Implementation of the Navigator Role in Community Based

Implementation of the Navigator Role in Community – Based Oncology Program Our Journey Joan M. Daugherty, RN, MS Executive Director, Richard A. Henson Cancer Institute Peninsula Regional Medical Center

Recipient of the Outstanding Achievement Award by the American College of Surgeons

Today’s Presentation ü Who We Are ü Our Journey ü Our Goal

Peninsula Regional Medical Center v. Peninsula Regional Medical Center in Salisbury, Maryland (not-for-profit) offers the widest array of specialty & sub-specialty services on the Delmarva Peninsula. v. Peninsula Regional has been meeting the needs of Delmarva Peninsula residents since 1897. Accredited by the American College of Surgeons since 1970.

Primary Site Cancer Cases Total 2009 2010 2011 2012 2013 Brain Head & Neck Larynx Esophagus Lung Stomach Pancreas Colorectal Bladder Breast Melanoma/Skin Prostate Cervix Corpus Uteri Ovary 36 21 12 15 224 19 23 116 66 225 179 251 3 41 13 19 26 13 8 236 12 27 102 72 205 161 238 8 36 7 34 34 17 9 239 12 31 102 55 184 157 224 10 29 18 24 31 15 20 241 24 26 90 65 189 155 169 9 38 15 25 35 16 15 195 21 26 80 66 208 162 146 9 35 6 Lymphoma/Non Hodgkin's Other 58 217 54 236 44 364 58 353 69 335 1519 1460 1563 1522 1449 Total

Organizational need was not defined Navigators were hired without: v Clearly defining organizational need. v Defining their role. v Defining expectation. v Established method of evaluation.

Patient Navigators v v 1 RN Breast Health Navigator 2 RN Navigators 1 Social Work Navigator Patient Care Assistant to coordinate transportation. v 1 CRNP Navigator Thoracic Oncology v 1 RN GYN Oncology Navigator

Committee Formed to Develop Role 2007 Our Journey Begins

Identified Challenges Duplication of Roles: v Office RN role versus RN Navigators role. Different expectations between providers & administration: v Patient confusion. v Limited access to Navigator.

Navigation program Coordination of care Strategic imperatives must: v Focus on clinical outcomes and quality. • • Evidence-based medicine Standardized care paths Transparency Move from process to outcomes metrics v Promote coordination and collaboration v Be fundamentally patient centered • • Personalized care Patient satisfaction v Disease specific

Breast Health Navigator Improve timely access Coordinate: v Timely biopsy. v Surgeon evaluation. v Access to financial assistance. v Access to multidisciplinary program. v. Breast Pathway v Hand-off to treatment.

Quality • National Consortium of Breast Center's National Quality Measures for Breast Centers Program. • Accredited by National Accreditation Program for Breast Centers

The Breast Program Quality Scorecard

Thoracic Oncology Program v Weekly Multidisciplinary Thoracic Clinic v Weekly Multidisciplinary prospective Case Conferences – treatment planning v Coordination of Care

Lisa Barnes, MSW LCSW, & Marybeth Watson, RN Results of Effective Navigation Include: Navigation is: Navigation: Mapping the Road to Survivorship: • Coordinated services. A process by which a • Consistent contact person to nurse and/or social • Standardized follow-up care call if the patient has a worker guides patients for survivors of lung cancer. question with suspicious findings through and around Navigators or problem. • Promoting the physical, • Support for emotional/physical barriers in the complex psychological, social and effects of cancer and cancer care system to spiritual well-being of treatments. ensure timely diagnosis survivors. • Connection with community and treatment. • Addressing advanced care resources. Lung Cancer Patients receive the following planning needs. • Informed and educated. Physicians patient. services: • Education on the disease process and all aspects of treatment. Radiology Lab • Information on resources available to the lung cancer patient. • Coordinated care to address any Patient psychosocial issues as well as financial Treatments Insurance needs. Navigators • Comprehensive Transportation treatment journals are Resources provided to each patient at the start of Emotional Education treatment. Support •

My Personal Treatment Journal v Created to help cancer patients and families take an active role in managing their health. v Makes it easy to organize appointments and keep track of information. v Includes information on cancer treatment and management of treatment side effects. v Provides information on local and national resources.

Coordination of Support Services v. Nutrition Counseling v Palliative Care v Pastoral Care v Cancer Rehabilitation: • Pulmonary Rehabilitation • Physical/Speech/Occupational Therapy v. Support Groups/Services v. Genetic Counseling & Testing

Across the Continuum of Care

Richard A. Henson Cancer Institute Commitment to the Future Continue to enhance our Comprehensive Cancer Program using an unparalleled combination of: v The most advanced medicine, treatment techniques & state-of-the-art technology. v Highly trained and compassionate specialists. v Comprehensive Services “under one roof”

Ultimate Goal: A patient-centered , fully integrated Cancer Care Program.