Care coordination — a fundamental piece of many of the models being tested under health care reform — already is gaining popularity in the treatment of cancer through the role known as a patient navigator.
Unrelated to health insurance exchange navigators, the use of patient navigators has been boosted by a mandate tied to federal grant money, expected future accreditation requirements and research that backs the concept.
Also central to the success of the navigator role in cancer care has been the reception by those receiving the care. “Patients love having a navigator on-site,” says Carma Herring, R.N., executive director of UnityPoint Health’s John Stoddard Cancer Center in Des Moines, Iowa.
The navigator position can be assumed by lay people or clinicians who assist patients in the various stages of the cancer journey — from screening and diagnosis to treatment and survivorship or end-of-life needs.
At John Stoddard, the patient navigator program launched with one nurse in 2007, and has expanded to six nurse coordinators over time, Herring says. Two focus on breast cancer, and the others concentrate on cancer of the colon, lung, head and neck, or prostate and gynecological organs. They all help patients with less common cancers.
The navigator often takes on duties that, in the past, a family member might have performed but is unavailable in these cases. Navigators can distill complex information from physicians and explain how various aspects of treatment fit together. And for patients without transportation or who have limited access, navigators facilitate travel to and from appointments, says Herring, the Oncology Nursing Society’s liaison to the Commission on Cancer at the American College of Surgeons.
The idea is gaining more industry acceptance. The stimulus package encouraged their use by tying grant money to mandates to include navigation programs. And by 2015, cancer centers’ seeking accreditation from the Commission on Cancer must demonstrate a patient navigation process that removes barriers to care.
Meanwhile, “research has demonstrated that patient navigators can help to improve care, making sure that patients get the appropriate screenings and treatments in a timely fashion,” says Electra Paskett, an epidemiologist at the Ohio State University.
Oncology nurses increasingly are joining the ranks of patient navigators. “Our nurse navigators have a strong clinical focus,” says Jean B. Sellers, R.N., administrative clinical director of the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, N.C., which has seen the number of its nurse navigators climb to 20 from nine in 2007. [Sellers also is president of the North Carolina Oncology Navigator Association.]
Surgeon Harold P. Freeman, M.D., founder of the Harold P. Freeman Patient Navigation Institute, says that cancer patients carry a lot of fear about the future. “We set out to resolve those issues.”