The driving forces in the evolution of health care are the aging US population, an increasing cultural awareness of health and cancer, and recognition of patients as consumers. In addition, the Internet provides patients with ready access to health information they may not fully understand. Advances in medical science and technology have made health care, especially cancer care, complex. Patients often need a person who can explain their diagnosis, re-explain their treatment options, and help them manage both their care and their lives while they undergo treatment.
A significant role for breast cancer navigators is communicator—with patients and with other members of the breast care team, explained Cynthia Cantril, RN, OCN, MPH, director Oncology Service Lines and Patient Navigation at Sutter Pacific Medical Foundation in Santa Rosa, California, at the 2014 NCONN Conference in Atlanta, Georgia. The navigator is the clinician to whom patients can turn to understand the transition from screening to diagnostic testing. Patients need to be educated about what tissue looks like, what the breast care team is looking for, and why additional tests may be needed.
Cantril has a personal theory on why breast cancer is such an emotionally charged situation: In most cases, patients are asymptomatic at screening. Unlike other cancers in which weight loss, unexplained fatigue, or some other symptom prompts testing to rule out suspicious disease, breast cancer patients have no clue that something is wrong.
A breast cancer navigator may face institutional/community barriers in the form of confusion about their role. Best-practice documentation is limited, and preparation for the role is not consistent or uniform across the specialty. For example, who delivers the results of a biopsy? “A well-trained breast cancer nurse navigator is the best person,” stated Cantril.
The nurse navigator can help the patient decompress after she hears those first words. The best approach is to have a physical appointment for patient and to have a physical copy of the pathology report ready to give the patient. Cantril likes to have a plan in place when the diagnosis is delivered. When they hear their diagnosis, 99% of women put themselves in a “death” zone. My idea is to put them in a “life zone.”
Breast cancer navigators establish a relationship with the patient at the screening; has explained what breast tissue looks like, what is being looked for, and what would constitute results that need a second look. Most importantly, the navigator has the patient’s personal history and knowledge of their preferences.
Nurses who take on the challenge of developing the role of breast cancer navigator will need to define the role of the navigator, but keep in mind that each setting will have different culture and systems. The NCCN Guidelines for treatment and surveillance decisions can serve as standards of care. The most important characteristic of breast cancer navigator is having a good support system.
Speaker: Cynthia Cantril, RN, OCN, MPH, director Oncology Service Lines and Patient Navigation, Sutter Pacific Medical Foundation, Santa Rosa, California.