Nurse Navigation Program Improves Access and Satisfaction with Cancer Care

TON - July 2017, Vol 10, No 4 - Best Practices
Alice Goodman

Denver, CO—A pilot project to incorporate nurse navigation for all new patients diagnosed with a hematologic or gynecologic malignancy has met with success, improving access to care for patients at the Rutgers Cancer Institute of New Jersey (CINJ), as well as increasing patient and provider satisfaction.

The need for nurse navigation is pressing, according to Janet Gordils-Perez, DNP, RN, ANP-BC, AOCNP, Executive Director, Oncology Nursing Services, Rutgers CINJ, New Brunswick, and lead author of a poster presented at the 42nd annual meeting of the Oncology Nursing Society.

“Cancer patients still face a long and arduous treatment journey, one that is often poorly coordinated and challenging to navigate. Given the multidisciplinary nature of cancer care and the realities of the healthcare system, patients are frequently left on their own to coordinate with numerous treatment providers, balance conflicting information, and make treatment decisions, all the while coping with their disease and treatment effects,” stated Dr Gordils-Perez.

“In the navigation model of care, an oncology nurse navigator can coordinate the overall care of patients throughout discrete phases of cancer care by removing barriers to care and assisting patients with timely access to care, from screening, diagnosis, and treatment, through to survivorship,” she added.

The nurse navigation pilot program at CINJ was a quality improvement project, designed as a cohort study with a historical cohort comparison. Two full-time nurse navigators were hired, each with ≥5 years of experience and Oncology Nursing Society/Oncology Nursing Certification Corporation certification. Both nurses received navigation orientation that consisted of shadowing a trained nurse navigator, and a didactic component.

The gynecology nurse navigator program was implemented in November 2014, and the hematology nurse navigator program was implemented in February 2015.

Key responsibilities of the nurse navigators included face-to-face interactions with all newly diagnosed patients, facilitation of communication among providers, enhancing the services of CINJ’s Office of Human Research Services, and identification and elimination of barriers to treatment to prevent delays. Other responsibilities included directing patients to appropriate support services and outreach programs, acting as a liaison between the cancer program and referring physicians, educating patients about their disease and its treatment, and orienting patients to CINJ’s system.

The investigators reviewed charts and electronic health records pre- and postimplementation of the nurse navigator pilot project, and compared navigated patients with nonnavigated patients. Patients and providers were surveyed about satisfaction with their relationship with the navigator, and with their cancer care.

Results showed that the navigator program reduced the average time interval for access to the first oncology provider visit by 4.5 days for patients with gynecologic malignancies, and by 2.6 days for patients with hematologic malignancies. The time interval from the first oncology visit with a provider to the first therapy was reduced by 7.1 days for patients with gynecologic malignancies, and by 11.1 days for patients with hematologic malignancies.

Patients expressed excellent satisfaction with the navigation program. Out of a possible satisfaction score of 5, patients with gynecologic malignancies had a mean satisfaction score of 4.8, and patients with hematologic malignancies had a mean satisfaction score of 4.9. Providers were also satisfied, as was reflected by a mean satisfaction score of 4.95 for gynecology providers and 4.39 for hematology providers.

Dr Gordils-Perez said the results of this small sample size, and lack of a comparison group for measuring patient–provider satisfaction, limited the generalizability of these results to other populations and cancer types.

When asked about the take-away message from this study, Dr Gordils-Perez replied, “As oncology nurses and leaders, we must look to innovative programs to ensure we are providing the best care for our patients. Our navigation program was found to facilitate access to care for gynecology and hematology patients through a decrease in time for patients to receive their first oncology appointment as well as to start therapy, and both patients and providers were highly satisfied with the newly established navigator’s role.”

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Last modified: August 7, 2017