Nurse navigators help cancer patients
Through diagnosis, treatment, and survivorship
Many newly diagnosed patients who are receiving outpatient cancer treatment at Winship Cancer Institute of Emory University in Atlanta have their care coordinated by nurse navigators who help them understand their disease, their treatment options, and help them navigate the health care maze.
"Cancer care has become more and more complex, and patients often feel lost. Most cancer patients are seeing a surgeon, a medical oncologist, and a radiation oncologist, along with their primary care physician, and often other clinicians. They need someone to guide them as they go through the treatment process," says Joan Giblin, MSN, APRN-BC, AOCM, a nurse practitioner and manager of patient access.
Winship Cancer Institute is a National Cancer Institute-designated center and is part of the Robert W. Woodruff Science Center of Emory University. The facility provides care for more than 70,000 patients a year.
Winship started its patient navigation program earlier this year with nurse navigators for patients with breast cancer, gastrointestinal cancer, and patients with cancer of the head, neck, and lung.
"We're starting where we have the biggest number of patients. They all work a little differently, but the goal is to make the treatment process go as smoothly as possible for the patients," she says.
The initiative is in alignment with the Emory Healthcare System's focus on patient- and family-centered care, Giblin adds.
"Our goal is to provide care that is patient-focused, rather than being disease-focused. The navigators are advocates for the patients and are someone they can call whenever they have a question or a concern. The navigators may not have all the answers, but they know where to find the answers," she says.
Winship Cancer Institute provides care for patients from all over the Southeast as well as international patients, Giblin says.
"Navigating the health care system is difficult at best, but it's particularly hard in an academic medical center, and it's even more difficult if you aren't familiar with the Atlanta area. I've been a nurse practitioner at Emory for 15 years and have seen people fall through the cracks despite our best efforts. The goal of the navigator program is to provide support from diagnosis through the treatment and survivorship and to make the process go as smoothly as possible for the patients," Giblin says.
The cancer treatment center chose nurses to be the navigators because their education enables them to talk to the patients about all aspects of the diagnosis and treatment process. They can assist patients and families in understanding everything from what a pathology report means to the long-term effects of treatment, Giblin says.
The three initial navigators have varying backgrounds, Giblin says. One was an oncology nurse in a local private oncology practice, another was an inpatient nurse in the Emory system, and the third came from the VA system and has a strong background in case managing Medicaid patients.
Heather Pinkerton, RN, BSN, OCN, nurse navigator for newly diagnosed breast cancer patients, has been an oncology nurse for 13 years.
"Currently, the breast cancer navigation program has only one nurse navigator, but the goal is to add more breast cancer navigators in the future so we can provide support for every breast cancer seen here at Winship. Currently, the navigator is working only with the newly diagnosed patients because they are the patients who most often need education and support upfront. They heard what the doctor said, but they aren't sure they understand the diagnosis and their options," Giblin says.
When a patient is referred to Pinkerton, she calls the patient and explains the role of the navigator and how she can help.
She answers questions about their pathology report, their treatment plan, and helps them set appointments for the next step in their care.
"Typically, a newly diagnosed breast cancer patient's referral for navigation will come from the Emory Breast Imaging Center, a surgical oncologist, or as a patient self-referral. When I receive the referral, I help the patient with the next step, which might be setting an appointment with surgical oncology, or it may be medical oncology and radiation oncology. I am there to assist the patient with what that next step needs to be," Pinkerton says.
Some patients already have an appointment with a surgeon and don't need a lot of support early in their treatment process, she adds.
"I let them know that I will be available whenever they have questions or need support. Some wait until they have had surgery and are about to start chemotherapy; then they call me back," she says.
The initial contact is typically by telephone, but Pinkerton meets all her patients in person when they come for their appointments.
"Sometimes I stay in the examining room with them as an extra pair of ears to help explain the treatment plan. At the beginning of the diagnosis, it can be very overwhelming and difficult for patients to absorb and remember a lot of what they hear when they meet with their doctors. I have a conversation with them a few days after their visit to make sure they understand what's going on," she says.
Sometimes, the physician or nurse calls Pinkerton when patients need a little extra education or follow up.
The navigators are available five days a week and through voice mail and e-mail. They're not aligned with any particular clinic and are available for a face-to-face visit if the physician or nurse calls them.
"I do a lot of coordination between different disciplines that are providing care for the patient. I'm their go-to person when they have a question or don't know where to turn," Pinkerton says.
For instance, patients who are just beginning their treatment may need help filling out their Family Medical Leave Act (FMLA) paperwork. Pinkerton doesn't actually fill out the forms but can put the patient in touch with the person who can.
When patients are undergoing chemotherapy, Pinkerton works as an additional team player with the clinic nurses to provide education and support for the patients.
"My job is not to do all the chemotherapy education. The clinic nurses do a lot of the education. My role is to help to hold their hands, answer their questions, and make sure they have support. I do the reassurance and the reinforcement. When they have side effects from their therapy, I can help them through that," she says.
The navigators work with the schedulers to coordinate appointments that involve as few trips as possible to the facility, especially if they are coming from a long distance.
If patients are from out of town, the navigators sometimes can identify clinicians in their hometown who can collaborate with Emory doctors and provide the treatment on a local basis.
"This is a long way for a lot of patients to come, and we try to make it possible for them to go to back home and get whatever care they need locally," Giblin says.
The nurses in the navigator program were interviewed by the doctors and staff with whom they work as part of the hiring process. As part of their training, they spent time at each individual clinic, getting to know the staff and learning about the disease and treatment options. They meet with the clinical trials staff, the nutritionists, and other ancillary services and work as a member of the multidisciplinary team providing care for the patients.
"At Winship, it's not just the chemotherapy team, the surgery team, or the radiation oncology team; the entire treatment team works together. The navigator is welcomed as an extra person on the team who is here to focus on the patient," Pinkerton says.
Many newly diagnosed patients who are receiving outpatient cancer treatment at Winship Cancer Institute of Emory University in Atlanta have their care coordinated by nurse navigators who help them understand their disease, their treatment options, and help them navigate the health care maze.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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