Multisite Tumor Navigators


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Jay Swanson, RN, BSN, OCN
Shanna Gillming, RN, BSN

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Multisite Tumor Navigators

  1. 1. Multisite Tumor Navigators<br />Jay Swanson, RN, BSN, OCN<br />Saint Elizabeth Cancer Institute<br />Shanna Gillming, RN, BSN<br />Good Samaritan Hospital Cancer Center<br />
  2. 2. Objectives<br />Discuss concerns with navigation<br />Identify potential best practices<br />Review case study highlighting the strengths and difficulties of multisite navigation<br />
  3. 3. Why Navigate Multiple Sites?<br />Small amount of cancer for service area<br />Program can only support 1 navigator<br />Referral systems not in place<br />“Don’t want to leave anyone out”<br />
  4. 4. Brainstorming Time<br />Take 5 minutes to think about…<br />Why are you/do you have a multisite navigator?<br />What are the benefits?<br />What are the concerns?<br />Would you want to be or wish you were specialized?<br />Do you have a preferred disease site to navigate?<br />
  5. 5. J.M. <br />75-year-old woman with stage IV lung cancer<br />Navigated at time of diagnosis through treatment<br />Including 2 different cycles of chemotherapy<br />WB XRT<br />Cyberknife to left rib cage<br />Now on PO TKI for therapy<br />
  6. 6. Thoughts<br />What are some thoughts about… <br />How often to follow up with this patient?<br />What are the main areas of focus for her care?<br />
  7. 7. Next Patient<br />E.L., 28-year-old woman with gastric cancer<br />Navigated for financial assistance through treatment and beyond<br />Patient had minimal side effects to chemotherapy<br />Always acted like it was not a big deal to be on treatment<br />Always had 12-year-old daughter in room<br />Admitted over weekend for anxiety and nausea<br />
  8. 8. Thoughts<br />What are your thoughts about…<br />Her care, and what concerns should be addressed with her?<br />How does she differ from the patient you saw before her?<br />How often should we follow up with her?<br />
  9. 9. Then…<br />J.C., plasmacytoma - spine<br />44-year-old man, lives with significant other<br />Uninsured, has worked as a truck driver<br />Unable to work as a result of tumor<br />Undergoing radiation<br />Tolerated radiation treatment fairly well<br />Has applied for public assistance <br />
  10. 10. Thoughts<br />What are your thoughts…<br />Regarding his care?<br />How does he differ from everyone else today?<br />
  11. 11. GYN Patient<br />J.N., 56-year-old patient with advanced cervical cancer<br />Waitress, uninsured<br />Was symptomatic for 2 years with spotting, pain, and weight loss. Waited to see an MD<br />Has a sister from California here to care for her<br />Borrowing a car from patient’s ex-husband to get back and forth to treatment<br />Hospitalized for several weeks with side effects from concurrent chemo/XRT<br />
  12. 12. Thoughts<br />What are your thoughts…<br />What are the barriers here?<br />How can a navigator assist this patient?<br />
  13. 13. H&N Patient<br />S.S., 56-year-old life-long smoker/drinker<br />Receiving radiation for 6 weeks<br />Using American Cancer Society for rides<br />Wife calls daily about concerns<br />Pain meds<br />Swallowing<br />Eating<br />Patient never has any concerns; rates distress level 0 on numerous occasions<br />
  14. 14. Thoughts on This Case…<br />What can we do for this gentleman?<br />Is his score concerning?<br />What can we do for his wife?<br />How is this different from other cancer navigation?<br />
  15. 15. Final Thoughts on Case Study<br />The purpose of specialization is to be able to provide a more focused knowledge base for care<br />How to specialize the following morning?<br />Stage IV lung<br />Gastric<br />Plasmacytoma<br />GYN<br />H&N<br />
  16. 16. Resources Utilized by Navigators<br />American Cancer Society<br />Med companies<br />Local resources (food, lodging)<br />National resources – Healthwell, Chronic Disease Fund, Cancer Care, Patient Advocate Foundation, LLS<br />Cleaning for a Reason<br />Centers for Medicare & Medicaid Services<br />
  17. 17. Next Steps<br />Within AONN we have a network<br />We have an ability to provide a safe place for multisite navigators<br />Certification for Navigation is happening on some level and will only become more prevalent in the coming year<br />
  18. 18. Next Steps<br />What are your thoughts about…<br />Building a place on the AONN site for multisite navigation<br />What would we include on the site?<br />Any tools that we use that would be helpful?<br />Contact information?<br />Resources?<br />Networking throughout the year to help address concerns, maybe as a teleconference or webinar?<br />