Patient navigator: A role for nurses that goes beyond clinical care

 

Nurse practitioners are also the ideal candidates for transitioning patients from the acute treatment stage to posttreatment survivor care. Health care trends often reflect a breakdown in implementing recommended follow-up care. Patients either do not fully understand the importance of follow-up care recommendations or health care providers are not communicating this message effectively. These breakdowns, when they occur in the oncology arena, have the potential to heighten the risk of cancer recurrence and secondary cancers.

Oncology NPs who also serve as navigators can provide the follow-up care, as well as coordinate their patients’ overall care needs. The pending shortage in primary care and oncology providers further validates utilizing APNs in this role. An advanced practice NP is also well suited for implementing the Commission on Cancer’s proposed new standards for patient navigator and survivorship programs.^6,9


NAVIGATION EVOLVES INTO CLINICAL CARE


The initial criteria developed for the patient navigation program at Harlem Hospital did not specify a level of formal education. Since that time, some programs have developed requirements for formal education or certification, while others continue to use layperson navigators.² However, growth of the navigator role and attempts to standardize it have demonstrated the advantages of the additional oncology experience or specialized education of an oncology nurse or nurse practitioner. Their comprehensive knowledge base of cancer pathophysiology, treatment modalities, disease progression, and systemic management enhances and strengthens the navigator’s role in the continuum of cancer care.⁶


That being said, patient navigation programs and the credentials of those who serve as navigators continue to be diverse, driven by system- and site-specific needs. One patient navigator model does not fit the needs of all medical systems or settings.^2,5-7 One program may place a greater emphasis on screening and access to care, as seen in the Harlem Hospital pilot program; whereas another program may have a stronger need for direct patient care. Still others may need to place a greater emphasis on transportation and financial issues for their patient populations. The scope of service is ultimately directed by a needs assessment that identifies the goals and mission of the program, the patient population, the community, and the individual navigator’s qualifications.^2,6,8



MEASURABLE BENEFITS


As stated, most patient navigation services are nonbillable. Thus, these services must demonstrate efficiency to justify their use of valuable and oftentimes scarce resources.^1,8 Effectual outcome metrics that can be monitored and trended are needed to support resource allocation. However, data on the cost effectiveness and efficiency of patient navigation programs are limited, but several studies are ongoing.²

Community cancer centers often struggle to provide a business case that demonstrates how navigator services generate revenue. The values of patient navigation services have been identified as enhanced communication and trust, and increased provider referrals when these services are offered.¹ The National Comprehensive Cancer Control Program (NCCCP) and some authors have found that cancer patient navigation programs aid patient care in the following ways^1,6,7:


• Reduce inpatient stays and ER visits

• Increase downstream revenues for other higher-volume services, such as surgery, infusion, radiation, and imaging tests
• Improve care coordination and quality of care
• Increase number of referrals to the individual cancer center
• Reduce wait times from abnormal findings to diagnosis
• Improve patient satisfaction survey results
• Direct divergent populations through the continuum of care
• Facilitate shared decision making between the health care team and the patient and family, which impacts patient choices and decisions
• Decrease financial stress on the health care system
• Lower patient stress.^1,6,7

Reporting tools that effectively evaluate navigation programs can range from paper documentation, simple databases, electronic patient navigation software systems, and electronic medical records. An accurate measure of the impact of navigation services can be made by reviewing patients’ perspectives on their treatment course. Navigator-specific patient satisfaction surveys provide a targeted approach. Patients report that navigators are effective because they provide information, assist with problem-solving, offer emotional support, and enhance logistical assistance.^1,5,8 


From the April 01, 2013 Issue of Oncology Nurse Advisor