Treatment plan dissemination A comprehensive treatment plan includes the goal of therapy, timing and dosing of therapy, special considerations, monitoring and follow-up procedures, and symptom management. Copies of the treatment plan should be given to the patient, placed in the chart, and sent to the primary care provider. It should also prepare patients for survivorship, or what they will need when therapy is over.

Monitoring and follow-up The navigator should determine what monitoring and follow-up strategies, such as patient visits to the office, web-based patient portals, phone-based check ups on patient status and the frequency of each.

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Ongoing patient/caregiver education Navigators need to make the most of office visits by tying in ongoing education for patients and caregivers with office visits. Work from a check-off sheet that will help ensure consistency and completeness of information, include “unknown” topics such as sexuality, vaccination, etc. Provide information based on the patient’s and caregiver’s needs in chunks of 15- to 20-minute sessions to avoid overwhelming them.

Document, document, document A comprehensive record from treatment start date to completion of therapy, including trends, side effects, and adherence ensures efficient patient care and provides a complete treatment summary.

Communication Navigators cannot assume every member of the care team—physicians, nurses, and pharmacists, as well as the patient and caregiver—are communicating with each other. Navigators have to keep the lines of communication open between pharmacies, pharmacies and the practice, pharmacies and patients, and the oncology practice and other providers.

Evaluate the process Quality assessment should evaluate patient, caregiver, and staff satisfaction. Consider adherence/persistence; side effects; dose holds/reductions, intensity; and time to first dose.

Policies, procedures, variance reporting Review the policies and procedures to ensure they reflect the needs of oral medication management program. Develop a variance reporting mechanism to support plans that can enhance care.

Pelusi suggests navigators review the guidelines and recommendations, evaluate what they currently have in their practice, get everyone—including patients and caregivers—in developing and evaluating their program, keep everyone informed of findings and process issues, and to trust the process.