- H1. Beyond “C”: A Nurse Navigator–Led Education Project to Increase Survivorship Referrals and Cancer Survivorship Attendance
- H2. Implementation and Impact of an Oncology Nurse Navigator–Led Survivorship Program in a Hospital Outpatient Setting
H1 Beyond “C”: A Nurse Navigator–Led Education Project to Increase Survivorship Referrals and Cancer Survivorship Attendance
Carem Costa, MHL, BSN, RN; Natalie Bermudez, PhD, RN; Pamela M. DeLongchamp, BSN, RN, OCN, ONN-CG; Luz M. Morales, BSN, RN, ONN-CG; Tania Silva Santos, MSN, RN, OCN, ONN-CG; Morgan T. Nestingen, PhD, APRN, AGCNS-BC, NEA-BC, OCN, ONN-CG
Baptist Health Miami Cancer Institute, Miami, FL
Background: Oncology nurse navigator (ONN)–led educational interventions may promote positive outcomes such as improved quality of care, patient self-efficacy, health literacy, and health promotion, including initiation of survivorship referrals and consult attendance. Therefore, ONNs are in a prime position to provide cancer survivors with the education to promote and encourage their participation in survivorship programs.
Objective: The purpose of this evidence-based–practice (EBP) project is to evaluate the effect of nurse navigator–led patient and staff education on the number of navigator-initiated survivorship referrals and patient attendance at the first scheduled survivorship visit.
Methods: A plan-do-study-act (PDSA) was used to identify issues and implement changes in the survivorship referral process. The proposed changes were: (1) to identify issues related to low survivorship referrals initiated by ONNs; (2) to implement ONN survivorship education and compliance with initiated referrals; and (3) to improve education efficacy provided by ONNs, demonstrated as increased patient attendance at survivorship appointments. Baptist Health Clinical Excellence Through Evidence-based Practice (CETEP) EBP model was used to design the practice change. Data were collected from an outpatient oncology institute for comparison before and after PDSA implementation, to evaluate: (1) the difference in the number of referrals; and (2) the attendance rate at the scheduled initial survivorship appointments. Data were collected for the 3 months before (ie, preintervention [October-December 2022]) and the 3 months after (ie, postintervention [February-April 2023]) program initiation.
Results: Postintervention results showed a 276% increase in ONN-initiated referrals (n=185), compared to the preintervention ONN-initiated referrals (n=67). The number of patients who attended preintervention survivorship consults was 12, compared to 28 who attended survivorship consults in the postintervention time period, representing a 30% attendance-rate increase.
Conclusion: Implementation of the ONN survivorship education and compliance program significantly increased the number of survivorship referrals and patients’ attendance at the first scheduled survivorship visit. ONNs develop a relationship with their patients who trust their judgment. Cancer centers can leverage the nurse navigator role to improve care of cancer survivors in their continuum of care, including survivorship referrals and attendance, thereby improving health outcomes.
Sources
McMullen L. Oncology nurse navigators and the continuum of cancer care. Semin Oncol Nurs. 2013;29(2):105-117. Accessed July 1, 2023. https://doi.org/10.1016/j.soncn.2013.02.005
Young AM, Charalambous A, Owen RI, et al. Essential oncology nursing care along the cancer continuum. Lancet Oncology. 2020;21(12):e555-e563. Accessed July 1, 2023. https://www.sciencedirect.com/science/article/abs/pii/S1470204520306124
Return to TopH2 Implementation and Impact of an Oncology Nurse Navigator–Led Survivorship Program in a Hospital Outpatient Setting
Catherine Bailey, RN, BSN
OSF HealthCare Saint Francis Medical Center, Peoria, IL
Background: The burden of long-term and late effects of cancer treatment is well researched. Patients are often left to navigate survivorship without a healthcare advocate. The American College of Surgeons Commission on Cancer (CoC) has implemented new expectations for survivorship care under Standard 4.8 of the Optimal Resources for Cancer Care: 2020 Standards. At the time of the implementation of this program, no published articles or abstracts were discovered on the topic of nurse navigator–led survivorship programs.
Objective: The objective of this quality improvement project is to meet CoC standards for survivorship by introducing a comprehensive program led by oncology nurse navigators to meet the ongoing needs of cancer survivors by providing supportive services and advocacy to high-risk, posttreatment cancer patients.
Methods: OSF HealthCare implemented a survivorship program called Survive, Thrive, and Recover Together (START), led by 2 oncology nurse navigators. To meet CoC’s survivorship standards, the program offers a dedicated dietitian and exercise therapist. Other services include counseling, financial navigation, palliative care, intimacy clinic, physical therapy, lymphedema therapy, speech/language pathology, massage therapy, and pastoral care. There are also educational workshops, exercise classes, and various social activities available to the participants. The navigators work with oncology providers within OSF to identify patients at high risk of late and long-term effects of their cancer treatment. These patients are offered the START program after completion of treatment. The navigator provides a comprehensive nursing assessment of physical, socioeconomic, and psychosocial needs through a questionnaire and via in-person or telephone appointments. They provide regular points of contact by phone between surveillance appointments and, based on results of these ongoing assessments, offer supportive services as appropriate.
Results: In the first year of the program, 285 survivors were enrolled. Late and long-term effects of treatment were assessed in 4 domains: physical, dietary, social/mental, and healthy lifestyle. Surveys and assessments found that the top 5 areas of concern among survivors included dietary, dental, exercise, pain, and coping difficulties. The navigators arranged 116 referrals to various services both within and outside the START program. The most utilized services included dietitian (48 referrals); exercise therapy (35 referrals); rehabilitation, including physical therapy, occupational therapy, speech, and lymphedema care (27 referrals); and massage therapy (22 referrals). Nine referrals were made to the dental clinic. Survivor participation in social activities and educational programs was significantly increased. Participation in exercise classes increased approximately 300% since the inception of the START program. Quarterly educational workshops are being offered for all cancer survivors, and biannual workshops are available specific to head and neck cancer survivors.
Conclusion: After the first year, a nurse navigator–led survivorship program has been found to be successful and effective at meeting CoC Standard 4.8: Survivorship Care. Patient referrals and programming are growing in number and effectiveness. The preliminary data support that the navigator, in close relationship with the oncology team, is able to increase patient access to care and impact the management of late and long-term effects of cancer treatment. Further data will need to be collected to determine how patients perceive the improvement of their side effects and quality of life due to the interventions provided by this program. There is also opportunity to learn more about the program’s impacts on patient satisfaction and the financial benefit to the institution.
Source
American College of Surgeons, Commission on Cancer. Optimal Resources for Cancer Care: 2020 Standards. American College of Surgeons; 2019:36-37. Accessed May 16, 2023. https://accreditation.facs.org/accreditationdocuments/CoC/Standards/Optimal_Resources_for_Cancer_Care_Feb_2023.pdf
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