The complexity of the health care system and of cancer care in general can overwhelm patients who are already facing a difficult diagnosis. To help patients understand their diagnosis and its treatments, manage their care, identify the gaps and barriers to care, and serve as a port of access to Fox Chase Cancer Center (FCCC), FCCC developed a navigation process. Its rationale for the nurse navigator (NN) role is to align the institution’s goals with the patients’ goals.

FCCC’s 24-hour appointment policy has a medical oncologist available to see patients every clinical day. Catherine MacFarland, RN, BSN, OCN, gastrointestinal nurse navigator (GI NN) at FCCC, explained how the GI service line at FCCC uses clinical pathways to take this a step further. GI NNs can take call directly from the first call into the cancer center, access the schedule system, and initiate the patient’s continuum of cancer care.

Clinical navigation at FCCC follows a disease-specific model of care. Service lines that use NNs include breast, gynecologic oncology, head and neck, thoracic/sarcoma, GI/cutaneous oncology, genitourinary, and hematology/BMT. GI navigation process is unique to the nuances of the specific staging requirements and treatment of individual GI cancers. The benefits of a nurse serving as NN is that nurses have the skills to bring patient assessment, support and preparation, supportive care, management of disease complexity, and integration with other clinicians together. “As an oncology nurse, I can answer many patient questions; as a member of the GI team, I know who to go to when I do not know the answer,” explained MacFarland.

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Clinical pathways allow the GI service to further refine the navigation process for patients with GI cancers. Using NCCN guidelines as a key resource, the clinical pathways were developed by consensus from GI team members, consisting of medical, radiation, and surgical oncologists; front desk personnel; supportive services; clinical trial office; pathology; radiology; risk assessment/genetics; administrative assistants; residents and fellows; advanced-practice clinicians; nursing staff; and the nurse navigators.

A clinical pathway is a basic outline of the care plan presented in an algorithm form. It guides the navigator to obtain any pre-appointment testing, gather the necessary reports, and consult the appropriate team members. The algorithms allow for seamless scheduling of multidisciplinary appointments and timely care coordination that leads up to referral to the appropriate oncologist.

Using clinical pathways has had a positive impact on patient satisfaction, physician satisfaction, and patient retention. Current clinical pathways are designed for pancreatic cancer, rectal cancer, and esophageal cancer. New clinical pathways in development will focus on liver cancer and hepatocellular carcinoma (HCC).

Speaker: Catherine MacFarland, RN, BSN, OCN, Gastrointestinal Nurse Navigator, Fox Chase Cancer Center.