently new blood-based multicancer early detection (MCED) tests that simultaneously screen for multiple types of cancer have been developed. Oncology nurses are critical to the cancer screening process and can benefit from understanding that MCED testing can enable earlier cancer detection and more efficient treatment, thereby improving cancer-related survival and lowering cancer-related treatment costs.

Objectives: To compare key economic and health outcomes of MCED testing in patients with additional risk factors versus the general population.

Methods: A Markov model was implemented to compare annual MCED testing plus standard-of-care screening with standard of care alone in US patients without a history of cancer starting at age 50 until age 79 years. The impact of MCED testing was compared between the general population and the following subgroups: currently smoking, any smoking history, and obesity (BMI ≥30 kg/m2). The model explicitly tracked initial cancer diagnoses for 19 solid cancer groupings that represent >80% of cancer incidence. Surveillance, Epidemiology, and End Results (SEER) data informed incidence by age and stage at detection for the general population. To reflect higher cancer incidence and background mortality associated with smoking status and obesity, cancer-specific incidence and mortality for each subgroup were adjusted relative to the general population using published literature. SEER-Medicare linked data informed resource use and commercial costs. Performance of an MCED test was described in Klein et al, 2021. Costs, life-years, and quality-adjusted life-years (QALYs) were estimated over patients’ lifetime, discounted at 3% per year. Value-based price was estimated for willingness-to-pay (WTP) thresholds of $50,000/QALY and $150,000/QALY.

Results: Compared with the general population, initial cancer diagnoses were 13%, 7%, and 5% higher, respectively, in populations currently smoking, with smoking history, and with obesity. MCED testing increased cancer detection in early stages by between 75% and 78% in all subgroups considered. Use of MCED testing in the subgroups was more cost-effective than use in the general population. Incremental cost-effectiveness ratios were $11,112/QALY, $27,534/QALY, and $44,650/QALY, respectively, in the currently smoking, any smoking history, and with obesity subgroups at a test price corresponding to a WTP of $50,000/QALY in the general population ($769). At a test price corresponding to a $150,000/QALY WTP in the general population ($1615), incremental cost-effectiveness ratios were $65,829/QALY, $101,209/QALY, and $138,983/QALY in the same subgroups.

Conclusion: An MCED test that is cost-effective in the general population is even more cost-effective in populations with obesity or a history of smoking because the increased number of cancers detected by the MCED test outweighs competing mortality risks in these populations.

Funding: Funded by GRAIL, LLC, a subsidiary of Illumina Inc.

*Evidera, Bethesda, MD, at time of study.

Currently held separate from Illumina Inc. under the terms of the Interim Measures Order of the European Commission dated October 29, 2021.

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G4 Creation of ONN Float Pool to Address Staffing Shortages

Laura Ma, MS, BSN, RN, OCN; Kaitlen Reyes, DNP, FNP, RN; Susan Twohig, BSN, RN, ONN-CG; Elizabeth Wigozki, MSN, RN, OCN, CNL

Dana-Farber Cancer Institute, Boston, MA

Background: The demand to increase oncology nurse navigator (ONN) staffing at Dana-Farber Cancer Institute (DFCI) has been driven by institute-wide growth, increased patient volume, and a new state employment policy change in 2021 extending maternity and medical leave up to 26 weeks.1 Longer leaves have resulted in significant gaps in staffing. Historically, DFCI would hire temporary travel nurses to fill these gaps at considerable cost. The total expenditure on nurse travelers to cover ONNs in 2018 was $196,996. This has increased every year to a high of $427,188 in 2020. The total hours covered by temp nurses rose from 3444 in 2018 to 5382 in 2020. ONNs at DFCI specialize by disease site and are responsible for symptom management, care coordination, and patient education, often acting as the hub of interdisciplinary patient communication and follow the patient through the continuum of their care. Ensuring adequate staffing is essential for patient safety. In addition, Yackzan et al found that patients who had contact with ONNs had a higher rate of satisfaction with their care than patients without an ONN.2 The implementation of a float pool would ensure that all patients would have access to an ONN despite prolonged staff leaves. Nursing float pools to address shortages have been implemented successfully nationally for years.3 However, an ONN float pool has not been reported in the literature.

Objectives: To create an ONN float pool to address staffing gaps.

Methods: Over 7 months, 6 full-time float ONNs were hired, oriented, and deployed to disease centers in need of long-term staffing coverage. Five float ONNs were hired for solid tumor groups, and 1 float for hematological malignancy groups. Disease specific orientation is provided in each assigned group to include onsite and remote work. ONNs also receive a dedicated float orientation and attend monthly float ONN team meetings.

Results: Fifty percent of departments at DFCI have utilized a float ONN in the past 7 months due to critical staffing needs, and zero dollars have been spent on temporary travel nurses. An unexpected benefit of creating an ONN float pool was that these nurses can more agilely share best practice across teams they are assigned to. Implementation of standard communication tools and adoption of more efficient workflows are being disseminated.

Conclusion: The development of the float ONN pool at DFCI has met staffing and patient care needs in a more fiscally responsible way and ensured that patients received navigation throughout their care journey despite prolonged staff medical leaves. Permanent float ONNs are in a unique position to support and optimize ONN practice across the institute. Their insight and perspective help to identify best practice and efficiencies across teams. The floats are partnering with ONN leadership to develop standards of practice for float ONN practice and refining float orientation. Through shared governance and partnership with nursing leadership, the float ONN program has proved instrumental to supporting and refining navigator practice. Due to the success of implementation, DFCI plans to continue the growth of the ONN float pool.


  1. Commonwealth of Massachusetts. Paid Family and Medical Leave (PFML) overview and benefits: fo-details/paid-fami ly-and-medical-leave-pfml-overview-and-benefits. 2022.
  2. Yackzan S, Stanifer S, Barker S, et al. Outcome measurement: patient satisfaction scores and contact with oncology nurse navigators. Clin J Oncol Nurs. 2019;23:76-81.
  3. Straw C. Engagement and retention in float pools: keeping the team above water. Nurs Manage. 2018;49:30-36.

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G5 Oncology Nurse Navigator Team Leads Play Critical Role in Launch to Remote Work

Laura Ma, MS, BSN, RN, OCN; Elizabeth Wigozki, MSN, RN, OCN, CNL

Dana-Farber Cancer Institute, Boston, MA

Background: In March 2020, the oncology nurse navigators (ONNs) at Dana-Farber Cancer Institute (DFCI) were instructed to begin working at home with only 24 hours’ notice due to the increased spread of COVID-19 and the need to de-densify the hospital environment. The ONNs had never worked from home before, although there has been literature showing the benefits of teleoncology care and telenavigation.1 The ONN team consisted of 67 nurses across 13 different teams that ranged from 2 to 10 team members. Leadership needed to develop new ways to communicate, as well as accountabilities, tools, and workflows adapted to a remote setting. Kniel and Comi2 posited that one of the key competencies of remote teams is knowing how to communicate. COVID-19 information was changing rapidly, and communication to keep the nurses updated was more important than ever.

Objectives: To develop methods to keep ONN team cohesion and solid communication within teams and ONN leadership during remote transition of workforce.

Methods: A communication lead structure was created across ONN teams. Leadership met with each team prior to launching to remote work, and volunteers were selected to be a communication lead within each ONN team. The responsibility of the communication lead was to host a virtual huddle over Zoom 3 times per day with their respective ONN team for status checks and questions. Check-ins ensured teams connected with each other during a volatile time when many ONNs expressed fear and isolation. The leads additionally attended a daily end-of-day huddle via Zoom with leadership to report out issues and questions their teams experienced during the day. Leadership communicated new changes and highlighted e-mail communication that occurred during the day to ensure important information was understood. The lead ONN would bring back any leadership communication to their respective team.

Results: The communication lead structure empowered ONNs with leadership positions within their teams. It enhanced accountability of all team members to check in throughout day and actively participate in escalating issues and questions and sharing best practices. The end-of-day huddles with leadership enabled proactive interventions by leadership in addressing real-time issues, bridging workflow gaps, and keeping in close communication with all teams in a new remote environment. In addition, this structure built comradery within the ONN community that helped battle compassion fatigue3 and deterred staff turnover throughout the pandemic. We are the only nursing discipline within our institution that has not experienced nurse attrition over the past 3 years.

Conclusion: The ONNs are now a hybrid workforce and are 50% remote. The communication lead structure continues today. ONNs who were not communication leads began aspiring for the role and adding it as part of their professional goals in annual performance reviews. The communication lead role now rotates each month so that each nurse on the team can take on the role. The structure has proved to be indispensable in team cohesion, comradery, sharing of best practice, and relationship building with ONN leadership and across teams.


  1. Emfield Rowett K., Christensen D. Oncology nurse navigation: expansion of the navigator role through telehealth. Clin J Oncol Nurs. 2020; 24:24-31.
  2. Kniel J, Comi A. Riding the same wavelength: designers’ perceptions of shared understanding in remote teams. SAGE Open. /21582440211040129. 2021.
  3. Cunningham T, Catallozzi M, Rosenthal D. Camaraderie and community: buffers against compassion fatigue among expatriate healthcare workers during the Ebola epidemic of 2013-16. Health Emergency and Disaster Nursing. 2018;5:2-11.

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G6 Optimization of Nursing Informatics to Enhance Navigation Practice During the COVID-19 Pandemic

Elizabeth Wigozki, MSN, RN, OCN, CNL; Kaitlen Reyes, DNP, FNP, RN; Laura Ma, MS, BSN, RN, OCN

Dana-Farber Cancer Institute, Boston, MA

Background: The oncology nurse navigators (ONNs) at Dana-Farber Cancer Institute (DFCI) are the first-line communicators with patients who are calling or messaging their care team. The COVID-19 pandemic created an enormous influx of patient triage and added a layer of complexity to an already vulnerable patient population. Oncology patients and their caregivers looked to ONNs to navigate their complex cancer care, a new novel virus, and constantly emerging information related to the pandemic. With the increase of COVID-19–related concerns, the multidisciplinary teams needed a clear and systematic way to assess and communicate. Clinical assessments performed by ONNs via telephone had a significant downstream impact on multiple stakeholders. ONN assessments of patients’ COVID inquiries ensured safe timing of patient treatments, informed staff of the required personal protective equipment needed, and helped with allocation of negative pressure rooms. Wu discussed the importance of nurses reimagining their practice to meet the rise in patient desire for remote care.1 The American Association of Colleges of Nursing published core competencies for nursing education, establishing informatics and technology competency as critical components.2 With increased COVID-19 triage volume via telephone, the opportunity to incorporate nursing informatics to optimize patient care and nursing practice became imperative.

Objectives: To standardize COVID-19 assessments of patients via telephone and streamline communication and documentation within multidisciplinary teams across the institute.

Methods: ONN leadership met with multiple clinical stakeholders, including infection control, infusion floor leadership, and clinical specialists to collaborate on a shared communication template within the electronic medical record (EMR). Key assessment points were identified to create 3 COVID-19 templates for patients: COVID-19 positive, COVID-19 exposed, and COVID-19 risk due to symptoms. ONNs gathered specific data in their assessments that included validation of exposure, dates of exposure, time points of symptoms, and testing results. Leveraging nursing informatics, ONN leadership developed standardized assessment templates in the EMR to optimize nursing assessment and documentation.

Results: Three COVID-19 assessment templates were created within the EMR system for ONNs to use across the enterprise. Training to utilize the assessments was provided to navigators at the monthly ONN committee. A quick reference guide of how to use the templates was developed and stored on the institute website and widely disseminated to all nursing roles at DFCI, including ONNs, research nurses, infusion nurses, and advanced practice nurses. This implementation standardized documentation across all nurses performing COVID-19 assessments and streamlined multidisciplinary communication.

Conclusions: The increased volume of COVID-19 inquiries necessitated clear, concise documentation and assessment to ensure safety. Standardizing documentation of COVID-19 inquiries enabled ONNs, care teams, infection control, and infusion floors to quickly decipher the patient’s current clinical situation and helped ensure the necessary safety protocols were being employed for each individual patient. Standardization improved the ONNs workflow and enabled them to triage COVID-19 inquiries more efficiently and systematically. Continued optimization of nursing informatics in ONN practice is crucial to our success as we continue to navigate patients in an increasingly digital world and communicate with remote clinical team models.3


  1. Wu Y. Utilization of telehealth and the advancement of nursing informatics during COVID-19 pandemic. Int J Nurs Sci. 2021;8:367-369.
  2. American Association of Colleges of Nursing. The Essentials: Core Competencies for Professional Nursing Education. 2021.
  3. Kaundinya T, Agrawal R. Unpacking a telemedical takeover: recommendations for improving the sustainability and usage of telemedicine post-COVID-19. Qual Manag Health Care. 2022;31:68-73.

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G7 Pharma/Biotech Nurse Educator Engagement Survey

Sharon Gentry, MSN, RN, HON-ON-CG, AOCN, CBCN1; Denise Chambley, PharmD2; Emily Gentry, RN, BSN, OCN, HON-ONN-CG3

1Academy of Oncology Nurse & Patient Navigators, Cranbury, NJ; 2Amplity Health, Vice President North America Medical Solutions; 3The Lynx Group, AONN+ Senior Director of Education and Program Development

Background: The Academy of Oncology Nurse & Patient Navigators (AONN+) participates in client engagement with pharmaceutical and biotechnology companies to promote programs and products for sharing oncology patient navigation best practices and advancing professional education. The Lynx Group, the managing company of AONN+, questioned how navigators interact with pharmaceutical and biotechnology nurse educators. This question had never been asked of the AONN+ membership. A literature review was completed showing zero evidence on the interaction of navigators with industry nurse educators.

Objectives: To develop a survey for AONN+ membership asking about their relationship with industry nurse educators. The desire was to capture the navigator voice to highlight engagement patterns from nurse educator interactions. This unprecedented work has relevance to navigation practice to improve patient navigation education by exploring reasons why they engage with nurse educators, preferred learning method for interactions, the type of information desired on oncology advancements, and choice of “leave-behind” resources.

Methods: A 17-item multiple choice and open-ended survey to capture navigators’ interactions with nurse educators from pharmaceutical and biotechnology companies was developed by the Amplity project team and AONN+ leadership. A mixed method survey was developed with a focus to describe the navigator respondent with quantitative questions, a qualitative “select all that apply,” ranking, and an open-ended experience/suggestion section to provide detailed insight into the navigator and educator interactions.1 The survey was e-mailed to the AONN+ membership, and each member was given the opportunity to respond over a 1-week period. A follow-up reminder to the nonresponders was sent 2 days before the survey ended. As a thank you, all participants who completed the survey were entered into a drawing for a chance to win 1 of 100 $25 Amazon gift cards.

Results: A total of 346 responses were received in the open period. The majority were nurse navigators (54%) or oncology nurses (9%), but patient navigators (18.5%) and social workers (11%) also voiced their educator experience. Monthly engagement was the norm for nurse educator interaction. Navigator preference is in-person interaction or live in-service presentations. The most desired information is patient management/adverse effects and patient cases. Navigators appreciate caregiver brochures, disease overviews, and financial/insurance information as takeaways. Four concepts were identified when navigators were asked how pharma/biotech companies can provide enhanced education: (1) direct patient impact as creative solutions are shared for patients, (2) direct navigation impact as education is enhanced on oncology advancements, (3) meeting suggestions for best knowledge retention, and (4) communication means to augment navigator and patient education.

Conclusion: This information will enrich the interaction of project teams as they interact with industry to focus on navigation in developing best practices for the improvement of patient access to care, evidence-based treatment, and quality of life. The insightful data will tie to professional practice as they are used to support the professional growth of oncology patient navigators. This study highlights the collaborative nature of educators along the oncology patient care continuum and demonstrates interest and professional development benefits in connecting oncology colleagues and resources.

Was this abstract previously submitted to other associations? If so, please list: No


  1. Ponto J. Understanding and evaluating survey research. J Adv Pract Oncol. 2015;6:168-171.

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G8 Providing Resources and Support: Removing the Barriers to Abstract Writing

Nicole Bravo, BSN, BS, RN, ONN-CG; Emily Compton, MSN, OCN, RN; Michelle Eck; Laura Frazier, MSN, RN, OCN; Sarah Ochieng, BSN, RN, OCN; Heather Waggoner, MSN, RN, CN-BN

Sarah Cannon, Nashville, TN

Background: The Advisory Board of Sarah Cannon comprises oncology nurse navigators across all divisions. Their shared purpose is to provide a platform for collaboration and networking among colleagues to optimize the navigation role and encourage the provision of high-quality cancer care. Board members also engage in subcommittees that are focused on a specific objective or task-project initiative. The abstract subcommittee was created with the intention of providing navigators with education and resources to encourage active participation in abstract writing and submission.

Objectives: To assess preconceived attitudes, actual and potential barriers, and the current knowledge base and deficits of nurse navigators surrounding the abstract writing and submittal process. Ultimately, this will lead to an opportunity for professional development and an increased number of abstract submissions by our navigators.

Methods: To gain a baseline understanding of which resources would be of the greatest benefit, the subcommittee sent an initial pulse survey to 190 navigators across the Sarah Cannon enterprise. Working meetings were scheduled with the subcommittee members to research and produce resources based on the direct feedback from the survey. In continuation, the group plans to send a follow-up survey to the respondents to evaluate the effectiveness of the developed resources.

Results: Sixty-four navigators from various divisions and tumor sites responded. The results included 4 main concepts: the process of writing an abstract, topics and data availability, conference abstract guidelines and deadlines, and mentorship/partnership opportunities. To provide a thorough overview of the process of abstract writing and the selection process, the AONN+ Abstract Writing Panel Discussion webinar was sent via e-mail to all navigators for viewing. In addition, the Sarah Connect intranet site was updated with an abstract and conference resource page where all information could be compiled for easy access. On this webpage, the team included a list of available conference references, abstract due dates, ideas for abstract topics and data points, as well as examples of past poster presentations. The existing Sarah Cannon abstract writing guidelines were posted on this site, along with an interactive spreadsheet tool for tracking the timeline for submitting an abstract. Finally, an enterprise-wide Webex Teams group was created for nurse navigators to facilitate mentorship opportunities, co-authoring collaboration, and to foster a community for brainstorming and discussion.

Conclusion: The Advisory Board abstract subcommittee addressed knowledge gaps, generated educational resources and purposeful tools, produced a central platform for current and future materials, and provided a virtual community promoting mentorship and partnership in abstract writing. In follow-up, the subcommittee plans to measure the project’s impact on the number of abstract submissions year over year. The group intends to utilize survey analytics and crowdsourcing feedback to remove barriers and provide ongoing support and additional resources to encourage engagement in research and abstract writing.

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G9 Tailoring Oncology Nurse Navigator Competencies

Elizabeth Wigozki, MSN, RN, OCN, CNL; Kaitlen Reyes, DNP, FNP, RN; Katherine Magni, MSN, RN, OCN; Laura Ma, MS, BSN, RN, OCN

Dana-Farber Cancer Institute, Boston, MA

Background: The role of the oncology nurse navigator (ONN) has continued to evolve.1 It is essential that there be ongoing work to develop standardized navigation competencies, processes, documentation, and outcome measurements.2 In 2017, the Oncology Nursing Society published the Oncology Nurse Navigator Core Competencies, which highlights care coordination, communication, education, and the expectations for the professional role.3 This has provided infrastructure for the ONN role. Within the care delivery microsystem, as the ONN role continues to evolve and expand, a need to update and revise the ONN competencies was identified at Dana-Farber Cancer Institute (DFCI). Navigation needs to be tailored to the institution given the various navigation resources that are available at each center.4 The Oncology Navigation Standards of Professional Practice describe the necessary knowledge and skillset required by professional navigators to deliver competent high-quality care in a variety of healthcare settings.1 ONN staffing at DFCI has grown 97% over the past 4 years, and we now have nearly 150 ONNs across the enterprise. This growth has driven the need to iterate the DFCI ONN competency checklist to optimize training and onboarding to the role.

Objectives: To refresh the ONN competency at DFCI, improve orientation to the unique role of the ONN, and ensure standardized training, tools, and resources for new hires in alignment with oncology navigation standards and evolving practice.

Methods: The existing competency checklist was reviewed by DFCI ONN leadership, clinical nurse specialists, and ONNs from across the institute. The competency checklist was dissected with revisions, additions, and validation of content to reflect the current practice of ONNs at DFCI.

Results: The refreshed ONN Orientation Competency was implemented, which helped streamline orientation for new hires and ease the burden on ONN preceptors. This ensured that current practice competencies, as well as critical tools and resources, were covered during new hire orientation. The competency was outlined in policy review, information management, safety and infection control, professionalism and professional development, provision of care, and symptom management. Unique workflows were not included so that standardized training could be conducted across all ONN roles at the institute.

Conclusion: There is a need to continue to evolve the role of the ONN at DFCI. A first step was revising the orientation competency record. More work is necessary to further scope the role, as the role continues to evolve each year. The next steps to be taken will include a modified telephone triage policy and development of scope of practice for the ONN role at DFCI. These additional steps will strengthen the role, ensure navigators are maximizing their scope of practice, and provide a framework for new ONN hires.


  1. Franklin E, Burke S, Dean M, et al. Oncology navigation standards of professional practice. Journal of Oncology Navigation & Survivorship. 2022;13(3):74-85.
  2. Cantril C, Christensen D, Moore E. Standardizing roles: evaluating oncology nurse navigator clarity, educational preparation, and scope of work within two healthcare systems. Clin J Oncol Nurs. 2019;23:52-59.
  3. Oncology Nursing Society. 2017 Oncology Nurse Navigator Core Competencies. 2017.
  4. Reed L, Rua K. Defining the role of the oncology nurse navigator. Journal of Oncology Navigation & Survivorship. 2020;11(3):90-92.

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G10 The Effects of Organizational Support to Improve Access and Navigation Skill in Clinical Trial Conversations and Education

Jeanne Silva, MSN, RN-BC, CMSRN, CN-BN; Avni Patel, BSN, RN; Michelle Ashley, MSN/MPH, RN, OCN, CBCN, CN-BN, NCTTP

RWJBarnabas Health System and Rutgers Cancer Institute of New Jersey, Somerset, NJ

Background: Clinical trials (CTs) use research to study new ways to prevent, diagnose, or treat diseases. Many life-extending medical advances result from CT discoveries. Despite the benefits of participation, less than 10% of people in the United States participate. Participation and recruitment are an enduring challenge, with 40% of National Cancer Institute CTs discontinued from poor participation. More daunting is that 80% of industry-funded trials fail to meet their target.

Nurse navigators (NNs) can play an essential role in CTs because of the trusting relationship between the navigator and the patient throughout the care continuum. The navigator is skilled in overcoming patient barriers and, through open discussions, can dispel the myths and concerns associated with enrollment. Nurse navigation is a realistic strategy to address CT gaps. The strategy is to increase the NN’s confidence in discussing CTs and to standardize the delivery process. The NN can ensure all patients have the opportunity to participate in CTs, particularly minorities and underserved populations.

Objectives: To (1) obtain baseline data on NNs’ knowledge and deficits, (2) provide professional development sessions and mentoring to increase NNs’ knowledge and their ability to communicate information to patients, (3) develop multimedia culturally competent evidence-based CT education highlighting the NN role and dispel CT myths, and (4) determine pivotal time points for navigator–patient discussions on CTs.

Methods: The study used a 3-pronged approach to address care gaps, patient-centered care team, and system. The study used a mixed method to evaluate the NNs’ perception of CT barriers. Stakeholders conducted baseline estimates and established outcome metrics. Research team members partnered to align organizational CT accrual goals and standardize the marketing efforts. Phase 1 for the study was January 2021 to December 2021, with ongoing evaluation resulting in modifications for phase 2 in 2022.

Results: Baseline data showed that the top barriers to patient participation are lack of awareness, fear, and lack of trust. Similarly, the NNs’ barriers were lack of knowledge and the perception that CTs are the last resort for treatment. The system barrier is a lack of marketing.

The 2020 baseline data authenticated that 1 patient had received education on CTs from an NN. The aim was to offer 5 education programs on CTs, including one focused on cultural diversity, and a segmented video aimed at conversations with diverse populations to broaden the scope of accruing minorities, who often have lower or no enrollment.

After implementing NN tools, 3598 patients (2021), ~30% of the system’s NN volume (~10,949), received education, with 1022 considering joining a CT. In phase 1 (2021), 92 patients enrolled, with 220 registering in the first half of 2022 (phase 2).

Conclusions: CTs bring revenue to the organization and cutting-edge opportunities to patients to improve outcomes and advance science. Using NNs is a proven method to engage patients in CTs. Educating the navigators to discuss trials is a realistic approach to increasing accruals. Navigators develop strong bonds with patients over time and are familiar with personalizing conversation and care plans to patients’ individual needs.

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G11 Time to Diagnosis Among Patients with Cancer in the United States

Matthew Gitlin, PharmD1; November McGarvey, PhD, MPH1; Namrata Shivaprakash, MPH, MS1; Ze Cong, PhD, MS2

1BluePath Solutions, Los Angeles, CA; 2GRAIL, LLC,* a subsidiary of Illumina, Inc., Menlo Park, CA

Background: Cancer patients may often experience a lengthy diagnostic process that leads to treatment delays, poor outcomes, and high costs. Limited evidence on the duration of the cancer diagnostic pathway in the United States exists.

Objective: To quantify the time to diagnosis among patients newly diagnosed with cancer in the United States.

Methods: A retrospective claims analysis of patients newly diagnosed with cancer in 2018 to 2019 was conducted using Optum’s de-identified Clinformatics Data Mart database, which includes Medicare Advantage and commercially insured members. Patients were identified using ICD-10 codes requiring ≥2 outpatient visits ≥30 days apart or 1 inpatient visit without a prior cancer claim. The first diagnostic test was selected by reviewing the records for diagnostic tests prior to the cancer diagnosis until a gap of >60 days was observed. The index date was defined as the first diagnostic test date or, if available, the office visit date closest to and <4 weeks prior to the first diagnostic test. The time to diagnosis (time from index to cancer diagnosis date) was summarized descriptively and by tumor type.

Results: A total of 458,818 patients were identified with diagnoses across 20 cancer types. Patients were a mean age of 71 years, had a mean Charlson Comorbidity Index of 2.1, and 50% were male. Breast (26%), prostate (19%), lung (13%), urothelial and bladder (9%), and kidney (8%) cancers were most prevalent. Mean (SD) time to diagnosis was 5.2 (5.5) months (median = 3.9 months) and varied across cancer types and among patients with the same cancer type; 15.4% of patients had a time to diagnosis of >6 months. Cancer types with more than a quarter of diagnosed patients experiencing a time to diagnosis of >6 months included multiple myeloma (52.8%), stomach (48.8%), esophagus (46.1%), colorectal (44.6%), lymphoma (31.9%), kidney (28.7%), and gallbladder (26.5%).

Conclusions: Nearly 1 in 6 patients newly diagnosed with cancer experienced a lengthy diagnosis process of >6 months with large variations across patients and cancer types, highlighting an unmet need for efficient cancer diagnosis in the United States. Policies, guidelines, and interventions that streamline cancer diagnostic pathways are critical to optimize patient outcomes. Oncology nurses will be vital to this process, as they play an important role in coordinating cancer diagnosis and treatment.

Funding: Funded by GRAIL, LLC, a subsidiary of Illumina Inc.*

*GRAIL, LLC, is currently held separate from Illumina Inc. under the terms of the Interim Measures Order of the European Commission dated October 29, 2021.

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G12 Understanding Opportunities to Strengthen and Support Patient Navigation in Pennsylvania

Samantha Curriero, MPH; Kate Konkle, MPH; Eugene Lengerich, VMD, MS

Penn State Cancer Institute, Hershey, PA

Background: Patient navigation (PN) improves cancer-related care, especially care among vulnerable populations.

The Cancer Navigation and Survivorship Network (CaNSuN), established in 2018, aims to connect, educate, and share evidence-based practices among navigators in Pennsylvania. Pennsylvania is one of many states that have multiple PN programs but lack statewide guidelines on PN.

Objectives: In 2021, CaNSuN conducted an environmental scan to gain increased understanding of cancer navigation programs in Pennsylvania. Specifically, we wanted to:

  • Understand who performs navigation, how PN is funded, primary location, how success is measured, and primary challenges
  • Identify ways to better support and strengthen PN in the state

Methods: A 19-question survey was developed and administered in September 2021. The target population included navigators, including social workers, nurse and lay navigators, community health workers, and navigation program managers.

The survey was administered using a snowball approach. The survey was sent to the CaNSuN newsletter subscribers and shared by the Pennsylvania Cancer Coalition and key stakeholders, who were each asked to share with their networks and colleagues. Nonresponses to questions were reported as missing data. Analysis was conducted using SPSS software.

Results: Eighty-one individuals completed the survey. Nurse navigators and community health workers made up almost 80% of respondents, and respondents were almost equally divided between working in community, clinical, and hospital settings; 25 organizations were represented.

The median time respondents reported being in their role was 5 years (range 0.08-30 years), and the median number of patients navigated per month was 42.5.

Navigators indicated their biggest challenges were lack of clarity on the role (32%), lack of guidelines for navigation (28%), measuring program success (28%), and funding (25%). Approximately 2 in 5 of those who responded reported their positions were funded by the hospital or health system and 1 in 5 by nonprofits.

Patient satisfaction (50%) and time to treatment (24%) were the most common measures used to evaluate success. More than one-quarter of respondents put “N/A,” signifying they did not evaluate or were unaware of what metrics might be collected.

Discussion: Survey results indicate that there are opportunities to strengthen support for both navigators and navigation systems in Pennsylvania:

  • Many navigators are newer to their roles and have high patient loads; groups like CaNSuN can provide needed professional development and educational resources but also connection between navigators so they can learn from each other
  • Adequate evaluation of PN metrics will hopefully provide justification and value for supporting PN programs and justify ongoing support
  • Community health workers are a growing part of the navigation workforce, and future consideration for how to support and integrate their work is needed
  • There are opportunities to advocate for formalizing PN within healthcare systems and to better support it at a state level for reimbursement.

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Last modified: August 10, 2023

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