Patient Engagement: The Role of Navigators in Cancer Care

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 - Patient Engagement: The Role of Navigators in Cancer Care
Thomas Buse, MD

A suspected cancer is bewildering and frightening—and for some patients, that suspicion is the beginning of an arduous journey through the health system. Proactive providers are adding navigators empowered to guide cancer patients, coordinating and expediting their care (and providing exactly the support that patients need). In the process, they are generating enthusiastic comments on Press Ganey surveys, in addition to fierce loyalty and donations to their organizations from grateful patients.

“Our approach to the cancer patient is multidisciplinary and comprehensive, not fragmented. You have the surgeon, the oncologist, the medical oncologist, the radiologist, and the pathologist—a lot of moving parts. The person who glues all of the disciplines together is that navigator," says Thomas Buse, MD, medical director of radiology, Riverside Methodist Hospital, Columbus, Ohio.

Like Columbus, Ohio-based Riverside Radiology and Interventional Associates, of which Buse is a member, many of the 17 radiology practices in the Strategic Radiology (SR) consortium have implemented navigator programs for breast-cancer inpatients and outpatients, gaining valuable experience and refining care protocols. While lung-cancer navigators are less common, that is beginning to change as more providers add low-dose CT lung-cancer screening.

As medical director of radiology at 796-bed Riverside Methodist Hospital (Columbus, Ohio), Buse oversees the outpatient centers owned by the multihospital OhioHealth system. While he can’t put a price tag on the program, he says that it includes salaries for the system’s nurse navigators, office space, patient-tracking software, and IT support.

OhioHealth’s program began about a dozen years ago; it has grown to include 16 breast-cancer navigators with responsibility for diagnosis and treatment at both hospitals and breast centers. As a mammographer and medical director, Buse works closely with the navigators on clinical and administrative levels.

“If I read a screening mammogram and see a spot or some calcifications that need to be worked up, they get involved at the call-back point,” he explains. Diagnosis navigators coordinate the diagnostic mammogram, biopsy (if necessary), and delivery of pathology results to the referring physician. Treatment navigators take patients through chemotherapy, surgery, radiation therapy, home care, palliation, and hospice care (as required)—providing education, friendly support, and a consistent presence.

Diagnosing Cancer: Vital Statistics

Strategic Radiology is a nationwide consortium of 17 radiology practices that share data to optimize quality and safety in medical imaging. In 2013, they performed the following diagnostic procedures.

Screening mammograms: 1,356,743

Diagnostic mammograms: 371,415

Cancers detected: 8,429

Stereotactic biopsies: 21,755

Breast ultrasound: 258,323

Lung cancer screening: 4,446

Coordination of Care

As health-care providers seek greater coordination of care, the navigator program at 625-bed Huntington Memorial Hospital (Pasadena, California) demonstrates how it is done. The hospital began its program nearly 20 years ago, according to Cathy Vesolowski, vice president of operations for The Hill Medical Corp (Pasadena, California), the radiology group contracted to read the hospital’s studies and to operate and manage its outpatient imaging centers.

What began as an informal program of cooperation and communication among the hospital’s surgeons and radiologists evolved, over the years, into a vast support network that revolves around the Huntington-Hill Breast Center (Pasadena), accredited by the National Accreditation Program for Breast Centers. “You have to have this huge support group to be accredited,” Vesolowski notes. “It starts with the breast center where patients are diagnosed and must include the surgeons, social workers, hospital, oncologists, and pathologists.”

She continues, “The nurse navigator is a very important piece of this program.” In addition, the network includes psychiatrists who help patients deal with emotional difficulties; a physician who performs acupuncture to alleviate the side effects of chemotherapy; and an appearance center, staffed by a hairstylist who works with patients experiencing hair loss.

Educating the Patient

Two nurse navigators track patients of the Huntington-Hill Breast Center and two imaging centers, in addition to patients whose cancers are diagnosed elsewhere,