The Role of a Patient Navigator, with Lillie D. Shockney, RN, BS, MAS

November 14, 2016
Download MP3 (3.8 MB/8:18)

In today’s podcast, Lillie Shockney discusses her article, “The Value of Patient Navigators as Members of the Multidisciplinary Oncology Care Team.” Nurse navigators, also known as patient navigators, help a person with cancer “navigate” the hospital and human services bureaucracies. This includes assisting with decision making, coordinating services, and advocating for the patient with the other members of the health care team. 

Transcript: 

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ASCO: You’re listening to a podcast from Lineagotica. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors that care for people with cancer.

In today’s podcast, Lillie Shockney discusses her article, “The Value of Patient Navigators as Members of the Multidisciplinary Oncology Care Team.” Nurse navigators, also known as patient navigators, help a person with cancer “navigate” the hospital and human services bureaucracies. This includes assisting with decision making, coordinating services, and advocating for the patient with the other members of the health care team. Ms. Shockney is a registered nurse and the Administrative Director at Johns Hopkins Breast Center, as well as the co-founder of the Academy of Oncology Nurse & Patient Navigators. ASCO would like to thank Ms. Shockney for discussing this topic.

Lillie Shockney: Hello. My name is Lillie Shockney from the Johns Hopkins Breast Center, and the Academy of Oncology Nurse & Patient Navigators. I will be sharing some of the key points from my presentation at the 2016 ASCO Annual Meeting titled "The Value of Patient Navigators as a Member of the Multidisciplinary Oncology Care Team," and talking about the implications for patients.

Multidisciplinary oncology teams allow patients to receive care from a team that works together to provide the right treatment, in the right order, and the right setting, at the right time. A new addition to this team of specialists is the oncology nurse navigator. Let's start this discussion with some background on what an oncology nurse navigator is, and how this role began.

The role of a nurse navigator began in the 1970s when nurses would review medical records retroactively to identify any barriers to treatment or to timely discharge. This review usually led to conflicts with hospital, and professional fees would be denied, which caused the friction between nurses, and the hospital administration, as well as the physicians. But in the late 1990s, this role evolved into case management. This allowed nurses to become team members with the other specialists. Nurses continued to identify barriers to care, but now they were empowered to resolve these barriers in real time. They were also able to provide a new level of care that included outpatient treatment and chronic care management. By the end of the century, case managers had evolved to become what is now known as nurse navigator. This role was specifically designed for patients with cancer, and some of the first patients to receive the support of nurse navigators were patients with breast cancer.

Now that I've given a little background on how the role of nurse navigator developed, I'd like to discuss the responsibilities of an oncology nurse navigator. The role of a nurse navigator is to help patients navigate the bureaucracies of hospital and human services. They provide psychosocial support, help patients make treatment decisions, help with insurance issues, arrange transportation, coordinate services such as fertility preservation or cancer rehabilitation, track interventions and outcomes, and build relationships with other specialists and navigators involved in patient care. That's a lot of responsibility, but the main focus of all nurse navigators is to ensure care coordination and to be a strong advocate for their patients. Being a patient advocate means ensuring that the patient's confidentiality is maintained, the patient is always treated with respect, all care is culturally competent, and care and services are always compassionately delivered.

Often times, when a patient is diagnosed with cancer, the immediate focus is on the patient's medical needs. As treatment planning takes over, the patient can get lost. One of the wonderful assets of the nurse navigator is that they are advocates that ensure that the patient is much more than just a test result. Before a patient begins treatment, the patient and navigator can sit down and discuss what the patient's life goals were before the cancer diagnosis. The navigator can include these goals into medical records so that all of the members of the multidisciplinary team can factor these goals into treatment planning. This allows survivorship care to start with the diagnosis rather than at the end of treatment. Nurse navigators also perform additional roles in survivorship care and can help prepare patients for life after treatment. They can help patients recognize survivorship milestones, educate survivors on adopting a healthy lifestyle to reduce future cancer risk, assist survivors with their fears of cancer recurrence, and a multitude of other survivorship concerns. Patients with advanced cancer or patients with untreatable diseases can also benefit from working with a nurse navigator. The navigator can work with these patients to develop alternative ways to fulfill life goals and when the disease progresses, navigators can become confidants and assist with the patient's current goals, which may result in a patient choosing to stop treatment and focus on their quality of life.

I think we all have a good understanding of what a nurse navigator does and how this role was created. Let's move on to how to implement a navigation process. The goals of patient navigation systems are to reduce cancer incidence and mortality, and improve the patient quality of life, develop culturally targeted education, provide access to early screening diagnoses and treatment, and assist the patient with navigating the healthcare system, and removing any barriers to care. Before a patient can enter the navigation system, it is important to look at the current healthcare delivery system that the patient is experiencing. It is crucial to objectively evaluate that process, and to try to identify where a patient could fall through the cracks, and what the tasks and functions are of each team member. There are many models of patient navigation out there, and different nurse navigators work in different navigation models. Some models are based on specific tumor type, while others are based on patient entry point. Some models are physician based, which means that the nurse navigator works only with assigned physicians regardless of their specialty. Other navigation models are community-based which involves a navigator performing needs assessments and community outreach for specific communities.

Regardless of the model chosen, oncology nurse navigators are a valuable component of the multidisciplinary care team. As the population of patients with cancer grows, physicians face increasing time constraints, and this only increases the role and value of an oncology nurse navigator. For more information please visit the AONN website, aonnonline.org, which stands for the Academy of Oncology Nurse and Patient Navigators. Thank you very much.

ASCO: Thank you Ms. Shockney. To learn more about the role of other members of the cancer care team, please visit the Lineagotica Blog at lineagotica.info/blog.

Lineagotica is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Lineagotica Podcast.

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