Patient navigation: Is it a process or person?

Patient navigation: Is it a process or person?
Patient navigation: Is it a process or person?

Cancer survivorship begins at diagnosis, and continues through the balance of the person's life, as defined by the National Coalition for Cancer Survivorship (NCCS) and the National Cancer Institute (NCI). Cancer survivors were asked what would have helped them; the answer was “Someone who could guide us on the path,” said Pamela Haylock, PhD, RN, FAAN, an oncology consultant in San Antonio, Texas, at the NCONN Conference in Atlanta, Georgia. This is cusp of the role of the nurse navigator.

More people are surviving cancer than ever before, and they are living longer after a cancer diagnosis. Overall 5-year survival is more than 68%, 5-year survival for childhood cancers is 83%, and by 2014, the US population will include an estimated 19 million cancer survivors, 11 million of them will be 65 years or older.

Mandates for survivorship care are coming from various sources. The American College of Surgeons Commission on Cancer mandates that cancer centers must have a patient navigation process in place by 2015. The National Accreditation Program for Breast Centers (NAPBC) requires a navigation process to obtain and maintain accreditation as a Breast Center of Excellence. Navigation and care coordination concepts are addressed in the Affordable Care Act (ACA) of 2010.

But what is a navigation process? Although the descriptions from various organizations may differ, the essential element of a navigation process is the same: individualized services, support, or assistance provided by a professional nurse. The nurse performs the duties of guidance counselor, case manager, educator, care coordinator, and patient advocate, explained Haylock.

Optimum, risk-based survivorship health care is a provision of lifelong care that integrates cancer and survivorship experiences in survivors' overall health care needs. It incorporates components such as previous cancer, cancer therapy, genetic factors, lifestyle behaviors, and comorbid health conditions into a systematic, evidence-based plan for surveillance for recurrence, screening for late effects and second primary cancers, and targeted prevention.

Survivorship care consists of four components: prevention and detection of new cancers and recurrent cancer; surveillance for recurrence or new primaries, interventions for long-term and late effects from cancer and its therapies, and coordination between specialists and primary care providers to ensure that all of the survivor's needs are met.

Haylock's presentation asked, “Which of the knowledge, tasks, and skills of the role are distinctively different from those held by oncology-certified nurses in other roles?” The role of nurse navigator was defined to let everyone know a nurse is providing the service. Survivorship care is not about which nurse fulfills the role, but that the care and resources patients need to continue their life journey are in place.

Speaker: Pamela J. Haylock, PhD, RN, FAAN, oncology consultant, San Antonio, Texas.
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