October 17, 2013
By Laura Long
|Liz Bessette, RN; Carol Bush, RN; and Jennifer Gray, RN|
When Liz Bessette, RN, was asked to help guide patients through their care after St. Francis Hospital in Topeka opened its cancer center in 2003, she had no idea she was making Kansas history. Bessette, a nurse at St. Francis since 1968, had spent many years in critical care administration and was involved in staff education when the CEO of St. Francis asked her to help steer cancer center patients through the overwhelming maze of treatment and logistics they would encounter. Bessette thus became the first nurse navigator in Kansas.
Nurse navigators help patients make informed medical decisions and assist with setting up multiple doctors' appointments and tests. Navigators also provide tips on coping with patients' prognoses; make sure patients stay on track with their treatment plans, run interference on insurance issues and offer emotional support. All this is at no additional charge to patients.
Bessette's years of nursing experience helped her quickly assume her new responsibilities. "It didn't take long to see how navigation could help patients achieve better outcomes."
Cancer care navigators first came to the general public's attention in 1990 when Dr. Harold Freeman, who was then president of the American Cancer Society, developed the Harlem Cancer Education and Demonstration Project to help low-income families in New York City get access to the health care they needed in order to prevent, detect and treat cancer. A disproportionate number of poor people in New York were dying from cancer, and Freeman's research indicated a need for caring professionals to help uninsured and under-insured get the care and follow-up they needed to survive. Freeman believed no one with cancer should spend more time fighting their way through the system than fighting the disease.
Bessette recalled working with patients diagnosed with cancer who faced additional challenges like drug addiction, poverty and physical disabilities. "These were people who struggled to get through a normal day, much less having to stay on track with medications, insurance and appointments," she explained. " But thanks to navigational assistance, even patients facing numerous obstacles were completing treatment."
By 2006 Bessette was sharing her knowledge about navigation with the Kansas Department of Health & Environment and developing nurse navigation tools for the Kansas Cancer Partnership. Interest in the concept began picking up steam across the state as word of improved outcomes spread in the health care community.
Less than two years after Bessette began providing navigation in Topeka, Dorothy Austin, RN, OCN, was hired as a nurse navigator by Douglas Girod, M.D., then the chair of otolaryngology at The University of Kansas Hospital.
Girod, who is now Executive Vice Chancellor at KU Medical Center, says he knew this was an area where nurses would excel.
"Oncology nurses in particular understand how challenging the journey can be," Girod says. "I think navigators have filled a critical gap as the liaisons between doctors, patients and their families."
Austin recalls that, although she was serving as a navigator, at first she was called a clinic nurse coordinator because the term navigator was not widely known. "Regardless of what we called it,' says Austin, 'it was clear that the navigational assistance was decreasing wait times and increasing patient satisfaction."
Results like these helped ensure passage of the Patient Navigator Outreach & Chronic Disease Act, signed by President George W. Bush in 2005 to help fund implementation of patient navigation programs in cancer treatment centers. Successful outcomes also spurred the National Cancer Institute to establish patient navigator research programs in nine centers across the country that same year.
By the time the Midwest Cancer Alliance (MCA) was formed at KU Medical Center in 2008 to help extend research and trials into rural Kansas, health professionals in the region had a clear idea of how critical the navigation role was in improving treatment and outcomes.
"One of the first positions we filled was for a nurse navigator, because we knew how crucial it would be in helping to improve access to the latest care and treatment across the state," says Hope Krebill, the executive director of the MCA.
Carol Bush, RN, had experience as an infusion nurse and had been a complex cancer and transplant case manager when she was hired by the MCA as a nurse navigator through an endowment provided by the Kansas Masonic Foundation. Bush spent some time shadowing Bessette as she learned about her new role.
Five years in navigation have taught Bush that success as a navigator requires broad clinical experience, exceptional communication skills and the ability to collaborate and broker relationships. With guidance from Bessette and other navigators she has met across the country, Bush has helped build a network of navigators in rural Kansas, including Heather Wright-Renick, BSN, at St. Catherine Hospital in Garden City. A nurse for 15 years, Wright-Renick is a recent graduate from the KU School of Nursing and a breast cancer survivor - which helps her bring a unique perspective to the care she provides.
"I don't mind sharing my own cancer experience with patients," says Wright-Renick." In fact, it helps some patients feel a connection to me."
Lynn Marshall, RN, the patient navigator at Salina Regional Health Center's Tammy Walker Cancer Center, points out that navigators not only have to connect with patients, they also serve as a bridge to services and resources. As a navigator, she was able to help set up a second opinion consultation for Stephen Pearce of Wells, Kan., a melanoma patient who needed a treatment that was not available in Salina. Pearce was able to see Gary Doolittle, M.D., at The University of Kansas Cancer Center for a second opinion and be admitted for treatment in a matter of days - a process that could have taken weeks without navigation and interactive televideo services.
"Lynn was instrumental in guiding us through my husband's treatment plan," says Polly Pearce, Stephen's wife. "She helped us with everything from his second opinion appointment to recommendations on hotels and maps and directions at KU Cancer Center. Lynn has also been available for questions now that my husband is back home and getting his follow-up care in Salina."
The University of Kansas Cancer Center has jumped on the nurse navigator bandwagon in a big way.
"We've gone from one navigator to nearly a dozen in less than three years," says Teri Banman, RN, BSN, OCN, who heads up the navigator program at the KU Cancer Center. "I wouldn't be surprised to see our team expand further, as the cancer center treats increasing numbers of patients."
One of the new navigators at the KU Cancer Center is Jennifer Gray, RN, who is currently a graduate student at the KU School of Nursing.
"As a navigator," explains Gray, "I put many of the things I've learned both on the job and in school to use every day."
Nurse navigation programs have advanced so far that some nurses are going into navigation specialties. For example, the KU Cancer Center has a nurse navigator whose primary focus is palliative care. The navigator helps patients who are dying or who have long-term illnesses address quality-of-life issues, discusses best avenues for a treatment track and helps with advance care planning and end of life care.
Several studies have shown that navigation services increase participation in cancer screenings and commitment to follow-up care. Data from a five-year study sponsored by the National Cancer Institute and involving thousands of patients is currently being analyzed to determine the benefits of patient navigation to groups including racial and ethnic minorities, who often don't get early screening and face multiple barriers to timely and effective care.
In the meantime, patient satisfaction provides some of the strongest evidence of how valuable navigators have become in Kansas. Steven Pearce's wife, Polly, sums it up best.
"Dealing with cancer is never easy. But having someone on your side certainly makes it more bearable."