The Unmet Needs of Breast Cancer Navigation Services: Reconciling Clinical Care With the Emotional and Logistical Challenges Experienced by Younger Women with Breast Cancer in a Healthcare Delivery System.

This study explores the experience of the breast cancer journey for younger women receiving patient navigation services in a healthcare delivery system and any remaining challenges that navigation services may leave unaddressed. In this qualitative analysis, we used a purposeful sampling approach to conduct a semistructured in-person interview with 19 younger women (under 50 years at the time of diagnosis) at various stages of breast cancer treatment and receiving care that included some form of patient navigation services/within the Sutter Health system. Thematic analysis was performed using an inductive grounded theory approach. The patient experience revealed that women receiving navigation services throughout their cancer journey had little concern related to clinical decision-making and treatment. Rather, emotional, and logistical challenges dominate their experience and perceptions of the cancer journey. Managing day-to-day life and the emotional aspects of a cancer diagnosis cannot be disentangled from clinical care. Navigating the emotional and logistical aspects of the cancer journey is an ongoing unmet need for women under age 50, and navigation services can potentially be enhanced to help address these specific needs. Women with breast cancer may benefit from navigation programs focused not only on clinically related challenges but also on recognizing the daily needs of younger women and guiding them through family and job-related obstacles encountered while navigating cancer care. Health systems could enhance existing nurse navigation programs and redesign other aspects of care to focus on meeting these needs.

Lean Practices for Resource Use, Timeliness, and Coordination of Care in Breast Cancer Navigation.

BACKGROUND: Cancer care is described as insufficiently patient-centered, requiring improved accessibility and coordination. Breast oncology nurse navigators may help provide timely patient care by improving care coordination. OBJECTIVES: This study evaluated a breast cancer navigation (BCN) program in a large ambulatory healthcare system. It examined measures related to quality and value, including timely service delivery, appropriate use of resources, and care coordination. METHODS: Using Lean methods, a BCN program focused on women receiving a breast biopsy was developed at a pilot site and later implemented throughout the healthcare system. Study data evaluated timely disclosure of biopsy results, prompt scheduling of initial consultations, outpatient use of cancer specialists, and coordination between primary care and oncology practices. FINDINGS: After implementing the BCN program, more timely biopsy results were delivered to patients. Patients were more likely to complete an initial consultation within two weeks of biopsy and made fewer outpatient visits. Referrals to cancer specialists within a month of biopsy increased, and primary care encounters with patients decreased.

Breast Cancer Navigation: Using Physician and Patient Surveys to Explore Nurse Navigator Program Experiences.

BACKGROUND: Patient navigators can improve patient experiences of care and outcomes, but little is known about how navigation programs may affect physician workflows and experience. OBJECTIVES: This study aimed to understand patient and physician experiences with a breast cancer navigation (BCN) program using Lean design principles. METHODS: Surveys were developed and distributed from 2019 to 2020 to 255 patients diagnosed with breast cancer and 128 physicians in primary care and cancer-related specialties. Descriptive analyses were conducted. FINDINGS: Eighty-three physicians and 94 patients completed the survey. A large majority of physicians reported that the BCN program "made their day easier" and improved flow, care coordination, and patient experience. A large majority of patients reported receiving the right level of support during diagnosis communication and high satisfaction in other domains measured.

Diagnosis Disclosure: Patient Preferences and the Role of the Breast Nurse Navigator.

BACKGROUND: Receiving a breast cancer diagnosis can be traumatic and anxiety-producing. The way the diagnosis is disclosed to patients can affect their experience. OBJECTIVES: The aim of this article is to determine patient preferences for being informed of a breast cancer diagnosis and the breast nurse navigator (BNN) role during the diagnostic experience. METHODS: A survey was mailed to 517 patients with breast cancer. Summary statistics were performed on 199 completed surveys. FINDINGS: Patients preferred to hear their diagnosis in person. BNNs were more likely to provide the right amount of support and resources compared to other providers. Patients described the following preferences.

Patient Navigation in Cancer: The Business Case to Support Clinical Needs.

PURPOSE: Patient navigation (PN) is an increasingly recognized element of high-quality, patient-centered cancer care, yet PN in many cancer programs is absent or limited, often because of concerns of extra cost without tangible financial benefits. METHODS: Five real-world examples of PN programs are used to demonstrate that in the pure fee-for-service and the alternative payment model worlds of reimbursement, strong cases can be made to support the benefits of PN. RESULTS: In three large programs, PN resulted in increased patient retention and increased physician loyalty within the cancer programs, leading to increased revenue. In addition, in two programs, PN was associated with a reduction in unnecessary resource utilization, such as emergency department visits and hospitalizations. PN also reduces burdens on oncology providers, potentially reducing burnout, errors, and costly staff turnover. CONCLUSION: PN has resulted in improved patient outcomes and patient satisfaction and has important financial benefits for cancer programs in the fee-for-service and the alternative payment model worlds, lending support for more robust staffing of PN programs.

Novice Oncology Nurse Navigator: Core Elements in Establishing Training Needs and Building on Competencies.

BACKGROUND: Oncology nurse navigation opportunities are rapidly expanding as the value of the role is recognized. However, there is a lack of training opportunities focusing on the unique needs of the oncology nurse navigator (ONN). Most navigator training programs provide only general oncology navigation content. OBJECTIVES: The purpose of this article is to evaluate the current state of training for the novice ONN and begin to identify core elements to inform development of a standardized training program. METHODS: Navigator training programs and literature related to the role and development needs of the novice ONN were reviewed. FINDINGS: Training of the novice ONN varies widely, with little evaluation of the most effective way to prepare for the role. It is clear that the learning needs of the ONN are different than those of other types of navigators and oncology nurses.

Standardizing Roles: Evaluating Oncology Nurse Navigator Clarity, Educational Preparation, and Scope of Work Within Two Healthcare Systems.

BACKGROUND: Since the introduction of patient navigation, challenges persist in standardizing the oncology nurse navigator (ONN) role, educational preparation, and scope of work. OBJECTIVES: With a goal of systemwide understanding of navigation services, two healthcare institutions examined the educational preparation, responsibilities, and understanding of the ONN role. METHODS: Two nurse leaders in navigation concurrently used surveys, focus groups, and interprofessional discussions to assess the current state of navigation within their comparable organizations. They aggregated their findings, identified commonalities, and shared standardization approaches. FINDINGS: Data demonstrated noteworthy variation in ONNs' academic preparation, professional certifications, job titles, and scope of work. Additional findings included overall lack of understanding of the role and responsibilities of ONNs, inconsistent role preparation and implementation, random tracking of methods and metrics, and insufficient job-related resources.

Identifying Educational Needs of the Multidisciplinary Cancer Team in the Treatment of Metastatic Breast Cancer.

Background: Rapid advancements in the field of metastatic breast cancer (mBC) add to the complexity of managing patients with this disease. An educational needs assessment of multidisciplinary mBC clinicians was executed to identify practice performance gaps and recommend educational strategies aimed at closing these gaps. Methods: To ensure a collection of reliable data for assessment, a systematic process was used to design, develop, and validate the tools that were used. This grounded theory approach included assessment and confirmation by clinical experts and validation testing within the target audiences. A mixed-methods approach was used to identify practice performance gaps in care, using both qualitative in-depth interviews and quantitative surveying. The quantitative survey assessment consisted of 2 main sections: the Clinician Change Readiness Inventory tool and a Clinical Knowledge and Practice Assessment. Results: The study included 42 clinicians in the interview phase and 186 clinicians in the survey phase from 36 different states. Five key practice performance gaps were identified: (1) selecting optimal treatment, (2) personalizing therapy, (3) monitoring mBC, (4) engaging in effective communication, and (5) balancing patient access and time. Most of the gaps overlap and are related to the integral role communication plays in management decision-making in mBC. Conclusions: Awareness of the key practice performance gaps is critical to inform improvements in quality care.

Patient navigation in the oncology care setting.

OBJECTIVES: To review the evolution and current status of patient navigation in cancer care settings, discuss challenges as navigation evolves, and suggest education and research needs to optimize outcomes associated with navigation processes and nurse navigator roles. DATA SOURCES: Literature review, association publications, and government and non-governmental documents. CONCLUSION: Since its inception over two decades ago, navigation programs have been established in hospitals in the United States, Canada, Australia, and other nations. Despite wide-spread implementation, challenges remain in defining the navigator processes and navigator roles, preparation, qualifications, and job descriptions. Scientific efforts are needed to craft and codify these definitions. IMPLICATIONS FOR NURSING PRACTICE: Nurses and organized nursing must identify the needs reflected by the navigation processes and support role delineation, identification, and validation of educational curriculum and competencies.

Development of a breast navigation program.

OBJECTIVES: To review the development of a navigation program in a major US academic health care institution, and provide guidance for navigation programmatic development in other settings. DATA SOURCES: The Johns Hopkins Breast Center Steering Committee minutes, Hospital Cancer Registry; administrative data, and literature. CONCLUSION: Incorporating navigation services throughout the cancer continuum, from diagnosis to survivorship, provides guidance for patients with cancer. Navigation processes and programs must remain dynamic, reflecting patient and community needs. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses have traditionally performed many tasks associated with navigation, including patient education, psychosocial support, and addressing barriers to care. This article provides an exemplar for nurses developing or enhancing comprehensive breast programs.

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.

Healing with horses: fostering recovery from cancer with horses as therapists.

Nearly 10 years ago, I looked at a poster exhibit for a nonprofit organization's camping experience for cancer survivors. One of the images in particular remains with me to this day. It was of an elderly man wearing a cowboy hat and the great grin on his wrinkled face as he stood next to a beautiful sorrel horse. The woman at the poster told me the story behind the picture: The man had advanced cancer and had already entered a hospice program, even though he was still physically active. He'd told many people that his biggest regret in life was that he'd never gotten to ride a horse. The photograph was taken the day his wish to ride had finally come true, and he died only weeks later. At that moment, I started thinking about how to describe the benefit the equine experience had given that man. A growing number of experiential programs offer cancer survivors, primarily children, the opportunity to ride horses as one of many recreational activities. But, that man had experienced something that surpassed a momentary recreational thrill. That started a quest that, after 10 years, is coming to fruition.