Oncology Navigation Standards Help Patients Overcome Disparities and Barriers to Care
Patients with cancer, especially those from underrepresented groups or who are experiencing racism, inequalities, social determinants of health factors, and other barriers to care, need oncology nurse navigation now more than ever before. Developed as a “strategy to improve outcomes in marginalized populations by eliminating barriers to timely diagnosis and treatment of cancer and other chronic diseases,” navigation has made a difference for patients since its introduction in 1990.
To help address the systemic disparities still emerging today, ONS joined the Professional Oncology Navigation Task Force, a group of professional organizations and individuals who served on the Biden Cancer Initiative Patient Navigation Working Group, to define a universal Oncology Navigation Standards of Professional Practice. The task force published (https://cjon.ons.org/oncology-navigation-standards-professional-practice) the final standards in March 2022 in the Clinical Journal of Oncology Nursing.
Patient Navigation Roles
The task force recognized that both clinical and nonclinical staff can provide navigation for patients with cancer. It formally identified (https://cjon.ons.org/oncology-navigation-standards-professional-practice) three established roles but recognized the emergence of additional new roles, such as financial navigation.
Oncology patient navigator: Nonclinical staff who work in either the healthcare system or a community-based organization. Patient navigators provide guidance at any point across the cancer care spectrum: screening, diagnosis, treatment, or survivorship.
Clinical oncology nurse navigator: RNs with clinical experience in oncology. Oncology nurse navigators use the nursing process to help patients and caregivers overcome barriers to care. The task force identified (https://cjon.ons.org/oncology-navigation-standards-professional-practice) that they provide “education and resources to facilitate informed decision-making and timely access to quality health and psychosocial care throughout all phases of the cancer continuum."
Clinical oncology social work navigator: Licensed social workers with a master’s degree who combine clinical oncology experience with psychosocial knowledge. Similar to oncology nurse navigators, social work navigators use the social work process to help patients and caregivers overcome barriers to care and provide supportive education and resources.
General Navigation Standards of Practice
The task force identified 19 standards of practice that apply to all three established navigation roles. The following summary includes general information for all navigators, but the full article covers specific practices for individual roles. Refer to the full article (https://cjon.ons.org/oncology-navigation-standards-professional-practice) by Franklin et al. for more comprehensive information.
Standard 1: Ethics: All navigators practice with compassion, respect, and empathy for the inherent dignity, worth, and unique attributes of every person; have a primary commitment to the patient; and promote, advocate for, and protect the rights, health, and safety of patients.
Standard 2: Qualifications: Oncology navigators obtain the necessary education, licensure, and certification for their position and are accountable to patients, the navigation profession, applicable state boards of licensure, their employer, and the communities in which they serve.
Standard 3: Knowledge: Oncology navigators have and continue to seek knowledge that reflects current navigation practice. They integrate current evidence into their daily practice.
Standard 4: Cultural and Linguistic Humility: Navigators continuously seek to provide culturally appropriate and affirming navigation services and demonstrate cultural humility, sensitivity, and responsiveness to diverse patient populations.
Standard 5: Interdisciplinary and Interorganizational Collaboration: Viewing patients as the center, oncology navigators collaborate with and facilitate communication across all interprofessional members of the healthcare team.
Standard 6: Communication: Using a variety of formats, oncology navigators communicate effectively with lay patients, caregivers, and the public as well as healthcare professionals in all areas of practice.
Standard 7: Professional Development: Oncology navigators engage in continuous professional development to obtain new knowledge and competence that reflect the current state of oncology navigation and cancer care and promote critical and future thinking.
Standard 8: Supervision: When tasked with supervision, oncology navigators have the necessary knowledge and skills to supervise, support, and develop the disciplines in their professional setting.
Standard 9: Mentorship and Leadership: Oncology navigators pursue leadership opportunities in their practice setting and the profession, and they establish peer and colleague mentorship relationships to develop and support the navigation role.
Standard 10: Self-Care: Oncology navigators practice well-being to support their physical, emotional, mental, and spiritual health and to reduce stress, compassion fatigue, secondary trauma, and burnout.
Standard 11: Prevention, Screening, and Assessment: They are up to date on and educate, promote, and advocate for cancer prevention behaviors, early detection, screening, and healthy behaviors. Oncology navigators help individuals access local, community, and national resources.
Standard 12: Treatment, Care Planning, and Intervention: By mitigating barriers to care and providing support and information, oncology navigators guide patients and caregivers through all phases of active cancer treatment.
Standard 13: Psychosocial Assessment and Intervention: Using empathy, patient-centered interviewing and listening skills, and other patient-appropriate methods, oncology navigators assess, assist, and provide clinical services to best support patients’ and caregivers’ psychosocial needs and expectations.
Standard 14: Survivorship: Oncology navigators prepare for, assess, and provide support to address patient needs when transitioning from active cancer treatment into survivorship or chronic cancer management.
Standard 15: End of Life: Oncology navigators prepare for, assess, and provide support to address patients’ end-of life needs.
Standard 16: Advocacy: Incorporating patient rights and preferences and to address their needs and goals, oncology navigators advocate with and on behalf of patients, survivors, families. They also advocate for their profession.
Standard 17: Operational Management: Oncology navigators understand organizational structure and advocate for the navigation role to improve patient experiences and outcomes. They contribute to oncology program and navigator role development, implementation, and evaluation in their healthcare system and community.
Standard 18: Practice Evaluation and Quality Improvement: Through data, metrics, and outcomes, oncology navigators routinely evaluate overall navigation programs and contribute to quality improvement initiatives.
Standard 19: Evidence-Based Care: Oncology navigators contribute to the knowledge and evidence base and integrate evidence and research findings into their practice.
For more information about the standards, refer to the task force’s full article (https://cjon.ons.org/oncology-navigation-standards-professional-practice). For more information about oncology nurse navigation, explore the resources listed in the sidebar.