Advances in the treatment of cancer and other disease means more people are surviving diseases that once had high mortality rates.
But the complexity of care required can be daunting for a patient to arrange.
That’s where nurse and patient navigators come in. Working for health care providers, they help patients find their way through the system.
"With our trends in care, patients are doing better and living longer," said Carol Bush, a nurse navigator for the Midwest Cancer Alliance, which is affiliated with the University of Kansas Cancer Center. But that care, she adds, “is becoming increasingly complex.”
Bush said the concept of health care navigators emerged about 20 years ago. Today the Academy of Oncology Nurse Navigators boasts over 1,700 members nationwide. In addition to those with nursing degrees, the membership includes patient navigators, social workers, patient care coordinators and others.
Nearly a third of the association’s members work with breast cancer patients, followed by lung, colon and prostate and other cancers. Bush said breast health care lends itself to navigation because it’s “a defined and linear progression. It really lends itself to streamlining."
Nurse navigators also are used for heart disease, diabetes and other chronic illnesses.
Terri Peters, who is Via Christi’s nurse navigator for breast cancer, said she often sits in on a patient’s initial consultation with a doctor following diagnosis.
When the doctor leaves, Peters explains any unfamiliar terms and gives the patient an idea of what’s ahead. "We go through the whole picture of what their journey may look like. We feed them a lot of information before they leave that first visit."
A patient’s plan of care may include seeing specialists, including an oncologist, radiation oncologist and plastic surgeon. Scheduling so many appointments is one challenge that Peters helps patients with. She also hosts a pre-treatment conference in which the specialists coordinate their care, and later makes sure that information flows efficiently among specialists.
“We have tried to shorten that process,” Peters said. “I can tell you that from when we first started (the navigation program) in ’07, women were waiting weeks to see a surgeon, weeks to come back and get the biopsy.” Now, she said, “once you’re diagnosed, we want you at the surgeon in no less than three days.”
Peters gives each patient a Breast Cancer Journal containing doctors’ business cards, educational materials and answers to frequently asked questions, and urges them to take the journal to their appointments. Peters offers counseling to some patients.
“The ones that I feel need some additional support, I definitely call them weekly, just to check in and see if they need anything,” she said.
Angie Carr is the patient navigator for the KU Wichita Breast Cancer Survivorship Center. She tries to be a “one-stop shop” for breast cancer patients and their families, making referrals to health care resources in the community and helping them take advantage of them.
“It could be anything from addressing finances to assisting with communications issues they might be having with health care providers,” she said.
Carr remembered one call from the husband of a breast cancer patient who wondered where he could buy a wig for his wife in their hometown. Bush remembered a call she received about a woman who’d been told her breast cancer had advanced and who was seeking a clinical trial to participate in. Bush found several.“She ended up going to the KU Cancer Center, was made eligible for a clinical trial, and received treatment there,” Bush said.
Bush, whose office is in Wichita, spends much of her time training nurse navigators. She said health care facilities don’t get reimbursed for nurse navigators by Medicare or private insurers, so most positions were initially grant funded. But more health care providers are now making them a part of their budgets because they’ve been shown to improve patient outcomes and reduce the cost of care.
“It doesn’t take as long for folks to get from point A to point B” in their treatment, Bush said. “It’s a win-win for the patient and the health care system.”