The following article features coverage from the ONA 2019 Navigation Summit. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

The Biden Cancer Initiative (BCI) is working to advance real and meaningful improvements to the culture of cancer research and care, and drive the “urgency of now” to give patients what they deserve: a system that puts saving lives above anything else. It is that commitment that led us to focus on patient navigation. We know that patient outcomes are much improved when patients and their families have access to navigation. Our goal is to ensure that navigation is more fully available to patients who need it, and we are working with a cross section of leaders in nursing and navigation to help us in that effort.

As we look to the future of navigation in these swirling headwinds of the current healthcare landscape, it’s important that we understand the path that has led us to this point. The seeds of navigation were born in response to the clear disparities in underserved and under-resourced communities when addressing cancer and chronic illness. Many of the findings from the American Cancer Society Hearings on Cancer and Poor in 1989 led the way to additional efforts that arose from the government and nonprofits in addressing these issues — some of these programs include the Harlem Hospital Program (1990), Breast Health Navigation Program – Long Island Hospital (2000), and the National Cancer Institute (NCI)’s Reduce Cancer Health Disparities Community Networks Program and Patient Navigation Research Program.

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The emergence of these community programs coincided with the changing world of oncology nursing. The field of nursing underwent a transformation as the patient centered approach was implemented in hospital settings. As hospital systems implemented utilization management (UM), nurses were at the forefront of decision-making in patient care and the emphasis on coordinated care and community outreach is the bedrock of patient navigation.

Navigation is an element of several programs that have been undertaken by organizations such as the American Cancer Society, as well as the National Cancer Institute, over the years. It has been integrated via policies including the 2005 Patient Navigator Outreach and Chronic Disease Prevention Act (2005) and most recently in the 2010 Patient Protection and Affordable Care Act (ACA). The inclusion of navigation in the ACA brought navigation further into the healthcare system but it also laid out some of the barriers that hinder its expansion and full utilization.

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The Biden Cancer Initiative added navigation as one of its 6 core issue areas because we see it as a critical component to improving the system for patients and their families. BCI’s Patient Navigation Working Group is focused on an actionable plan that will move us closer to more implementation of patient navigation programs across the country. Our work has laid out several foundational issues that are barriers to patient navigation, including:

  • Varied definitions of patient navigation
  • Lack of uniform best practices, accreditation, role delineation
  • Lack of standardized evidence-based metrics in the domains of return on investment, clinical outcomes, and patient experience
  • Issues related to policy and payment

Our approach to addressing these foundational issues starts with a building block model allowing each focus area to build on the others. We must first define navigation and roles and scope so we are all working from the same starting point before we begin to define certification and training, then we can develop a uniform way to measure navigation and report outcomes. This will allow us the ability to measure acuity to determine resource allocation and needs, before we tackle reimbursement and policy.

In addition to the work of the Biden Cancer Initiative, The National Navigation Roundtable launched in 2017, is a national coalition of more than 50 member organizations and invited experts dedicated to achieving health equity and access to quality care across the cancer continuum through effective patient navigation

This is an exciting time in the field of navigation with the synergy of efforts on the national, state, and community level; we cannot miss this opportunity. We must work together to ensure that patient navigation is available to all those who need this critical support at one of the most difficult times of their lives, as they deal with cancer and other illnesses. We cannot let this moment of opportunity pass, and BCI looks forward to working with you.