With the growing demand for cancer services and a shrinking workforce, new ideas and innovative approaches are needed. During a session at the Oncology Nurse Advisor Navigation Summit, ONS member Jean B. Sellers, RN, MSN, administrative clinical director at the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, discussed the current landscape and future of navigation services.
The aging population, expanded Medicare eligibility, a shift toward oral chemotherapy, and financial toxicity have required North Carolina’s cancer programs to shift the focus toward lay patient navigators. Oncology nurse navigators have many clinical and nonclinical responsibilities, and lay patient navigators are trained volunteer community members who can help patients with cancer overcome more of the nonclinical barriers to care. They may have previous experience in the healthcare setting as an employee, a cancer survivor or caregiver, or a premed student.
Lay patient navigators will communicate with patients in a respectful and supportive manner, provide emotional support, identify nonmedical barriers to care, and connect patients with existing caner support programs and resources. Example lay navigator interventions can include providing financial assistance, transportation, scheduling appointments, coordinating lodging, and assisting with child or pet care.
Sellers then described a few examples of lay navigation programs in North Carolina.
From 2008–2012, a community model of lay navigation was assessed in Nags Head. She said critical steps in the program development included having a physician championing the program; an advisory team; bimonthly meetings; comprehensive training, policies, and outcome measures; resource guide, monthly lay navigation education meetings; and marketing and community outreach for recruitment. Sellers said the program transitioned to a local hospital in 2013. “Nonclinical support can be provided, but requires nursing leadership,” she said.
The academic model of lay navigation in Chapel Hill has been ongoing since 2013 and was implemented because breast nurse navigators were overwhelmed because of patient volume. A phone survey revealed that many patients with breast cancer were unaware of the services the cancer program offers. In addition, retrospective chart reviews indicated missed appointments, patients lost to follow-up, duplicate testing, and problems with data.
The program included a 6-hour training and a 20-hour orientation, as well as monthly educational support meetings, an educational video library, a yearly navigation symposium, and a resource guide. The program delineates responsibilities to maximize provider roles through regular check ins. Sellers provided a sample patient navigation encounter sheet that the lay navigator would complete after visiting a patient. Since 2014, the program has trained 56 volunteer lay navigators.