When Sally B., a 60-year-old retired school counselor, was diagnosed with colon cancer 2 years ago, she felt overwhelmed—not just by learning that she had a life-threatening illness, but also by the health care maze she confronted. “At first,” she said, “I just had no idea what I was supposed to do to get the treatment I needed.”
Fortunately for Sally, her hospital assigned an oncology nurse navigator to guide her through the process, educate her about cancer and its treatment, help her control her symptoms, and answer her questions. “She did things like informing me about the treatments I would undergo and making sure that anyone who was supposed to call me actually called me,” Sally said. “But the main thing was, she was a tremendously empathic person who was there for me whenever I needed someone to talk to.”
Oncology nurse navigators are members of a growing subspecialty who are finding important roles in the management of cancer and making a significant impact on patients’ lives. Sharon Francz, BHA, is Executive Director and Co-founder of the National Coalition of Oncology Nurse Navigators, an organization that fosters collaborative relationships and professional development in the field. She detailed some of the many functions performed by these providers. “Their primary role is to educate patients and their families about treatment,” she said, “but they do a great deal more. Oncology nurse navigators work with a multidisciplinary team with the goal of overcoming obstacles and barriers to early diagnosis and treatment.” Using their experience and training, oncology nurse navigators guide patients and families through the decision-making process, help evaluate treatment options, facilitate access to care, advise on symptom management, help with insurance and financial issues, and assist patients who seek entry into clinical trials.
There’s no single model for how an oncology nurse navigator works, Sharon Francz said. Some are based in hospitals, others in outpatient settings. In some facilities, patients work with one oncology nurse navigator during the diagnostic process, then transition to another for treatment and, possibly, a third for a survivorship program. In other facilities, a single oncology nurse navigator might work with a patient from the initial contact through survivorship.
The field got its start in 1990 when Harold P. Freeman, MD, a physician working in the Harlem neighborhood of New York City, realized that African American women faced numerous barriers to getting early diagnosis for breast cancer. He began training members of the community to help facilitate access to screening, early diagnosis, and prompt treatment. The navigator role continues to include lay people, but has grown to encompass oncology nurses and their special skills.
“Navigation has always existed in the oncology field,” Sharon Francz said. “With the advent of oncology nurse navigators as a subspecialty, it’s becoming more structured and more standardized.”
So far, there are no accrediting bodies and no accreditation for oncology nurse navigators, although certificate programs are springing up. Before an accreditation process can be established, a consensus must form around the roles and responsibilities of this new subspecialty and agreement must be reached on accepted core competencies.
Both patients and providers benefit from the efforts of oncology nurse navigators. Surveys and literature reviews have shown that patients who work with an oncology nurse navigator get earlier diagnosis and treatment, have lower levels of anxiety, obtain more help with financial issues, and express increased satisfaction with care. Hospitals benefit from having oncology nurse navigators on staff because they help retain patients, reduce emergency room visits, and bring about more efficient use of hospital resources.
Obtaining financing for the position is never a sure thing. The services of oncology nurse navigators aren’t billable, so many nurses who have taken on this role worry about job security. Earlier this year, however, the field received a boost when the American College of Surgeons Commission on Cancer specified that, starting in 2015, cancer programs must include a formal patient navigation process to address health care disparities and barriers to care, or risk losing their accreditation. This may be the first step to establishing the oncology nurse navigator as a required member of the health care team.
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