With a Nurse in their Corner, ‘Navigating’ Care Is Getting Easier for Cancer Patients

Dec. 14, 2018

Banner Health nurse navigators at the University of Arizona Cancer Center are paired with patients to guide them through their cancer journeys.

Media Contact: Anna C. Christensen, 520-626-6401, achristensen@email.arizona.edu

Dec. 14, 2018

UA Cancer Center nurse navigators (photo: Jacquelyne B. Echave)TUCSON, Ariz. – A cancer diagnosis can be overwhelming, sending new patients’ lives into a tailspin as they scramble to understand their disease, rearrange schedules and adjust future plans. During this difficult time, many patients could benefit from the guidance of an expert who knows every nook and cranny of the complicated cancer-care system.

In recent years, Banner Health nurse navigators at the University of Arizona Cancer Center have emerged to fill that role.

“The concept of nurse navigators is new to Tucson,” said Beth High, MSN, RN, a Banner Health clinical program manager for navigation with the UA Cancer Center. “Although awareness is low, the value of a nurse navigator is sky high.”

All patients with cancer are assigned nurse navigators, who educate and advocate for them throughout their cancer journey. By connecting patients to support services to equip them to overcome barriers to care, such as transportation issues or financial difficulties, a navigator helps lighten the burden of “navigating” the system.

Shawn Mulligan, MS, BSN, RN, recently joined the team as a breast oncology navigator.

“As navigators, we’re like the hub of the wheel,” Mulligan said. “We’re a point person they can call for any reason, whether it’s billing, treatment or coordination of care. As a navigator, I can point them in the right direction and get their questions answered.”

Nurse navigation defined

Nurse navigation leaders are hard at work defining what they do and how best to do it. The UA Cancer Center has been selected as one of eight sites to participate in NAVmetricsTM, a first-of-its-kind national study that will help the Academy of Oncology Nurse & Patient Navigators (AONN+) test uniform standards to guide successful nurse navigation programs nationwide.

“Our selection was due to the strength of our metrics data,” High said. “We were one of the first centers to collect a year’s worth of data, which we started collecting in January 2017.”

Data from the NAVmetricsTM study will be used to establish “best practices” for navigation programs as they work to build their teams and improve patient outcomes. The study also will uncover roadblocks encountered by navigation programs as they work to implement these standards. In the future, navigation programs may be able to monitor themselves with metrics validated by the NAVmetricsTM study, enabling them to sustain their successes and shore up their weaknesses.

Navigating care at the UA Cancer Center

The UA Cancer Center’s navigation program has been several years in the making, and has grown into a source of pride.

“Our program started in the fall of 2015 when I was hired to be the breast navigator,” High said. “Since then, we have developed a program that has helped cement our excellent reputation, with 11 oncology nurse navigators going to bat for their patients.”

Each nurse navigator specializes in a disease type, equipping them to answer questions about a patient’s specific cancer diagnosis, including cancer survivorship.

“A cancer diagnosis can be so stressful it can be difficult for a patient to fully absorb all the information coming at them while fearing the unknown,” Mulligan said. “We can help them process this information in the context of this fear so they can make treatment decisions. As a breast cancer survivor myself, I may share my experience when appropriate. Sometimes my story restores hope for a patient, giving her the resolve to move forward.”

Overcoming barriers

On its own, cancer is bad enough, but it’s too often accompanied by other problems, from mental health issues, such as depression and anxiety, to logistical challenges, such as finding transportation to the clinic or paying for care. These obstacles can pile up depending on many factors, including a patient’s socioeconomic status, geographical location and social support network.

Although each patient’s circumstances are unique, nurse navigators are attempting to quantify these problems with a metric they call “acuity,” a term used to refer to the level of patient distress and the number of barriers to care. Identifying patients with high acuity scores helps navigators target patients who need extra support. Navigators can help reduce these patients’ distress and address barriers to care, for example, by helping to resolve transportation issues.

High is examining strategies to lower acuity scores by addressing patient distress and barriers to care. Throughout 2018, she has been tracking patients’ acuity scores as they received care at the UA Cancer Center. Navigators contact new patients before their first appointment to assess their level of distress and number of barriers, which produces an initial acuity score. In subsequent follow-up phone calls, patients continually are reassessed to track changes in their acuity.

“I’m hypothesizing that moving a patient from high acuity to low acuity is a metric for navigation effectiveness,” High said. “Having an acuity tool to help us monitor and respond to our patients’ needs allows us to deliver the best care possible.”

High’s strategy is showing promising results. Her work received national attention last month, when she presented her ideas at the ninth annual AONN+ Navigation & Survivorship Conference in Dallas.

She has also been selected to co-chair the AONN+ National Acuity Project, which will consider many other aspects of acuity and help guide the direction of future research. AONN+ and Astellas are collaborating to develop, standardize and validate an evidence-based oncology acuity tool. When finalized, the acuity tool will be used to help oncology navigators characterize the intensity of patient navigation workload, aid in the allocation of resources and measure the effectiveness of navigation on patient outcomes. The acuity tool will support and enhance oncology navigators’ effectiveness through patient-centric methods that may have the potential to decrease the overall cost of care.

“Our team is doing novel work,” High said. “I am very proud of their innovative approach to improving patient care.”

To make an appointment at the UA Cancer Center – North Campus, call 520-694-CURE (2873). To make an appointment at the UA Cancer Center – Orange Grove campus, call 520-742-4183.

The NAVmetricsTM study is a collaboration between AONN+, Chartis Oncology Solutions, LLC, and the American Cancer Society.

About the University of Arizona Cancer Center
The University of Arizona Cancer Center is the only National Cancer Institute-designated Comprehensive Cancer Center with headquarters in Arizona. The UArizona Cancer Center is supported by NCI Cancer Center Support Grant No. CA023074. With its primary location at the University of Arizona in Tucson, the Cancer Center has more than a dozen research and education offices throughout the state, with more than 300 physicians and scientists working together to prevent and cure cancer. For more information: cancercenter.arizona.edu (Follow us: Facebook | Twitter | YouTube).

About Banner – University Medical Center Tucson and South

Banner – University Medical Center Tucson and Banner – University Medical Center South are part of Banner – University Medicine, a premier academic medical network. These institutions are the primary teaching hospitals for the University of Arizona College of Medicine – Tucson, and the clinical partner of the University of Arizona Cancer Center in Tucson. The two hospitals are part of Arizona-based Banner Health, one of the largest nonprofit health-care systems in the country. Banner Health is in six states: Arizona, California, Colorado, Nebraska, Nevada and Wyoming. For more information, visit BannerHealth.com/UniversityTucson or bannerhealth.com/UniversitySouth.

About the Academy of Oncology Nurse & Patient Navigators® (www.aonnonline.org)

The Academy of Oncology Nurse & Patient Navigators, Inc. (AONN+) is the largest national specialty organization dedicated to improving patient care and quality of life by defining, enhancing, and promoting the role of oncology nurses and patient navigators. The organization, which has more than 8,000 members, was founded in 2009 to provide a network for all professionals involved and interested in patient navigation and survivorship care services in order to better manage the complexities of the cancer treatment process.

Photo: UA Cancer Center nurse navigators (credit: Jacquelyne B. Echave)