By Tricia Strusowski, RN, MS
Although patient navigation services are becoming more common at cancer programs nationwide, physicians and administrators still frequently ask, “What are the responsibilities of the navigator?” Navigators coordinate care and remove barriers across the care continuum, which can potentially include many responsibilities. It is very important for navigators to be able to articulate their role concisely so that there is no room for misinterpretation. It is also important to share the Commission on Cancer Standards, Chapter 3: Continuum of Care Services, and navigator competencies/position statements from national organizations such as the Association of Oncology Social Work (AOSW), the Academy of Oncology Nurse & Patient Navigators (AONN+), and the Oncology Nursing Society (ONS), just to name a few.
Over the past year I’ve had several cancer programs request a tool to educate their physicians, office staff, and other departments on the role of the navigator and oncology support staff. For programs looking for a similar tool, here are two sample questions and suggested answers. These can be customized to reflect your cancer program’s structure and its navigation and support staff responsibilities.
What is a navigator and what are the Commission on Cancer (CoC) Standards for Navigation?
C-Change defines navigation as “individualized assistance offered to patients, families, and caregivers to help overcome health care system barriers and facilitate timely access to quality medical and psychosocial care from pre-diagnosis through all phases of the cancer experience.”
Commission on Cancer Standards, Chapter 3: Continuum of Care Services
Standard 3.1: Patient Navigation Process
A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations. The navigation process is evaluated, documented, and reported to the Cancer Committee annually. The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment.
Standard 3.2: Psychosocial Distress Screening
The Cancer Committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care.
The psychosocial representative on the cancer committee (oncology social worker, clinical psychologist or other mental health professional trained in the psychosocial aspects of cancer care) is required to oversee this activity and report to the cancer committee annually.
Timing of screening: Patients with cancer are offered screening for distress a minimum of 1 time per patient at a pivotal medical visit to be determined by the program. Some examples of a “pivotal medical visit” include time of diagnosis, presurgical and postsurgical visits, and first visit with the medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or a post-chemotherapy follow-up visit. Preference is given to pivotal medical visits at times of greatest risk for distress such as at time of diagnosis, transitions during treatment (such as from chemotherapy to radiation therapy) and transitions off treatment.
Standard 3.3: Survivorship Care Plan
The cancer committee develops and implements a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment. The process is monitored, evaluated, and presented at least annually to the cancer committee and documented in the minutes.
Include navigation position statements based on your navigation model. Use the following organizations:
Oncology Nursing Society Nurse Navigation Core Competencies
Academy of Oncology Nurse and Patient Navigators, Definition of Models of Navigation
Oncology Nursing Society, Association of Oncology Social Work, and National Association of Social Workers joint Position Statement on Navigation
How can the Navigator and Support Staff help your office?
Call us at _______________________________________
A nurse navigator provides patients and their families with education and assistance to overcome healthcare barriers and assist with timely access to quality medical and psychosocial care across the continuum of care.
How can the nurse navigator help?
- Provide a comprehensive assessment/psychosocial distress screening of the patient/family needs, introduction of appropriate support services.
- Reinforce education with patient patients/families regarding disease, treatments, side effects, and adverse reactions.
- Link patients with community agencies and resources.
- Make follow-up calls to patients/families at home.
- Review support groups and educational programs for patients/families.
- Educate patients on reportable signs/symptoms, based on physician’s plan of care.
- Follow-up with patients’/families’ status post (s/p) discharge to ensure services are set up as planned. Coordinate with inpatient staff.
- Conduct performance improvement (PI) projects.
- Participate in Tumor Site Team and tumor conferences.
A social worker can assist patients and their families with information on internal and external resources, financial, practical, and emotional concerns during their cancer journey.
How can the social worker help?
- Provide counseling for patients and families.
- Perform psychosocial assessments.
- Offer and facilitate Support Groups.
- Assist with completion of charitable application/patient assistance applications.
- Assist with medication applications.
- Evaluate patient for Medicaid/Medicare eligibility.
- Provide transportation resources.
- Identify community resources.
- Coordinate Community Assistance Program.
- Educate on Hospice.
- Assist with end-of-life decision making.
- Provide bereavement follow-up.
A registered dietitian is an expert in dietetics; that is, human nutrition and the regulation of diet. A dietitian advises oncology patients on what to eat in order to lead a healthy lifestyle or to achieve a specific health-related goal.
How can a registered dietitian help?
- Screen high-risk patients.
- Provide group and individual nutrition counseling.
- Connect patients with community and national resources.
A genetic counselor can offer education, testing and counseling for patients (and families) with a history of cancer. Cancers may or may not be inherited.
How can a genetic counselor help?
- Provide risk assessment.
- Provide genetic testing.
- Provide genetic counseling.
- Discuss strategies for risk reduction.
These are just two examples of how to create a tool to clearly and concisely explain the roles and responsibilities of navigators and support staff at a cancer program. These can be modified to describe the specific responsibilities for these roles at your cancer program. I encourage navigators to go forth and educate about your role.
Guest blogger ACCC member Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.