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Breast Cancer Navigation

Breast Cancer Navigation. Across the spectrum of the disease. System Director, Supportive Cancer Care OhioHealth. Mary E. Szczepanik, RN, BSN, MS. Disclosures. This speaker has no disclosures. Breast cancer navigation Across the spectrum of the disease.

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Breast Cancer Navigation

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  1. Breast Cancer Navigation Across the spectrum of the disease System Director, Supportive Cancer Care OhioHealth Mary E. Szczepanik, RN, BSN, MS

  2. Disclosures This speaker has no disclosures

  3. Breast cancer navigationAcross the spectrum of the disease • Process of navigation from detection to survivorship • Staffing model • Support structure

  4. Breast Cancer Navigation Process

  5. Breast Cancer NavigationAcross the spectrum of the disease

  6. Breast cancer navigationDetection to survivorship 2000 Program Goals: • Decrease days to detection • Reduce anxiety • Improve: Communication with PCP Patient satisfaction Retention

  7. Breast cancer navigation Detection to survivorship • Single point of contact • Experienced oncology nurses • Collaboration/commitment • Relationship building • Electronic medical record

  8. Breast cancer navigation Detection to survivorship Breast navigation roles • Diagnostic breast navigator • Treatment breast navigator Navigator • Education: BSN,OCN/CBCN • Experience: 3 to 5 years clinical oncology • Confidence/Credibility • Compassion

  9. Breast cancer navigation Detection to survivorship

  10. Breast cancer navigation Detection to survivorship

  11. Breast cancer navigation Detection to survivorship

  12. Breast cancer navigationDetection through survivorship • Lessons learned: • Offer to have family member join • Surgical consult is protocol for all patients before biopsy. • Anticoagulant status. • Call PCP every patient • Surgeon rotation list per campus. • Notify PCP, surgeon of appointment dates/times.

  13. Breast cancer navigation Detection to survivorship

  14. Breast cancer navigation

  15. Breast cancer navigationTreatment breast navigator Ongoing follow-up • Medical Oncology and Radiation Oncology • Assess understanding • Reinforce education • Review side effects and reportable symptoms • Assess psychosocial needs • Remove barriers to care • Establish follow-up schedule • Survivorship care plan

  16. Breast cancer navigationTreatment breast navigator

  17. Breast cancer navigationTreatment Summary/Survivorship Care Plans Provider • enters cancer diagnosis on problem list • enters pathology on problem list screen Navigator • populates form, attaches surveillance guidelines • reviews form with patient; provides copy • completes EPIC documentation • routes to PCP, treating cancer specialists

  18. Breast Cancer Navigation Staffing model

  19. Breast cancer navigationStaffing model • Create staffing model with metrics • Focus on treatment navigators • Calculate navigator time per patient • Firsts 30 - 45 days • Remaining 6 months • Survivorship Care Plans Translate calculations into new patients/navigator

  20. Breast Cancer NavigationStaffing model

  21. Breast cancer navigationStaffing model – documentation flowsheet

  22. Breast cancer navigationStaffing model calculations

  23. Breast cancer navigationStaffing model adjustments

  24. Breast cancer navigationCapacity

  25. Breast Cancer Navigation Support structure

  26. Breast cancer navigationSupport Structure – Social work navigationConcrete needs

  27. Breast cancer navigationSupport Structure – Social work navigationShort-term counseling

  28. Breast cancer navigationSupport Structure – distress screening

  29. Breast cancer navigationSupport structure – distress screening

  30. Breast cancer navigationSupport Structure – Multi-disciplinary second opinion clinic • Multi-specialty physicians • Weekly • Genetics Counselor • Breast Health Navigator • One appointment • No cost

  31. Breast cancer navigationSupport Structure – breast pre-treatment conference • Weekly • Every new case • All campuses • Combined: Riverside, Dublin Methodist, Grady • Multi-disciplinary • Genetics • Navigation • Research

  32. Breast cancer navigationContinuum of care: survivorship • Survivorship care plan • Survivorship clinics • Weight management for cancer survivors • Walk, Run, Fit Club • Lecture Series

  33. Breast Cancer Navigation Conclusion

  34. Breast cancer navigationBenefits

  35. Breast cancer navigation References • American College of Surgeons (2015). Cancer Program Standards 2012: Ensuring patient centered care; v. 1.2.1. American College of Surgeons Commission • Cantlie, C. Haylock, P. (2013). Patient navigation in the oncology setting. Seminars in Oncology Nursing, 29(2), 76-90. • National Comprehensive Cancer Network (2015). National Comprehensive Cancer Network Clinical Guidelines in Oncology. Distress management. Version 2.2015. Retrieved October 27, 2015 from http://www.nccn.org/professionals/physician_gls/pdf/distress.pdf. • Samuel M. Silver (2008). Institute of Medicine. Cancer Care for the Whole Patient—A New Institute of Medicine Report. Retrieved http://jop.ascopubs.org/content/4/3/131.full • Advisory Board-Building Successful Patient Navigation, Multidisciplinary Care and Survivorship Programs; George Washington University Center for Advancement of Cancer Survivorship, Navigation and Policy; and Fox Chase Cancer Center. • https://www.advisory.com/research/oncology-roundtable/tools/2016/cancer-support-services-volumes-staffing-and-operations-benchmark-generator# • www.jons-online.com/issue-archive 2017-issues/may-2017-vol-8-no5/value impact of navigation programs. • Wells, K. et.al. (2018). What are patient navigators doing, for whom, and where? A national survey evaluating the types of services provided by patient navigators. Patient Education and Counseling, 101(2), 285-294.

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