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Considerations in Patient Navigation: Insights from an ONS Panel Discussion

TON - June 2019, Vol 12, No 3 - ONS
Adam Buffery

Anaheim, CA—Although nurse navigation is a relatively new concept in healthcare, a growing number of organizations are launching navigation programs that provide patients with valuable services as they go through the many stages of their cancer journey. A panel of nurse navigators and healthcare professionals convened at the Oncology Nursing Society (ONS) 44th Annual Conference to discuss key aspects of patient navigation, and give attendees the opportunity to ask questions and learn how navigators perform their roles and collaborate with other oncology nurses and members of the cancer care team to improve patient outcomes.

Overcoming Barriers and Ensuring Access to Care

Barbara G. Lubejko, RN, MS, Project Manager, ONS, Pittsburgh, PA, stated that 2 key components of navigation are helping patients overcome barriers and ensuring access to care. She emphasized the importance of learning about the patient’s history and sitting down with each patient to review his or her individual plan of care. She recommended that navigators educate their patients on the benefits of a healthy diet, an issue she felt may often be overlooked in these discussions.

Ms Lubejko asserted that more experienced team members should offer their leadership expertise regarding the hiring of new navigators and the delineation of various roles within the navigation program. Her advice to new navigators was to “prove to leadership that what you’re doing matters.”

Offering Emotional Support

Patricia Simmers, MSN/Ed, RN, OCN, ONN-CG, Oncology Nurse Navigator, MountainView Hospital, Las Vegas, NV, explained that the cancer center where she works is owned by Sarah Cannon, which provides patient navigation services to institutions across the country. She said that, in her role as a nurse navigator working with patients with lung cancer, the most important aspect of her job is providing emotional support. One of her primary responsibilities is ensuring that patients who receive a positive pathology report for lung cancer schedule a follow-up appointment with a physician to discuss their results. She stated that she trusts her instincts when it comes to offering assistance to her patients, and that she can discern very quickly which patients are going to need additional help or active support.

Ms Simmers stressed the importance of being able to accommodate the needs of patients and their families in the present moment, and said that patients are likely to respond better when navigators remain open to their needs and requests. She encouraged navigators to schedule follow-up calls to ascertain whether patients have everything they need, adding that a simple phone call can demonstrate care, which may offer patients some peace of mind. Ms Simmers also shared that she tries to provide additional information and resources to patients during follow-up calls, and continually looks for ways to be a valuable support person for them.

Facilitating Communication and Providing Education

Cheryl Bellomo, MSN, RN, OCN, ONN-CG, Oncology Nurse Navigator, Intermountain Cancer Center, Cedar City Hospital, UT, explained that her role as a nurse navigator begins at the time of the patient’s diagnosis, and continues through the patient’s treatment and beyond.

As a member of the Academy of Oncology Nurse & Patient Navigators, the largest national specialty organization dedicated to improving patient care and quality of life by defining, enhancing, and promoting the role of oncology nurse and patient navigators, Ms Bellomo was able to provide attendees with valuable insights on the responsibilities and challenges of patient navigation.

The “main goal [of navigators] is to really provide our patients with safe, effective, and efficient care,” she stated, adding that navigators are tasked with “providing multidisciplinary care and education, and addressing symptom management,” as well as assessing barriers to care. A core responsibility of navigators is to facilitate communication between patients, family, and the healthcare team, which includes engaging, informing, and empowering patients in their care.

Ms Bellomo explained that the treatment phase of the care continuum can present significant challenges for navigators, who can have a real impact on outcomes during this phase. She stressed the importance of using available metrics and providing patients with education at any and all steps of the navigation process as this allows them to more effectively manage their symptoms. “If they better manage their symptoms, this can help treatment,” she said.

She concluded by saying that comprehensive patient education and care can lead to “fewer unnecessary [emergency department] visits and unnecessary hospital visits,” which can decrease medical costs and increase return on investment. With the proper education, patients will have improved experiences and outcomes, she added.

Offering Assistance with Financial Challenges

Sharon Cavone, RN, ONN-CG, Oncology Nurse Navigator, Penn Medicine Princeton Health, Plainsboro, NJ, stated that she prides herself in being a “jack-of-all-trades” navigator, and discussed some of the financial challenges patients with cancer face during the continuum of care. She said that because each cancer center has a unique population, it is vital for navigators to know the needs of their specific institution’s population so that they can offer the best care to patients. She explained that because her facility is located in Princeton, the patient population at her center includes many financially stable individuals, most of whom have private health insurance; only a small portion of the population is underinsured. She said that some of her patients who have Medicare but no secondary insurance do not realize that one day they will have to pay the 20% that Medicare does not cover.

Ms Cavone discussed how a former patient, a woman aged 32 years who was legally blind, had Medicare and could not “buy a secondary plan to save her life.” Navigators, she emphasized, must be aware of their patients’ financial needs.

“Gone are the days of ‘it doesn’t matter how my patients are insured’….that’s living in a dream world,” she said.

To determine the financial needs of patients, navigators may need to ask a lot of questions and conduct their own research so that they can offer appropriate help. Situations may arise in which a navigator can refer patients to healthcare professionals who can better accommodate their financial needs. For example, a patient in the military may benefit from going through the Department of Veterans Affairs (VA) healthcare system for their medications if they have no insurance. The navigator could assist the patient by arranging transportation to the nearest VA clinic.

Addressing Survivorship Issues

Jennifer Barnas, RN, BSN, OCN, Breast Nurse Navigator, AMITA Health Cancer Institute, Elgin, IL, discussed the topic of survivorship as it relates to navigating patients with cancer. She drew a few “wows” and laughs from the audience when she revealed that she has given her personal cell phone number to an estimated 600 patients whom she has navigated throughout the years. She explained that survivorship incorporates all aspects of navigation.

“Survivorship is more than just treatment. It begins at the beginning, with diagnosis,” she said, adding that introducing patients to the terms “survivor” and “survivorship” may help them “see a finish line,” and gives them something to aspire to.

Ms Barnas shared an analogy to explain the resistance some patients have when it comes to hearing about survivorship. “Survivorship is almost like feeding someone who is full,” she said. Therefore, when dealing with the survivorship phase, it is important for navigators to be mindful of the fact that patients and their families have already been through a lot.

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Last modified: August 6, 2019