Managing a Navigation Program: The Role of Administrators Phyllis A. DeAntonio, RN, MSN, FAAMA Administrator, Cancer Services Pitt County Memorial Hospital University Health Systems of Eastern North Carolina Greenville, NC
“ This is an excellent program. After being diagnosed, I was in a state of shock! Debra has helped clarify what the doctor’s plan of action and lab reports meant. She has been an excellent liaison, and true help in a very difficult time.” “ Debra did an outstanding job in serving as a resource for both my doctors and me. Her warm compassionate mannerism is to be commended. She has a way of making you feel that you are her only patient. Debra truly cares about her patients. Breast cancer is very scary and the journey is difficult. Debra walks the journey with you – calming your fears and reassuring you there’s HOPE for tomorrow.”
“ Increased comfort level of patients thus improving oncology compliance and other treatment outcomes. Improved communications related to procedures enhancing patients’ care.” “ Has made it much easier for patients to get through the system of multidisciplinary care and provide physical and psychological support during difficult times for our patients.” “ Debra develops trusting relationships with the patients prior to their visit in the outpatient setting, thus developing a lesser means of patient adaptation to the outpatient setting. She is a mediator between patient/MD, her additional educational opportunities help the patients greatly.”
Cancer Services began its patient navigation program in Fall 2007. This program guides newly diagnosed patients and their family members to various services and resources they need for receiving the best cancer treatment. Patient navigation programs are part of a growing trend in
our country that involves the development of special services to help patients through the maze of appointments, treatments and follow-up that are necessary components of cancer care. Here at PCMH, referrals come from private practice physicians and Leo W. Jenkins Cancer Center. Pitt County Memorial Hospital has a registered nurse, Debra Mascarenhas, dedicated to
helping patients find answers and support for their health care. Ms. Mascarenhas, who monitors gynecological and breast cancer cases, first meets a patient at the time of her diagnosis and is present when the physician explains the phases of treatment. Ms. Mascarenhas facilitates support services and helps patients find financial, transportation and other resources Most patients referred are under the age of 40 and are dealing with the emotions that accompany a cancer diagnosis. Oftentimes patients have problems understanding the disease or have difficulty coming to terms with their conditions and treatments. A navigator can: provide education on various support programs that help patients cope with their cancer experiences help patients desiring a link to other survivors locate local support groups for patients living outside the Greenville area to reduce the difficulty of travel.
A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations. The navigation process is evaluated, documented and reported to the cancer committee annually. The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment.
The Cancer Committee develops and implements a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment. The process is monitored, evaluated, and presented at least annually to the cancer committee and documented in minutes.
Nationwide Free Sources of Patient/Family Information
American Cancer Society (ACS)
American Institute of Cancer Research (AICR)
Lance Armstrong Foundation
National Cancer Institute (NCI)
National Coalition for Cancer Survivorship
Susan G. Koman for the Cure
Nationwide Free Sources of Patient/Family Information (cont.)
Breast Health Coordinator STATS July 2010 CCMC Springfield Media Brinton Lake Total 24 5 0 1 Seen or Contacted 24 5 0 1 Stayed in System 21 5 0 1 Out migrated 3* 0 0 0 Patient Contacts = 59 Total New Bi-Rad 4 or 5 = 30 Total New malignancy New Breast Cancer Staying in System = 6 *Reason for Outmigration Pt referred by Dr. Vakil, preferred surgical biopsy with him Pt biopsy here- benign- to Jeff Pt referred to Lankenau by Dr Tirado
of newly diagnosed breast cancer patients stayed in our system for care
What Administration Wants: ROI Referrals From Patients Referrals for Supportive care Additional Radiographic Imaging Medical Oncology/ Chemo Radiation Therapy Surgery Surgical Consult Percutaneous biopsy Ultrasound Diagnostic mammogram Screening mammogram