Navigating in a New Era: Crisis and Opportunity

Established in 2017, the National Navigation Roundtable (NNRT) brings together organizations and individuals to stimulate collaboration in the fields of nurse, patient, and financial navigation; address unmet navigation needs; and prioritize health equity. Navigators serve those most in need, and the role of NNRT is to organize collective action to address the barriers to patient navigation in all populations. ACCC recognizes the critical role of nurse, patient, and financial navigators on the cancer care team and is a proud member of the NNRT.

On September 29, the NNRT convened its annual meeting. With the theme of “Navigating in a New Era: Crisis and Opportunity,” meeting attendees discussed the multiple challenges patients faced this year (e.g., COVID-19, social justice concerns, and natural disasters), shared ways navigators are creatively finding solutions to support patients through these challenges, and highlighted the role of navigators in promoting health equity and combating racism.

Jamie Callahan, BSN-RN, OCN, CBCN, an oncology nurse navigator at UCHealth in Fort Collins, CO, talked about the unique challenges that travel restrictions have posed for patients. Callahan explained that UCHealth sees many patients from rural communities who travel multiple hours for care from Wyoming or Utah. Because they travel across state lines, these patients can encounter barriers to their ongoing care as a result of quarantine requirements, potentially delaying essential treatment.

Callahan shared the story of one woman in Nebraska who had port surgery scheduled before an appointment for a second opinion that she wanted prior to starting chemotherapy. The patient was told that if she crossed state lines to get the second opinion before having the surgery (the doctor was not located in Nebraska), she would need to quarantine for 14 days, therefore delaying the start of her treatment. The UCHealth team enabled the woman to get the second opinion she wanted via a virtual visit with a physician who has a Nebraska medical license. While UCHealth does not typically offer new patients virtual appointments, they were flexible and did what was best for the patient in these circumstances.

Navigators also have a role to play when it comes to social determinants of health. Zarek Mena, OPN-CG, is a women’s health program manager at Whittingham Cancer Center in Norwalk, CT. In response to the needs the practice identified within its patient population, Mena established a food bank at her center to support patients who are food insecure. When she realized that her patients’ increased need for food assistance was a consequence of the pandemic, Mena worked with her cancer center to create a pop-up food bank that now delivers food to 150 families.

To remove barriers to care and maximize access for patients, families can indicate their interest in the Whittingham Cancer Center food bank without having to meet any financial criteria. Since starting the program, Mena has implemented updates that take the cultural diversity of their patient population into account. For example, Mena started offering grocery gift cards so families can select foods that align with their needs and cultural preferences. “This program is a collective effort of advocacy, support, and love to our cancer community,” says Mena.

Sandra Arellano, MA, CN-BM, a navigation program manager at Lovelace Women’s Hospital in Albuquerque, NM, was working with a skeleton crew after many staff were furloughed during the pandemic. “Navigators are critical thinkers and problem solvers,” says Arellano, highlighting the teamwork skills essential to navigation. “We are filling in gaps where we’re needed, helping at the front desk with screening and temperature checks, implementing cleaning protocol, and supporting staff with transitioning to virtual work.” While taking on additional duties, the navigation team also moved their supportive services online. Today, navigators at Lovelace Women’s Hospital are working with community partners to offer virtual “healing circles” that include cognitive behavioral therapy, guided imagery, and meditation. These virtual sessions have resulted in reduced stress for patients as they deal with a dual health crisis.

The closing keynote at the National Navigation Roundtable Annual Meeting was delivered by Natalie S. Burke, president and CEO of CommonHealth ACTION. Burke shared meaningful actions that navigators can take to better understand the role of racially based inequities in patient care. “Just because you engage with people and even if they do feel engaged, that doesn’t mean equity exists,” says Burke. She reminded her audience that cultural competency doesn’t always address what is at the root of inequity: an imbalance of power. “Power is the ability to define reality for yourself and for others … health equity requires someone to be able to share how they feel.” Burke’s call to action for navigators includes:

• Use an “equity lens” to understand who experiences the benefits and burdens of a program or policy
• Practice empathetic listening and ask patients how they feel about a given situation
• Be an ally and anti-racist, anti-sexist, anti-ageist, and anti-ableist
• Know that you may make missteps, forgive yourself in advance, and keep learning

Resources from the NNRT Annual Meeting can be found here. If you are interested in joining NNRT, please visit the NNRT website to submit an organization or individual membership form. Part 2 of the NNRT Annual Meeting will take place on December 7 at 2:00 ET.