Research and Scholarship

Improving Cancer Care Delivery: Learnings for Oncology Nurses and Patient Navigation From a National Quality Survey

Jennifer Aversano,(1,2) MSN, RN, OCN®, BMTCN®, Leigh M. Boehmer,(3) PharmD, BCOP, and Alexander Spira,(4,5) MD, PhD, FACP

From (1)Oncocyte Corporation, Irvine, California; (2)Advocate Lutheran General Hospital, Park Ridge, Illinois; (3)Association of Community Cancer Centers, Rockville, Maryland; (4)US Oncology Research, The Woodlands, Texas; (5)Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland

Authors’ disclosures of conflicts of interest are found at the end of this article.

Correspondence to: Leigh M. Boehmer, PharmD, BCOP, Association of Community Cancer Centers, 1801 Research Boulevard, Rockville, MD 20850 E-mail: lboehmer@accc-cancer.org

ABSTRACT

Background: Although implementation of patient navigation programs in clinical practice is widespread, heterogeneity exists in the design and delivery of these services. Greater clarity is required on competencies of personnel, delineation of their roles in multidisciplinary cancer care teams, navigation service components that positively impact patient outcomes, and associated metrics. Methods: A national, double-blind, online survey was implemented between January 24, 2019, and April 25, 2019, to investigate care coordination for advanced (stage III/IV) non–small cell lung cancer (NSCLC). Respondents included multidisciplinary team (MDT) members, such as oncologists, pathologists, oncology nurses, advanced practice nurses, and patient navigators, from US cancer programs. Customized questions covered NSCLC screening, diagnosis, treatment, and care coordination, with a focus on oncology nurses, advanced practice nurses, and patient navigation. Descriptive statistics were computed. Subanalyses examined relationships between care delivery and outcomes such as shared decision-making (SDM) through statistical testing. Results: Across programs, there was a lack of patient (nurse or lay) navigators (22.3%, 101/452) to assist patients with NSCLC. Most respondents (90.1%, 100/111) worked in programs with no formal health literacy assessments. Significantly higher mean SDM scores (p < .05) were observed in programs with patient navigators compared with programs without these specialists. Conclusion: Patient navigation is pivotal to enhancing the patient experience along the lung cancer care continuum and should be strategically integrated within lung cancer MDTs. These findings, along with survey inputs from other MDT disciplines, can help support process improvement plans for patient-centered advanced NSCLC care delivery.

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