What to do with screening for distress scores? Integrating descriptive data into clinical practice.

OBJECTIVE: Implementation of routine Screening for Distress constitutes a major change in cancer care, with the aim of achieving person-centered care. METHOD: Using a cross-sectional descriptive design within a University Tertiary Care Hospital setting, 911 patients from all cancer sites were screened at the time of their first meeting with a nurse navigator who administered a paper questionnaire that included: the Distress Thermometer (DT), the Canadian Problem Checklist (CPC), and the Edmonton Symptom Assessment System (ESAS). RESULTS: Results showed a mean score of 3.9 on the DT. Fears/worries, coping with the disease, and sleep were the most common problems reported on the CPC. Tiredness was the most prevalent symptom on the ESAS. A final regression model that included anxiety, the total number of problems on the CPC, well-being, and tiredness accounted for almost 50% of the variance of distress. A cutoff score of 5 on the DT together with a cutoff of 5 on the ESAS items represents the best combination of specificity and sensitivity to orient patients on the basis of their reported distress. SIGNIFICANCE OF RESULTS: These descriptive data will provide valuable feedback to answer practical questions for the purpose of effectively implementing and managing routine screening in cancer care.

Core areas of practice and associated competencies for nurses working as professional cancer navigators.

UNLABELLED: Fillion et al. (2012) recently designed a conceptual framework for professional cancer navigators describing key functions of professional cancer navigation. PURPOSE: Building on this framework, this study defines the core areas of practice and associated competencies for professional cancer navigators. METHODS: The methods used in this study included: literature review, mapping of navigation functions against practice standards and competencies, and validation of this mapping process with professional navigators, their managers and nursing experts and comparison of roles in similar navigation programs. FINDINGS: Associated competencies were linked to the three identified core areas of practice, which are: 1) providing information and education, 2) providing emotional and supportive care, and 3) facilitating coordination and continuity of care. CONCLUSION: Cancer navigators are in a key position to improve patient and family empowerment and continuity of care. IMPLICATIONS: This is an important step for advancing the role of oncology nurses in navigator positions and identifying areas for further research.

Professional navigation: a comparative study of two Canadian models.

For many cancer control programs, cancer navigation has emerged as a specific strategy to improve access to supportive care and the patients' experience of cancer care. This study contributes to a better understanding of professional navigation by comparing two Canadian models: Quebec's Pivot Nurse in Oncology (PNO) and Nova Scotia's Cancer Patient Navigator (CPN). Qualitative interviews were conducted with professional navigators, patients and family members, front-line staff, physicians and health administrators (interviews: n = 49; focus groups: n = 10). The two models were analyzed using the professional navigation framework (Fillion et al., 2012). Although the models are different, results show that professional navigators in both programs perform similar functions and face similar challenges. This study highlights the complexity and the value of cancer navigation and recommends relevant actions to optimize its management within the health care system.

Professional navigation framework: elaboration and validation in a Canadian context.

PURPOSE/OBJECTIVES: To elaborate, refine, and validate the professional navigation framework in a Canadian context. RESEARCH APPROACH: A two-step approach consisting of a qualitative evaluative design and formal consultations. SETTING: Two applications of professional navigators in Quebec and Nova Scotia, Canada. PARTICIPANTS: Patient navigators, medical oncology specialists, nurses and oncology staff, administrators, family physicians, patients with cancer, and patients' families and significant others. METHODS: Individual interviews (n = 49) and focus groups (n = 10) were conducted with professional navigators, patients and family members, front-line staff, family physicians, and health administrators. Formal consultations (n = 13) occurred with clinical experts, managers, and researchers from across Canada. MAIN RESEARCH VARIABLES: The interview guide was based on an evaluative conceptual framework integrating questions related to the implementation process of the role of professional navigators and their organizational and clinical functions. FINDINGS: Results support a bi-dimensional framework and define key role functions. The first dimension, health system-oriented, refers to continuity of care. The second dimension, patient-centered, corresponds to empowerment. For each dimension, related concepts were illustrated from data. Examples of outcomes also were suggested. CONCLUSIONS: The framework brings clarity to the role and functions of professional navigators and suggests relevant outcomes for program evaluations. INTERPRETATION: With a clear definition of their role, professional navigators may be more efficient and less challenged in terms of setting priorities and making decisions while having to face demands from the health system and patients. The integrative framework could improve the effectiveness of cancer navigation programs.

[The process of integrating oncology nurse navigators into joint (hospital-community) local teams]. / Processus d'implantation d'infirmières pivots en oncologie au sein d'equipes locales conjointes (Centre hospitalier-Communauté).

Implementing oncology nurse navigators or IPOs (which stands for "infirmière pivot en oncologie") is a key element of the Québec Cancer Control Program in order to improve the continuity of care. This qualitative study describes the process of implementing IPOs in teams working both in hospitals and in the community. Several groups of stakeholders (IPOs, physicians, nurses, various health workers, administrators, people with cancer and their families) described how they perceive the functions and effects related to this implementation. After putting results into perspective, we recommend developing measures promoting the dissemination of the role and integration of IPOs in formally defined health teams. We strongly advocate for the continuation of joint efforts in order to define and clarify this complex role.

Professional patient navigation in head and neck cancer.

OBJECTIVES: To discuss professional cancer navigation roles, models, implementation process and outcomes of patients and families dealing with head and neck cancers. One specific research is presented as an illustration. DATA SOURCES: Published scientific papers, research review articles, implementations studies. CONCLUSION: Two independent cohorts of patients with head and neck cancers were compared according to the presence of the professional navigator (Exposed cohort n=83) or not (Historical cohort n=75). The Exposed cohort showed a better profile on several indicators of outcomes. The results clearly indicate an association between the presence of the professional navigator with continuity of care (higher satisfaction and shorter duration of hospitalization), and empowerment (fewer cancer-related problems, including body images concerns, and better emotional quality of life). IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can not only play an important role in continuity of care but also in supportive care by helping patients to cope better with cancer treatments, recovery or cancer progression and death issues.

Implementing the role of patient-navigator nurse at a university hospital centre.

A profile of the role and functions of an oncology patient-navigator nurse (OPN) and the preliminary phases to implementing this role within a team specializing in oncology are first presented. This is followed by a qualitative study that provides a descriptive assessment for implementing an initial OPN in the head and neck oncology area of a university hospital centre (UHC) with a supraregional model for oncology. Three groups of stakeholders (individuals with cancer and families, caregivers, network partners) were interviewed on three occasions: before, during and after implementation. The results show that this new role can be integrated within a team specializing in oncology. The beneficial effects of this role on the process of adaptation to illness, interdisciplinary work and continuity of care are described. Several recommendations are formulated, one being the importance of situating the implementation process from an organizational change perspective.