Two Programs, One Goal: Meeting the Challenges of Oncology Navigation

“Patient navigation is not one-size-fits-all,” Kris Blackley, RN, MSN, BBA, OCN®, stated in her presentation at the 2018 Oncology Nurse Advisor (ONA) Navigation Summit. She and her co-presenter, Rev Diane L. Baldwin, RN, OCN®, CBCN, described how their respective teams tackled various challenges to build efficient, effective navigation systems that also provide metrics to measure the value of navigation to patients, nurses, and facilities.

At the University of South Alabama Mitchell Cancer Institute (MCI), a staff, at that time, of 2 navigators were challenged to extend navigation services to a wide range of patients with limited resources. We were pretty much asked to do the impossible, explained Rev Baldwin. So, she and her coworker searched for tools that would help them manage their large caseload. 

What they found is that many tools were available, but no 1 tool fit their needs. They needed something less simple; therefore, they decided to develop their own tool: the MCI Oncology Navigation Acuity Tool. The tool assigned an acuity level of 0 to 4 to patients assessed by a nurse navigator at the time of placement on the caseload based on 12 clinical, personal, and social factors. Patients were reassessed if a significant change in one or more factors was noted. The goal of MCI’s tool is to optimize resource utilization.

The first 11 factors are related to the patient: staging and diagnosis, family support, PHQ score, performance score (ECOG), comorbidities, nonadherence to treatment, multiple and/or concurrent treatment modalities (chemotherapy, radiotherapy, surgery), hospitalizations (how frequently, reason), use of a medical device (colostomy, ileostomy, trach, feeding tube), type of chemotherapy (multi-agent, single agent, oral), and stage of care (new patient, active treatment, survivorship, end of life).

The 12th factor is the individualized assessment of the nurse navigator. “Our patients are more than a compilation of predefined factors that lead to a score,” explained Rev Baldwin. For example, a patient with early stage breast cancer may assess as a level 0 or 1, but the patient has a PHQ score of 23 and appears depressed. These additional factors could indicate a need to assign this patient a higher level so the high-acuity factors are properly managed.

All patients start at level 2, indicating a new cancer diagnosis and receiving initial therapy. Level 0 indicates patients who are stable, in survivorship, and active treatment has ended; level 1 indicates starting surveillance/observation, patient has been prescribed AI or tamoxifen in last 6 months, or is receiving single-agent chemotherapy. Acuity levels 3 and 4 are patients who may have a colostomy, multiple comorbidities, recent or frequent hospitalizations, little or no family support, are receiving multiple treatments concurrently, or at the end of life.

The tool is not intended to minimize the care for patients at level 0 or 1, Rev Baldwin explained. But to ensure that patients at level 3 and 4 receive the additional support and resources they may need. It assists with triage to ensure that their navigation is responsive to their individual case (disease stage, treatment, home life, family/caregiver support, etc).