Patient Assistance Programs: Easing the Burden of Financial Toxicity During Cancer Treatment.

BACKGROUND: As the cost of cancer treatment escalates, patients with cancer are facing an increased financial burden because of their financial obligations for coinsurance, deductibles, and co-payments. OBJECTIVES: This article describes how clinical nurses who are supporting patients on their cancer journey are positioned to offer guidance to help alleviate financial burden associated with drug costs by enrolling patients in patient assistance programs (PAPs). METHODS: Details are provided about how PAPs work and how a basic knowledge of healthcare coverage terminology, assessment tools, interview techniques, and interprofessional collaboration can contribute to successfully accessing PAPs. FINDINGS: PAPs are sponsored by multiple sources and can be identified using web-based resources. For patients who meet eligibility criteria, assistance in the form of PAPs can reduce the impact of financial toxicity related to cancer treatment.

Nurse Navigator Core Competencies: An Update to Reflect the Evolution of the Role.

BACKGROUND: The Oncology Nursing Society published Oncology Nurse Navigator (ONN) Core Competencies in 2013. However, a 2016 role delineation study (RDS) indicated that the role had evolved since their release. The RDS also indicated that a growing number of nurse navigators have extensive oncology and navigation experience. OBJECTIVES: The update to the competencies was undertaken to identify current responsibilities of ONNs and differentiate novice from expert practice. METHODS: A list of competencies was developed based on a literature review, evaluation of the 2013 competencies, and input from six expert ONNs. These draft competencies were vetted through field and expert review, with subsequent updates. FINDINGS: The 2017 competencies include 52 competencies.

Providing Novice Navigators With a GPS for Role Development: Oncology Nurse Navigator Competency Project.

BACKGROUND: The care of patients with cancer has evolved to include various lay and professional roles to enhance care coordination with the focus on delivering patient-centered care. Oncology nurses in the role of oncology nurse navigators (ONNs) contribute to the delivery of patient-centered care by guiding patients and families through the cancer continuum and providing resources to overcome system and practical barriers and to enhance psychosocial support and cancer-specific education. However, the role of the ONN is often defined differently depending on the practice setting and institutional policy. The result is an inconsistent assortment of role functions and educational backgrounds. OBJECTIVES: This article aims to promote standardization of the role of the ONN as well as the structure and boundaries of how ONNs function. METHODS: A project team was established by the Oncology Nursing Society to develop a professional practice framework and to identify core competencies for use by ONNs across a variety of practice settings. FINDINGS: The development of core competencies as well as examples of how the core competencies can be applied to ONN practice will help to define the ONN role and better serve the needs of patients with cancer, their families, and their caregivers.

Oncology nurse navigators and the continuum of cancer care.

OBJECTIVES: To discuss the role and challenges of the oncology nurse navigator working within a multidisciplinary team caring for patients with various types of cancers. DATA SOURCES: Published empirical research and critical analysis articles. CONCLUSION: The experienced oncology nurse in the role of navigator has the disease-specific knowledge necessary to provide patient-centered care throughout the cancer continuum and promote positive patient outcomes. The role of the oncology nurse navigator has a positive impact on both the patient and the cancer team by providing continuity of care and improved communication. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurse navigators need a concrete definition of their role and function as they serve not only the patient but the cancer care system in which they work. Acknowledging foundational concepts as a guide, programs can then develop and expand. The role needs to be flexible as the health care system changes. Future development of the role can be guided by oncology nurse navigators who evaluate their programs and identify common challenges and system barriers.

Oncology nurse navigator role delineation study: an oncology nursing society report.

The purpose of the Oncology Nursing Society (ONS) Oncology Nurse Navigator Role Delineation Study was to examine the job-function activities of the oncology nurse navigator, thus providing an understanding of this unique role. The Role Delineation Advisory Committee consisting mainly of oncology nurse navigators was formed to provide content expertise to Applied Measurement Professionals, which conducted the role delineation study. Three hundred and thirty nurses completed the survey. The study clearly defined tasks, knowledge areas, and skills that are very specific to the nurse navigator role; however, the overlap in knowledge with the general oncology nurse role needs to be explored. The ONS Board of Directors and the Oncology Nursing Certification Corporation Board of Directors currently are exploring the need for additional initiatives to help define the role and competencies of the oncology nurse navigator.

Evaluation of left atrial lesions after initial and repeat atrial fibrillation ablation: lessons learned from delayed-enhancement MRI in repeat ablation procedures.

BACKGROUND: We evaluated scar lesions after initial and repeat catheter ablation of atrial fibrillation (AF) and correlated these regions to low-voltage tissue on repeat electroanatomic mapping. We also identified gaps in lesion sets that could be targeted and closed during repeat procedures. METHODS AND RESULTS: One hundred forty-four patients underwent AF ablation and received a delayed-enhancement MRI at 3 months after ablation. The number of pulmonary veins (PV) with circumferential lesions were assessed and correlated with procedural outcome. Eighteen patients with AF recurrence underwent repeat ablation. MRI scar regions were compared with electroanatomic maps during the repeat procedure. Regions of incomplete scar around the PVs were then identified and targeted during repeat ablation to ensure complete circumferential lesions. After the initial procedure, complete circumferential scarring of all 4 PV antrum (PVA) was achieved in only 7% of patients, with the majority of patients (69%) having <2 completely scarred PVA. After the first procedure, the number of PVs with complete circumferential scarring and total left atrial wall (LA) scar burden was associated with better clinical outcome. Patients with successful AF termination had higher average total left atrial wall scar of 16.4%+/-9.8 (P=0.004) and percent PVA scar of 66.2+/-25.4 (P=0.01) compared with patients with AF recurrence who had an average total LA wall scar 11.3%+/-8.1 and PVA percent scar 50.0+/-24.7. In patients who underwent repeat ablation, the PVA scar percentage was 56.1%+/-21.4 after the first procedure compared with 77.2%+/-19.5 after the second procedure. The average total LA scar after the first ablation was 11.0%+/-4.1, whereas the average total LA scar after second ablation was 21.2%+/-7.4. All patients had an increased number of completely scarred pulmonary vein antra after the second procedure. MRI scar after the first procedure and low-voltage regions on electroanatomic mapping obtained during repeat ablation demonstrated a positive quantitative correlation of R(2)=0.57. CONCLUSIONS: Complete circumferential PV scarring difficult to achieve but is associated with better clinical outcome. Delayed-enhancement MRI can accurately define scar lesions after AF ablation and can be used to target breaks in lesion sets during repeat ablation.