Category VI: Quality, Performance Improvement

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

F1 A Community of Navigators: Komen’s Patient Navigation Training Program

Kyandra Fox, MHA; Samantha Scott, MPH; Sabina Emerenini, MPH; Julie McMahon, MPH

Susan G. Komen, Dallas, TX

Background: Research has shown that while patient navigation is an effective tool to reduce patient barriers, there are gaps in training availability, particularly related to health inequities and nonclinical patient navigation.1,2 Komen’s Patient Navigation Training Program was developed in response to the identified gaps. The program features courses, tools, resources, virtual events, and panel discussions designed to help develop and/or enhance the skills patient navigators need to best address disparities in breast cancer outcomes.

Objective: To describe a program that was developed to foster a community of expert patient navigators through its 2-pronged approach of diversifying the workforce and providing navigators with the tools, resources, and strategies needed to navigate patients of varying cultures, backgrounds, races, and ethnicities.

Methods: Komen’s Patient Navigation Training Program core training curriculum was adapted from George Washington University, with additional content created by Komen focused on navigating underserved populations. All content is intended to provide navigators with detailed information on how to navigate patients through their healthcare experience with an equity lens. The program launched in May 2021 and includes virtual social hours, panel discussions, summits, and other networking and peer-to-peer engagement opportunities. Additional engagement with Komen’s internal team is provided via e-mail and training portal support. Active recruitment of navigators in diverse markets has been focused in areas that have a high prevalence of underserved patients and disproportionate cancer outcomes. Trainees complete a registration survey to provide demographic information, along with postprogram and 90-day postprogram surveys to provide feedback on their experience of being a part of the Patient Navigation Training Program.

Results: Throughout the program’s first fiscal year (April 1, 2021-March 31, 2022), 114 individuals completed the program, including 13 internal Komen staff. Among the trainees, 64% self-identified as Black, 16% White, 12% Hispanic, 6% chose not to disclose, and 2% Asian; 38% were already working as navigators. Among the 69 postprogram survey respondents (61% response rate), 95% reported an improved understanding of patient navigation, 90% expressed they intend to apply the information learned through the training program within their current roles, and 86% reported satisfaction with the training program overall. Respondents also provided suggestions that were implemented for the ongoing program, such as additional resources, more live opportunities, and a job board within the training portal.

Conclusion: The program is effective in fostering a community of navigators and providing them with the skills needed to equitably navigate a diverse patient pool. Trainees have demonstrated an increased knowledge of health equity–based patient navigation. Many of the trainees expressed their intention of applying the knowledge and skills gained through the program. Understanding the needs and wants of the trainees has jump-started the building of a “navigation nation community.” To maintain and increase engagement, adaptations made to the program include additional virtual opportunities and more content focused on navigating underserved populations. Future adaptations will include a case study forum to share best practices and resources for difficult cases and new content responsive to knowledge gaps reported by navigators.


  1. Battaglia TA, Zhang X, Dwyer AJ, et al. Change agents in oncology workforce: let’s be clear about community health workers and patient navigators. Cancer. 2022;128(suppl 13):2664-2668
  2. Wells KJ, Wightman P, Aguilar RC, et al; for the National Navigation Roundtable Evidence-Based Task Group. Comparing clinical and nonclinical cancer patient navigators: a national study in the United States. Cancer. 2022;128(suppl 13):2601-2609.

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F2 Cancer Advocacy & Patient Education (CAPE) Initiative: Patient & Healthcare Provider Insights

Linda Fleisher, PhD, MPH; Cassidy Kenny, MBA; Zoe Landau, MPH; Cheryl Bellomo, MSN, RN, OCN, ONN-CG; Amy Jo Pixley, MSN, RN, OCN, ONN-CG; Emily Gentry, BSN, RN, OCN, HON-ONN-CG

Academy of Oncology Nurse & Patient Navigators, Cranbury, NJ

Background: The Cancer Advocacy & Patient Education (CAPE) lung initiative is a web-based patient education platform that warehouses best-practice resources and educational materials. Created by the Academy of Oncology Nurse & Patient Navigators (AONN+), CAPE is designed to improve patient education and enhance patient care. CAPE permits navigators and other cancer care team members to send patients “e-prescriptions” that contain personalized education customized for each patient’s circumstances and treatment status. AONN+ in collaboration with Fox Chase Cancer Center (FCCC) conducted a pilot study to evaluate patient and healthcare provider feedback regarding the CAPE resources and to assess CAPE implementation at 4 cancer centers (2 urban medical centers and 2 rural medical facilities).

Objectives: The pilot study was commissioned with 2


  • Could the participants identify at least 2 benefits of CAPE?
  • Could the participants identify at least 2 possible barriers to CAPE implementation?

Methods: Fifty-three English-speaking non–small-cell lung cancer patients were enrolled in the CAPE program within 12 weeks of their diagnosis. Participants completed a baseline survey, received personalized e-prescriptions (printed or via e-mail), and completed a 1-month follow-up survey over the phone with the FCCC research team about their experience with CAPE. Implementation strategies were site-specific and tailored to meet the needs of each site’s clinical workflows. The FCCC research team conducted an analysis of the perceived usefulness and educational value of CAPE across the diverse sites and conducted interviews with staff members using the Consolidated Framework for Implementation Research to better understand the differences between sites and guide future dissemination.

Results: Of the 53 patients enrolled, 16 patients reported viewing the CAPE materials, and the majority of those patients’ felt CAPE helped them understand their diagnosis and treatment options. The patients who recalled receiving CAPE materials felt the resources equipped them to talk with their doctor. Notably, the patients were more likely to remember receiving the materials when enrollment was in-person with their navigator, which was how the study was implemented at the urban sites. As with many technology-based patient resources, several factors influenced effective CAPE implementation: overwhelmed patients, short-staffing, low technology literacy, and provider handoffs, which varied between rural and urban sites. Overall, providers felt that CAPE is a great resource for patients, and that it fits within their patient workflow practices and matched patient educational needs.

Conclusions: The majority of the patients who used the CAPE resources viewed them positively. However, some patients felt overwhelmed by their diagnosis or other external factors, so their ability to use or absorb the information provided through CAPE was diminished. Based on these findings, AONN+ believes there are strategic points in the patient care process at which CAPE could be introduced. A one-size-fits-all approach to implementation timing may not be optimal. The insights from these preliminary findings will guide future implementation and dissemination of CAPE.

Acknowledgment: AONN+ acknowledges Takeda Oncology for its support and funding of this innovative, leveraged, and evidence-based program.


Bellomo C, Pixley A, Johnston D. Filling an educational void: AONN+ announces Cancer Advocacy & Patient Education (CAPE) Lung Cancer Initiative. Journal of Oncology Navigation & Survivorship. 2019;10(12):532-538.

Check DK, Zullig LL, Davis MM, et al. Improvement science and implementation science in cancer care: identifying areas of synergy and opportunities for further integration. J Gen Intern Med. 2021;36:186-195.

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F3 Do Barriers Exist That May Impact Decision-Making for Routine Screening Mammogram Among Nurses Working in a Community Hospital?

Sharon Lieb Inzetta, RN, MS, CN-BN, CBCN, ONN-CG; Eileen Fleming, MSN, RN, NE-BC

Summa Health, Akron, OH

Background: Screening mammogram results in earlier detection of breast cancer and impacts overall improved survival. Despite many years of research demonstrating the impact screening mammography may have on reducing mortality, morbidity, and earlier-stage diagnosis for breast cancer, many individuals choose to defer screening mammogram. National screening guidelines may differ and can be confusing.

Barriers may exist for women undergoing screening mammogram. Barriers may involve personal beliefs and knowledge, social and interpersonal barriers, and system-related barriers. If these barriers can be identified among nurses here in our community hospital, can we implement strategies to decrease these barriers for nurses, and can we generalize to all women in our surrounding local community?

Objectives: This nonexperimental exploratory study targeted 3 objectives:

  1. To identify rates for screening mammogram compliance for nurses working within our health system.
  2. To identify self-reported barriers and health beliefs among nurses that may impact the decision to have a screening mammogram and then possibly generalize these barriers to our local community.
  3. To plan interventions to address identified barriers and improve screening mammogram rates.

Method: All registered nurses (N = 2800) across multiple system locations, both inpatient and ambulatory, were invited by e-mail to participate in the study. An anonymous REDCap Survey was developed and completed by 336 nurses.

Results: Survey data analysis using descriptive statistics was completed. The average age of participants was 49.4 years, with 13.47 years of experience; 215 reported compliance with screening mammogram. Significant barriers were identified in the following categories:

Nurse’s Health Beliefs/Knowledge: Fear of screening, fear of pain, lack of information/knowledge, privacy concern, and no breast symptoms.

System: Received a mailer; lack of time.

Social/Interpersonal: Lack of doctor referral, and no family history.

The members of the group found to be noncompliant for screening mammogram (n = 121) were 7 to 9 times higher in reporting no family history and no breast symptoms versus those associated with compliancy for screening.

Conclusions: The study investigated self-reported barriers to screening mammography in an urban healthcare system among nurses. The intended outcome is to work with system leadership to identify and develop strategies targeting education to remove barriers and increase screening access for all nurses. Only 58.8% of nurses reported self-awareness for recommended screening guidelines within the system. Improving access for nurses by expanding hours for early morning and later evening hours was identified as a strategy that might impact increased decision for screening mammogram. The survey did not identify that the COVID-19 pandemic was reported as a barrier in our study. Education for individual risk, family risk, and symptoms surrounding breast cancer is planned. Our goal is to educate nurses toward increased compliance for preventive screening health beliefs and behaviors, with an end result for transfer of knowledge to their patients.


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Dodendorf DM, Deogun GK, Rodie AR, Poi L. Assessing the patient’s mammogram experience. Health Care Manag Rev. 2004;29:77-87.

Edwards S, Chiarelli AM, Ritvo P, et al. Satisfaction with initial screen and compliance with biennial breast screening at centers with and without nurses. Cancer Nurs. 2011;34:293-301.

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Pace LE, Vianney Dusengimana JM, Keating NL, et al. Impact of breast cancer early detection training on Rwandan health workers’ knowledge and skills. J Glob Oncol. 2018;10:1-10.

Rosenstock IM. Historical origins of the Health Belief Model. Health Education Monographs. 1974;2(4):328-335.

Russell KM, Champion VL, Skinner CS. Psychosocial factors related to repeat mammography screening over 5 years in African American women. Cancer Nurs. 2006;29:236-243.

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Ueland AS, Hornung PA, Greenwald B. Colorectal cancer prevention and screening: a Health Belief Model-based research study to increase disease awareness. Gastroenterol Nurs. 2006;29:357-363.

Weedon-Fekjær H, Romundstad PR, Vatten LJ. Modern mammography screening and breast cancer mortality: population study. BMJ. 2014;348:g3701.

Weston C, Akinlotan M, Lichorad A, et al. The impact of interprofessional education on family nurse practitioner students’ and family medicine residents’ knowledge and confidence in screening for breast and cervical cancer. J Am Assoc Nurse Pract. 2018;30:511-518.

Wujick D, Fair A. Barriers to diagnostic resolution after abnormal mammography. Cancer Nurs. 2008;31:E16-E30.

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F4 Early Detection of Lung Cancer Through Low-Dose CT Lung Cancer Screening and Incidental Findings of Pulmonary Nodules

Amy R. Perugini, BS, RN; Ainsleigh Brown, BSN, RN

Cancer Coordination, McLeod Center for Cancer Treatment and Research, Florence, SC

Background: Lung cancer is the second most diagnosed cancer and the leading cause of cancer-related deaths in the United States. Early detection has a direct impact on survival outcomes, but sadly, 47% of lung cancer is diagnosed late stage (stage III or IV).1 Contributing to this advanced-stage lung cancer at diagnosis, incidental pulmonary nodules are frequently lost to follow-up.

Objectives: Earlier detection of lung cancer and mitigation of patients lost to follow-up.

Methods: McLeod Health (MH) implemented low-dose CT lung cancer screening and an incidental lung nodules pathway as part of a Healthy Lungs Initiative in FY2019 to include 3 modalities: low-dose CT lung cancer screenings, incidental lung nodule findings, and multidisciplinary lung conference for diagnosis/treatment of suspicious pulmonary nodule findings.

Results: Following US Preventive Services Task Force (USPSTF) guidelines, managed by an RN navigator, the lung cancer screening modality resulted in an early-stage diagnosis rate of 81%, compared with 23% nationally. Also, using commercially available software, a dedicated RN lung nodule navigator coordinated data mining of radiological imaging reports. Over an 18-month period, 18,668 reports were identified that required clinical review. The results of the review yielded 524 patients in need of advanced clinician evaluation. FY2021 McLeod Regional Medical Center (MRMC) – Lung Cancer Screening Modality:

  • 1220 patients received lung cancer screenings at MRMC
    • 164 of the 1220 patients received Lung-RADS score of 3 or higher
    • 26 of 1220 (2%) were diagnosed with lung cancer
      • 21 of the 26 (81%) diagnosed cancers were at early stage (I, II), with recommendations for treatment with curative intent
      • 5 of 26 (19%) patients were diagnosed at a later stage (III, IV)

Of the 18,668 radiology reports receiving additional clinical review – MH-Incidental Modality:

  • 524 (3%) patients were identified with pulmonary nodules ≥6 mm; of whom:
    • 112 (21%) are currently being worked up
    • 73 (14%) resulted in a negative clinical workup or review
    • 30 (6%) were enrolled in MH lung cancer screening
    • 15 (3%) have remained stable
    • 26 (5%) are pending pulmonary evaluation
    • 97 (19%) patients elected their primary care provider evaluation
    • 5 (1%) elected outmigration
    • 11 (2%) declined further workup
    • 155 (30%) were diagnosed with lung cancer
      • Early stage (I, II) = 15% of Ca; 4% overall
      • Late stage (III, IV) = 56% of Ca; 17% overall
      • Unknown stage = 29% of Ca; 9% overall

Conclusion: The return on investing in human capital and software support, and dedicated attention to mitigation of patients through lung cancer screening and those traditionally lost to follow-up, resulted in positive clinical and financial outcomes. In concordance with USPSTF, screening patients at high risk of developing lung cancer demonstrates rates of earlier detection of lung cancer, which offers opportunities for treatment with curative intent and increased survivability. In addition, having a dedicated incidental pulmonary nodule pathway has contributed to this earlier stage of lung cancer diagnosis.


  1. American Lung Association. State of Lung Cancer 2020 Report.

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F5 Incorporating Upstream Oncology Nurse Navigation to Improve Timeliness to Treatment in Lung Cancer

Kathryn Hall, MSN, RN, CNL, OCN, ONN-CG

Solinsky Center for Cancer Care at the Elliot SolutionHealth Cancer Institute Manchester, NH

Background: As a result of our complex and fragmented healthcare system, patients often experience delays in care. Oncology nurse navigators (ONNs) serve as liaisons, playing a crucial role in facilitating seamless care transitions before, during, and following the completion of each phase and modality of treatment. Collaboration and coordination among primary care providers, oncologists, specialists, and other members of the team are essential for patients to receive quality and timely cancer care. According to the literature, time to treatment is considered a quality indicator for cancer care, but it is not well-defined. Laerum et al in 2021 defined time to treatment as the total number of days from the date of referral, due to suspicion of lung cancer, to the first day of treatment.

Objective: To decrease the length of time, measured in days, from initial consult to initiation of treatment by August 1, 2022, with the implementation of a standardized thoracic oncology clinical pathway and subsequent integration of upstream nurse navigation.

Methods: Upon completion of the Plan-Do-Study-Act quality improvement method and a retrospective chart review from June 2021 to June 2022, metrics for continuous and categorical data collection were used to quantify time to treatment. An Excel formula was used to analyze diagnosis to treatment intervals by determining date of diagnosis to consult and date of initial consultation to start of treatment. ONN metrics were utilized to benchmark lung cancer treatment facilitated by the ONN (N = 130 patients navigated). Collaboration with the multidisciplinary team to create a clinical pathway aimed to standardize consistent workflow and integration of upstream ONNs.

Results: Upstream ONNs demonstrated a 5-day decrease in the average time to treatment when comparing thoracic referrals (n = 52) to nonthoracic referrals (n = 78). The analysis also revealed that ONN involvement improved time from biopsy to initial consult by 18% compared with patients who did not have an ONN facilitating a timely referral and subsequent consult. Another key finding of the collected data demonstrated that the average length of time from the biopsy to treatment initiation for all lung cancer patients navigated was 25 days (mean) when compared with the national benchmark to offer treatment within 42 days of initial diagnosis.

Conclusions: A positive correlation between upstream ONNs and decreased time to treatment with thoracic referrals is based on a proactive approach to initiating the diagnostic/staging evaluation (ie, PET/CT, brain MRI) at the time of referral. This allows the ONN to facilitate appropriate timing of consults, anticipating results to be available for review during the initial oncology consult.

Implication for Practice: The ONN can mitigate potential delays, remove barriers, and alleviate the fear of the unknown for patients newly diagnosed with cancer. Best-demonstrated care supported by a disease-specific ONN with a referral at the time of confirmed tissue diagnosis is the gold standard of cancer care. During the January 2022 AONN+ Facebook live session, Katie coined the phrase, “Upstream is the oncology nurse navigator’s dream” while promoting navigators working to the top of their scope.


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Jacobsen MM, Silverstein SC, Quinn M, et al. Timeliness of access to lung cancer diagnosis and treatment: a scoping literature review. Lung Cancer. 2017;112:156-164.

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Zhang J, IJzerman MJ, Oberoiet J, et al. Time to diagnosis and treatment of lung cancer: a systematic overview of risk factors, interventions, and impact on patient outcomes. Lung Cancer. 2022;166:27-39.

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F6 Management of Oncology Patients Can Be Improved Using Continuous Temperature Monitoring and Electronic Patient-Reported Outcomes Innovations

Ruth Phillips, RN, BSN, MS, OCN1; April Boyd2

1Blue Spark Technologies, Philadelphia, PA; 2Carevive, Houston, TX

Background: Continuous temperature monitoring (CTM) identifies fever earlier than standard of care,1 and symptom detection and documentation is improved using electronic patient-reported outcomes (ePRO).2 CTM includes a wearable patch that broadcasts temperature data to an application on a patient’s smartphone, while healthcare providers can view data on a HIPAA-compliant web portal. ePRO digital health software focuses on understanding and improving the cancer patient experience through patient reporting of common symptoms, such as pain or anxiety, and is easily accomplished through a friendly question-response format delivered directly to the patient’s device. Dashboard visualizations of ePRO data are readily accessible for clinician review. Patient engagement improves with the use of ePROs, which can, in turn, improve clinical efficiencies and outcomes.2 Earlier, faster, data-informed patient interventions can potentially reduce healthcare-related costs.2

Objectives: To explore the value and efficiencies of CTM and a symptom data set for patients at risk for febrile neutropenia (FN).

Methods: Health and symptom questions distributed via an ePRO platform are based on validated measures and designed to be answered using a patient smart device or web browser. Patients will enter symptom data at baseline, daily during their nadir, and weekly for a period appropriate to their treatment experience. They will also monitor their temperature using CTM during the nadir, typically days 7 to 14 following treatment. We intend to accrue 20 to 30 patients across 5 to 6 oncology centers. Postexperience interviews will gather feedback on the value of CTM data in conjunction with ePRO monitoring from both clinician and patient perspectives. The data will be analyzed using standard qualitative research methodologies.

Results: Data collection is in progress, with an expected completion date of March 2023. We believe combining CTM and ePROs in patients at risk for FN will improve identification and triage of patients experiencing symptoms by facilitating timely and efficient clinician assessment and intervention. For example, identifying symptoms that require assessment, such as fever and cough, could allow for the prioritization of a fever workup to determine cause and appropriate level of care.

Conclusion: We expect that this pilot study of FN patients will provide additional information about clinical decision- making for FN. CTM and ePRO data obtained from new digital health technologies have the potential to improve patient experiences, clinical outcomes, and clinician workflows. The outcomes of this pilot will inform a more extensive study that seeks to identify areas of improved health and economic benefits due to the incorporation of CTM and ePROs. Participating sites to date include the University of Alabama and University of Michigan.


  1. Flora C, Tyler J, Mayer C, et al. High-frequency temperature monitoring for early detection of febrile adverse events in patients with cancer. Cancer Cell. 2021;39:1167-1168.
  2. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol. 2016;34:557-565.

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F7 Navigating Liquid Biopsies to Improve Comprehensive Genotyping in Patients with Newly Diagnosed Metastatic Nonsquamous Non–Small-Cell Lung Cancer

Megan Roy, MSN, RN, OCN; Anthony Martella, BA

Abramson Cancer Center, Penn Medicine, Philadelphia, PA

Background: Despite current National Comprehensive Cancer Network (NCCN) guidelines, less than 50% of patients with newly diagnosed metastatic nonsquamous (mNSq) non–small-cell lung cancer (NSCLC) undergo comprehensive molecular genotyping. At our institution, we demonstrated improved rates of comprehensive genotyping, EGFR, ALK, BRAF, ROS1, MET, RET, and NTRK testing, with use of concurrent tissue (T) and plasma (P) next-generation sequencing (NGS). Based on these results, we designed an electronic medical record (EMR)-based “nudge intervention” to prompt provider teams to order P NGS at the time of initial consultation.

Objective: The first objective is to increase the number of newly diagnosed mNSq NSCLC patients to have comprehensive NGS as indicated in NCCN guidelines. The added benefit is decreasing time to treatment by having P NGS available sooner than T NGS.

Methods: An EMR-based nudge was designed to order P NGS at the time of the new patient consultation. At the time the patient is scheduled to see medical oncology, this order is generated based on 3 criteria—newly diagnosed, metastatic disease, and NSq NSCLC. The navigator then sends the order to the physician to sign and schedules the lab 20 minutes prior to the first consultation. The navigator then completes the lab form with the patient demographics, insurance information, and histology and sends the form to the physician’s advanced practice provider (APP) to prepare the P NGS kit for shipping after the specimen is collected. The navigator then calls the patient/family to educate them on the importance of molecular genotyping and confirms the lab appointment.

Results: Since the intervention began (April 2021-June 2022) 661 lung cancer patients were scheduled and screened for the above criteria. A P NGS order was generated for 275 of those patients. This increased our compliance of comprehensive NGS testing on all mNSq NSCLC >98% in this period compared with before.

Conclusions: Having the EMR-based nudge intervention is associated with a significantly higher number of patients with NSCLC undergoing comprehensive molecular genotyping. This removes the need for the consulting doctor to remember to order the P NGS and ensures the probability of starting treatment after comprehensive NGS results. Plans are to expand the nudge to the satellite facilities to ensure standard of care is met across the health system. This success prompted the health system to build another nudge for the early-stage surgically resected patients. The nudge generates the T NGS order for the APP to sign while prepping the chart for the post-op visit. Future plans are to involve navigation at the first visit with interventional pulmonology to arrange for P NGS testing when metastatic disease is found on imaging. The goal is to have comprehensive NGS results prior to the first consult with medical oncology. As comprehensive NGS becomes more important to other solid tumor cancers, this process can be easily implemented to assure compliance with cancer guidelines.

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F8 Oncology Nurse Navigator Antiemetic Teaching Quality Study

Karen DeRenzi, BSN, RN, OCN, ONN-CG1; Bridget Laudien, BSN, BA, RN, CNOR2; Mary Mason, BSN, RN, OCN, ONN-CG1; Donna Seidman, BSN, RN, CHPN3; Jannine Valledor, AND, RN, CMSRN3; Pamela Zack, BSN, RN1; Kelly Zukswert, BSN, RN, OCN, CNBN4

1Carol G. Simon Cancer Center, Morristown Medical Center, Morristown, NJ 2Chilton Medical Center, Pompton Plains, NJ 3Carol G. Simon Cancer Center, Overlook Medical Center, Summit, NJ 4Sparta Cancer Center, Sparta, NJ

Background: A cancer diagnosis, along with accompanying treatments and new medications, can significantly impact patients’ overall health and quality of life. Medication teaching that meets patients’ learning needs enhances knowledge and supports compliance, which in turn promotes patient safety, satisfaction, and improved outcomes. Throughout the oncology care centers of Atlantic Health System (AHS), licensed professionals provide patients with evidence-based education according to national guidelines about symptom management prior to the initiation of systemic chemotherapy treatment. However, the oncology nurse navigation team collectively observed that following the initial teaching, many chemotherapy patients demonstrated knowledge deficits related to the identification and appropriate utilization of antiemetic medications. Given the strong component of patient education in the role of the oncology nurse navigator (ONN), it was identified that this patient population could benefit from an ONN providing further teaching and education reinforcement regarding antiemetic medications and self-management of nausea symptoms.

Objective: To evaluate the effect of education reinforcement and additional teaching by an ONN on patient knowledge and confidence related to the identification and utilization of antiemetic medications and the self-management of nausea symptoms.

Methods: Five ONNs across 3 AHS outpatient oncology care centers worked with a sample size of 41 patients undergoing chemotherapy treatment. Cancer diagnoses included breast (n = 28), colon (n = 6), rectal (n = 3), esophageal (n = 2), pancreatic (n = 1), and lung (n = 1). After the initial teaching was provided by another oncology professional, prior to the first chemotherapy treatment, patients completed a self-assessment survey to identify their perception of their knowledge related to prescribed antiemetics, administration instructions, and what to do if medication(s) were not effective. The ONN also administered a nurse assessment questionnaire at this time to assess patients’ understanding of these topics. Both questionnaires were administered again within 2 months, after reinforcement teaching was provided by the ONN.

Results: Initial teaching about antiemetics and self-management of nausea was provided to 97.5% of study participants, after which the average level of confidence patients self-reported was 69.22%. The average number of correct answers on the first ONN-administered assessment questionnaire was 59.76%. Following additional education and reinforcement by an ONN, the averages rose to 86.95% and 85.37%, respectively. Improvements were seen on both questionnaires for 32 patients (78%). Eight patients (19.5%) reported decreased confidence, and 1 patient (2.4%) reported no change in confidence level. Two patients (4.9%) scored lower on the second ONN assessment, and 7 patients (17%) scored the same.

Conclusions: This quality improvement study demonstrated that prior teaching being reinforced by an ONN resulted in significant improvement in patients’ knowledge and confidence as related to the identification of antiemetic medication and self-management of nausea symptoms. These results underscore that providing ongoing education to patients in outpatient oncology settings is a valuable contribution of the ONN. Patient education provided by the ONNs at AHS will continue to include reinforcement of antiemetic medication teaching and the assessment of patients’ understanding as it relates to the identification and utilization of these medications.


Kean CC, Iverson L, Boylan A. Evaluation of a chemotherapy and medication education process for patients starting cancer treatment. Clin J Oncol Nurs. 2016;20:364-366.

Traeger L, McDonnell TM, McCarty CE, et al. Nursing intervention to enhance outpatient chemotherapy symptom management: patient-reported outcomes of a randomized controlled trial. Cancer. 2015;121:3905-3913.

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F9 Oncology Nurse Navigators: Taking Charge and Forging New Pathways to Reduce Time to Treatment

Jennifer Mulholland, Katie Barrett

St. Elizabeth Healthcare Cancer Center, Edgewood, KY

Background: Patients with suspected or newly diagnosed lung cancer have many referrals and appointments during their initial workup. Oncology nurse navigators (ONNs) play a pivotal role for cancer patients in coordinating their care. When time to treatment initiation (TTI) is 20 days or less, patients have improved survival rates of 10.5 months, and for each week of delay, patients have a 1.2% to 3.2% increase in mortality. Creating a process for patients before their medical oncology consult is imperative to ensure timely diagnosis and staging. Each appointment is vital for the creation of the individualized comprehensive treatment plan, and the ONNs play an essential role in this process.

Care coordination of these patients prior to a medical oncology consult was identified to be inconsistent due to a lack of evidence-based clinical pathways identified by the ONN. The TTI for lung cancer patients was 31 days for quarters 1 and 2 of 2021.

Objective: To create evidence-based clinical pathways to improve patient throughput, leveraging the ONNs to implement best practices related to care coordination needs for patients with suspected or newly diagnosed lung cancer, in order to decrease TTI.

Methods: The thoracic oncology multidisciplinary team reviewed and implemented the National Comprehensive Cancer Network guidelines in December 2021 allowing the ONN to increase their scope of practice. Through collaboration with the referring provider and consulting physician, the ONN obtains appropriate referrals and orders to coordinate care as directed by the clinical pathway prior to the medical oncology consult. This includes obtaining orders and referrals to facilitate tissue acquisition, PET scans, MRI of the brain, and molecular testing. The ONN updates the patient with orders received, coordinates timely appointments, addresses potential barriers for follow-up, continuously reassesses for any potential patient needs, and regularly communicates with the care team.

Results: For this research, data were analyzed and compared between quarters 1 and 2 of 2021 with the same quarters of 2022. After implementation of the clinical pathways, there was a nearly 25% reduction in TTI when comparing the 2 time frames, a decrease from 31 days to 23 days. New patient caseloads were similar between the 2 time frames: 179 new patients in 2021 and 186 in 2022.

Conclusions: Ensuring ONNs are utilizing evidence-based practices, given autonomy in their role, and practicing at the top of their license will guarantee patients are supported and have the shortest TTI. Building multidisciplinary collaboration is essential to successful outcomes.


Azzouga AG, Chen R, Lou Y, et al. Impact of time to treatment initiation (TTI) on survival of patients with newly diagnosed non-small cell lung cancer (NSCLC). J Clin Oncol. 2019;37(suppl). Abstract 9058.

Hanna TP, King WD, Thibodeau S, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020;371:m4087.

Schieszer J. Wait times from cancer diagnosis to first treatment longer, negative impact on survival. Oncology Nurse Advisor. to-first-treatment-longer-negative-impact-on-survival/. 2017.

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F10 Pulmonary Nodule Multidisciplinary Conference: Revolutionizing Patient-Centered Care Through Telemedicine

Ainsleigh C. Brown, BSN, RN; Amy Perugini, RN

Cancer Coordination, McLeod Center for Cancer Treatment and Research, Florence, SC

Background: Over half of patients with lung cancer present with distant metastatic disease at diagnosis, frequently due to delays in treatment decisions.1 Although low-dose CT screening promotes earlier detection, a diagnosis of lung cancer may still be delayed due to the multistep process creating additional barriers. Prior to the implementation of a dedicated lung nodule multidisciplinary conference (MDC), patients waited up to 3 months for a definitive plan of care.

Objectives: To expedite clinical evaluation, McLeod Health established a telehealth-supported MDC for patients with suspicious lung nodules. This conference was established to not only reduce the amount of time between diagnosis and treatment but also to immerse patients in this integrated approach to their care.

Methods: The MDC includes representatives from pulmonology, medical oncology, radiation oncology, cardiothoracic surgery, radiology, and nurse navigation. These specialists meet with the patient and his/her family via telehealth to discuss diagnostic findings, evidence-based treatment options, and next steps for coordinating care. The patient and family members witness the case discussion and can ask questions at the end of the session.

Results: From January 21, 2021, to January 20, 2022:

  • 114 nodule cases were reviewed at MDC
    • 59 patients recommended for surveillance with repeat imaging
    • 26 patients recommended for additional diagnostic interventions
    • 8 patients recommended for radiation therapy
    • 21 patients referred for surgical resection
  • Ultimately, 30 of these patients had pathologically confirmed pulmonary malignancies and/or were treated empirically with radiation

MDC has fundamentally impacted timely coordination of care by:

  • Reducing the gap from 6 weeks to 3 days for evaluation of suspicious pulmonary nodules
  • Improving the formation of the plan of care from 3 months to 2 weeks

Conclusions: The bottleneck effects created by previously established multistep processes caused delays in diagnosis/treatment planning for patients with suspicious lung nodules. By reducing process inefficiencies, an MDC with patient involvement removes barriers and expedites the diagnosis and treatment of lung cancer.


  1. Phillips WW, Copeland J, Hofferberth SC, et al. Lung Cancer Strategist Program: a novel care delivery model to improve timeliness of diagnosis and treatment in high-risk patients. Healthc (Amst). 2021;9:100563.

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F11 Time Is Money: Navigation Validation with a New Productivity Scale

Stephanie Bonfilio, MSN, RN, OCN, ONN-CG

St. Elizabeth Healthcare, Edgewood, KY

Background: Oncology nurse navigators (ONNs) play a pivotal role in cancer patients’ journeys, from diagnosis throughout the continuum, removing barriers, providing resources, and planning life during and after cancer treatments. The ONN work is individualized and tailored for each patient to meet their needs and often requires more hours than a work week allots. Therefore, being able to measure the ONN productivity is imperative, and being able to establish standards in the ONN arena requires data and outcomes for the key stakeholders and administration to effectively measure the workload and ensure that ONN programs are staffed to provide all the needed elements of a robust program.

Objective: To design, develop, and utilize the data obtained from the Oncology Nurse Navigator Productivity Scale (ONNPS) to assess, plan, implement, and evaluate the current and future needs of a new ONN program.

Methods: Quantitative data were obtained through discrete fields in the electronic medical record to track ONN time per patient care encounter, divided into 4 types: face-to-face, documentation only (care coordination), telephone/MyChart, and other. The average time per encounter, weighted by the percentage of encounter types, is multiplied by the total number of encounters per month, then divided to represent an average daily Patient Care Productivity Value. This is combined with the average nonpatient care time (data collection/analysis, meetings, etc), for the ONN Total Productivity Value (TPV). The ONNPS allows for weekly, monthly, and quarterly productivity measures for each ONN and can break down patient-facing time, nonpatient care time, and total productivity.

Results: The ONNPS tool showcased the thoracic ONN (n = 2) average TPV of 2.6 hours/day at initiation of the program. After 3 months, GI patients were added to the workload, and after 6 months the average TPV nearly tripled to 7.4 hours/day. An additional full-time ONN was approved and hired, resulting in 3 ONNs: 2 thoracic ONNs and 1 GI ONN. The thoracic ONNs’ TPV averaged 9.34 hours/day over the following 6 months, revealing a need for additional ONNs but uncertainty around the exact amount of full-time equivalent (FTE) required.

The GI ONN had a steady increase in TPV from July 2021 (4.21 hours/day) to January 2022 (7.17 hours/day), justifying the need for an additional ONN to support GI and build head and neck navigation.

Of note, each thoracic ONN averages 80 to 100 active patients, the GI ONN averages approximately 160 active patients, and the GI/head and neck ONN currently averages 40 to 50 active patients.

Conclusion: The ONNPS tool can be utilized in many ways to enhance ONN programs, measuring patient-facing and nonpatient care time spent. The tool can be used by leaders when making data-driven decisions to modify processes and workflows, and measure efficiencies. It creates transparency between the ONN team and leadership to better understand workloads and support additional FTE needs. It encourages ONNs to document and account for their time during all levels of patient care. Validating time spent and verifying accurate documentation is essential to assure this tool is an accurate portrayal of productivity.


Academy of Oncology Nurse & Patient Navigators. National Study Aims to Demonstrate Value of Navigation in the Cancer Care Continuum. 2018.

Shockney LD. Nobody Understands What I Do as an Oncology Navigator. AONN+ Blog. 3716-nobody-understands-what-i-do-as-an-oncology-navigator. May 20, 2021.

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F12 Training for Patient Navigators at Federally Qualified Health Centers

Ambrocia Lopez, MAT; Mandy Spadine, PhD, MPH, CPH, CHES; Lauren Fix; Julie McMahon, MPH

Susan G. Komen, Dallas, TX

Background: In 2018, Susan G. Komen (SGK) Orange County (OC) collaborated with the Cal State Fullerton Research Team to conduct a patient navigation gap analysis to understand the breast cancer navigation needs in the OC community. The report highlighted the need to establish a cohort of trained patient navigators (PNs) and patient protocols for prediagnosis navigation at Federally Qualified Health Centers (FQHCs) to address the socioeconomic and cultural barriers experienced by Latinx, Korean, and Vietnamese patients. SGK launched a multiyear pilot project to (1) provide skill-based training on topics such as cultural competency, insurance policies, resource availability, and patient-provider communication; (2) create networking opportunities to exchange ideas; (3) enhance the pool of PNs; and (4) identify health policy opportunities to impact navigation services in California.

Objective: To understand the impact of the SGK breast health PN pilot training program on navigators at OC FQHCs.

Methods: Twenty bicultural PNs from 6 FQHCs participated in the training cohort. Two meetings were held, covering local breast cancer statistics, county safety-net programs, leadership development, and resource sharing. PNs completed an online training curriculum to build patient navigation core competencies. Best-practice protocols for navigation were provided, including translated education materials in Spanish, Vietnamese, and Korean. PNs participating in the training cohort were asked to provide qualitative feedback on the impact (successes, knowledge gained) of the program through an online Qualtrics survey. The survey was sent 2 months after PNs completed training. A qualitative thematic analysis approach was used to identify patterns across the data to derive themes. Multiple coders were used to identify themes, and intercoder reliability was assessed.

Results: Ten PNs completed the qualitative survey (50% response rate). Four themes emerged: patient resources, patient support, navigator education, and collaboration. PNs reported the training program provided additional resources to help guide patients through the continuum of care. Patient support was defined as the ability to provide holistic help, including physical, mental, spiritual, and social. PNs emphasized the knowledge and skills gained through the curriculum led to improvements in understanding breast cancer care and the barriers patients face in the community experience. PNs also reported enhanced ability to effectively communicate and collaborate with other PNs, healthcare teams, and caregivers to provide comprehensive care to patients.

Conclusion: The SGK OC training program provided PNs with education, resources, and skill development to better help patients across the continuum of breast care. Due to COVID-19, all training was held virtually, which presented challenges but did not impact positive outcomes. Understanding the impact of this training program provides the opportunity for program staff to identify and apply areas of success and areas of improvement as the pilot continues to assure culturally competent care is provided to the community. These learnings provide other PN program leaders the opportunity to apply areas of success to enhance the PN workforce in their programs and communities. The final year of the pilot will include quarterly meetings focused on workforce development and peer-to-peer support to increase the navigator’s job satisfaction and avoid burnout.

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Last modified: August 10, 2023

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