In the past 12 months, patient navigation, specifically the role of oncology nurse navigators, has become of increased interest in the cancer community. Although the concept of patient navigation dates back to the early 1990s, the most recent surge surrounding this evolving area of patient care, as well as the signing of the Patient Protection and Affordable Care Act into law, has further solidified the growth of this movement in the US healthcare system.
Over the past year, ONS has focused more attention on patient navigation. They conducted a joint think tank and released a statement with the Association of Oncology Social Work (AOSW), held a session on the topic at the 10th Annual Institutes of Learning (IOL) meeting in Tampa, Florida, and devoted the first 2010 issue of Oncology Nursing Forum to it. At an ONS IOL session, presenters Lillie D. Shockney, RN, BS, MAS, and Sharon Gentry, RN, BSN, OCN, CBCN, discussed the history of the patient navigator, the various models, and the specific roles that navigators play in the cancer care continuum. Of note is that both presenters described their use of survivor volunteers as an extension of their role in the community. Shockney spoke about The Red Devils (www.the-red-devils.org), a Maryland-based nonprofit group that helps improve the quality of life of breast cancer patients and their families by funding services such as meal preparation and delivery, house cleaning, and transportation. Subsequently, Gentry spoke about her program’s recent decision to employ a cancer survivor to help with the administrative tasks that navigators perform, such as providing information about community services to patients. In the January 2010 issue of Oncology Nursing Forum, assistant editor Susan Moore, RN, MSN, ANP, AOCN, wrote an editorial titled “Making Room at the Table,” which highlighted the fact that various organizations have taken interest in patient navigation in cancer care, as evidenced by the greater number of manuscripts submitted and published in the literature; she also noted, however, that many questions remain unanswered. The three main articles and the Leadership and Professional Development feature all focused on the valuable role that patient navigators play and helped to begin to frame the national dialogue around patient navigation, especially in the oncology nursing community.
In June 2009, representatives from ONS, AOSW, and the National Association of Social Workers (NASW) met to discuss how oncology nurses and social workers should relate themselves to the patient navigation role. The position statement that came from this think tank highlights the integral aspects of patient navigation, including the fact that for optimal patient outcomes there must be a multidisciplinary navigation team consisting of nurses, social workers, and lay navigators. In addition, it clearly lays the groundwork for further research on national standards and appropriate outcomes and metrics to be measured. The release of this joint position represents a major step forward for patient navigation in cancer care and can be read in full at www.ons.org/Publications/Positions/Navigation.
ACCC has championed the role of patient navigation in the community cancer center setting. In March 2009, it released updated Cancer Program Guidelines, which describe the rationale for and characteristics of patient navigation services, including the distinction between nurses and social workers as navigators and between lay navigators and volunteers. Building from this update, it launched a patient navigation section of its website that can be accessed at www.accc-cancer.org/education/education-patientnavigation.asp. Over the course of its short existence, this section of the site has grown and is a great resource for navigators and all those interested in navigation.
On June 10, 2009, Tricia Strusowski, RN, MS, led the webinar “ACCC’s Cancer Care Patient Navigation: A Call to Action,” which is available online for continuing education credit until June 30, 2010. During her presentation, Strusowski discussed ACCC’s Patient Navigation Project, the various models of navigation, and a process to develop a program. To further this discussion, ACCC held a Cancer Care Patient Navigation Pre-Conference in Minneapolis, Minnesota, on September 22, 2009. A poster presented at this preconference outlined the various levels of need discussed during the webinar.
In 2009, NCBC held its beta year of testing for its Breast Patient Navigator Certification Program, with examinations conducted at their annual National Interdisciplinary Breast Center Conference in Las Vegas, Nevada, in March 2009, as well as at two regional sites in Baltimore, Maryland, and Chicago, Illinois. The first official examination was given in March 2010 at the NCBC annual conference, and more than 200 breast patient navigators were certified. NCBC has three regional examinations planned in 2010 and has also developed a comprehensive navigation matrix. For more information on the certification program, regional examinations, the matrix, and more, visit www.bpnc.org.
AONN began in early 2009 with the mission of advancing the role of patient navigation in cancer care and survivorship planning by providing a network for collaboration and development of best practices for the improvement of patient access to care and quality of life. At the 34th ONS Congress in San Antonio, Texas, in May 2009, AONN began to gain national recognition and to increase its membership. For the majority of 2009, AONN provided various online re sources through its website at www.AONNonline.org, including blogs written on various subjects relevant to patient navigation by members of its leadership council. In the fall of 2009, at ONS IOL in Tampa, Florida, AONN further engaged the oncology nursing community and released its first news letter, providing the history of nurse navigation for members and nonmembers alike. In addition, two members of the AONN leadership council, Lillie D. Shockney, RN, BS, MAS, and Sharon Gentry, RN, BSN, OCN, CBCN, presented the patient navigation session at this meeting.
AONN entered into a partnership with NCBC in mid-2009 to help raise awareness about their Breast Patient Navigator Certification Program. AONN continues to expand its reach in 2010 with the addition of several new leadership council members, the formation of state/regional chapters, and their first annual conference will be held in September. By forming partnerships with other professional and patient advocacy organizations, AONN continues to support navigators and ensure that patients benefit from their services. Finally, AONN has begun to accept manuscripts for a peer-reviewed journal on navigation and survivorship.
In addition to the several organizations discussed in this article, many others are actively supporting the navigator community. These organizations include the American Cancer Society, Lance Armstrong Foundation, American College of Oncology Administrators, Association of Cancer Executives, and the National Coalition of Oncology Nurse Navigators.
Although many questions remain surrounding the optimal role of patient navigators in the cancer care continuum, one thing is certain, there is great momentum behind this movement, as evidenced by the events of 2009 and the continued progress being made in 2010. Patient navigation will continue to be a major area of research and discourse and will take on further significance as navigators become more heavily involved in providing survivorship support and care for cancer patients.
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