Counseling The nurse navigator had become integral to cancer care at our facility. Physicians more often asked, “My patient has a new diagnosis … where is the navigator?!”

At this point, all patients with new prostate cancer diagnoses are routinely sent by their urologist to see me as the nurse navigator. A crash course in prostate cancer biology is soon followed by in-depth discussions of the cancer treatment options, as well as what to expect with each proposed care path. Shared-decision making (SDM) tools are also used in an effort to help patients choose from several options which may all seem to be equally effective at a glance.

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Care transitions “My patient is done with treatment … where is the navigator?!”

With more attention to quality of life issues after treatment and into survivorship, nurse navigators soon may be routinely asked to assist with these transitions of care. Having already developed a relationship with the patient and family, from the time of diagnosis, through treatment, the nurse navigator may already be the best resource to help patients with their transition to survivorship, working in collaboration with oncology specialists and primary care providers to help address concerns of patients even many years after treatment has been completed.

Similarly, nurse navigators may need to assist with transitions into palliative care, which may include conventional modalities such as chemotherapy and radiotherapy, or even emerging technologies and clinical trials.

From logistics, to education, to counseling, and transition to posttreatment care, the nurse navigator role has evolved from a mere amenity to a crucial component of cancer care, continuously assisting patients, families, and health care providers across the care continuum.

Focusing our efforts There is no singular blueprint for a successful navigator program that will work in all situations, yet we can learn so much by sharing best practices and successful model programs with fellow navigators. The ideal navigator program serves the specific needs of the facility and community. Starting a new navigator program, or even further developing an established one, can be a daunting task. Knowing the big picture upfront can help navigators best focus their efforts at each stage of program development.

Frank dela Rama is a clinical nurse specialist, oncology/genomics, and prostate cancer navigator at Palo Alto Medical Foundation in Palo Alto, California.


1. Benner PE. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley Publishing Company; 1984.