Male patients with prostate cancer, and patients with other genitourinary cancers, need information on how their cancer and its treatment will affect their life. They need education about prioritizing what is important to them. For example, does the patient want to be cancer-free or does he value quality of life (eg, intimate relationships, sexual functioning). Even patients who choose to let their physician choose their treatment need to be well informed. A nurse navigation program at Palo Alto Medical Foundation (PAMF) was developed to address this need. Frank dela Rama, clinical nurse specialist in Oncology/Genomics at PAMF developed the role of the prostate cancer nurse navigator (PC NN) and PAMF’s navigation program for patients with prostate cancer, and shared how the program evolved at the NCONN Conference in Atlanta, Georgia.
The role of the PC NN was initially the radiation oncology nurse coordinating rounds and arranging consultations and tests for patients with prostate cancer. In the early 2000s, additional radiation oncology nurses were hired so dela Rama could dedicate his time to patients with prostate cancer, and further develop the role of the prostate cancer nurse navigator and a program for patients with prostate cancer.
dela Rama first sought feedback from nurse navigators that served other types of cancer (eg, lung, breast) to explore how to educate the staff as well as patients in 2004. He led focus groups on care of the prostate cancer patient, and developed programs for staff education as well as community education. In 2006, patients with prostate cancer were invited to share their thoughts on what they wanted and needed from a PC NN.
Physician acceptance was important. An essential step in the development of the program was to educate physicians about the PC NN. Physicians at first asked, “What is a navigator? How will this help me?” They wanted to know what the navigator was teaching their patients, and how do they refer their patients. dela Rama was open to their questions and showed them the patient education tools he was using. This helped to build physician confidence in the program. The questions transitioned to “My patient has a new diagnosis … where is the navigator?” and “My patient is done with treatment … where is the navigator?”
Male patients have different feelings about health care and the need for survivorship care. These patients are inclined to feel “I’m cured. Why do I need to keep doing this?” dela Rama had to find other ways to approach survivorship. For example, a Buddy Program was created as part of survivorship care. Patients were matched based on clinical stage, treatment type, and treating physician; Buddies must be at least 1 year post completion of treatment; and the focus was on shared experience, not medical advice. The program is well received compared with support groups in this patient population. A Buddy connection is offered at the initial visit with the oncology nurse navigator.
From 2006 to the present, the Prostate Cancer Care Program has blossomed to include a survivor video, a Buddy Program, and hosting multispecialty clinics for non-PAMF patients. The most significant task for the PC NN is to focus on patients being happy with the treatment decisions they make, regardless of the outcome.
Speaker: Frank dela Rama, RN, MS, AOCNS, clinical nurse specialist, Oncology/Genomics, Palo Alto Medical Foundation, Sutter Health.