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Why Nurse Navigators Are Vital for Patients Living with Breast Cancer

October 2021 Vol 7 No 5
Fazila Seker, PhD
President and CEO, MOLLI Surgical
Toronto, Ontario, Canada

Advances in medical treatment and early detection have vastly improved survival rates for women with breast cancer, but more work remains. For example, we know that mental, emotional, and physical support can help people living with cancer in managing their symptoms and navigating their treatment.

Navigating the complexity of the healthcare system can be very challenging. Studies suggest that seeing a long list of medical professionals, doctors, and surgeons can lead to fragmented care and reduce the quality of care.1

With multidisciplinary care teams in a modern hospital, a patient seldom gets to know each provider as they might know their family doctor. And although a written plan of care is one solution to this fragmentation, it is not always available. This means that healthcare providers may not be aware of the patient’s personal factors, such as personal preferences, beliefs, or occupation—all of which can affect how a patient may wish to proceed with treatment.

One solution for this has been the creation of the nurse navigator—these are nurses who are assigned to the patient to provide consistent care from screening and diagnosis through to treatment and follow-up. The concept of nurse and patient navigation is not new and dates back to 1990 with Harold Freeman, MD, and his colleagues in New York’s Harlem Hospital.

Nurse Navigators

By understanding the complexities of the healthcare system and the nuances of the patient’s journey, a nurse navigator is able to consider each stage of treatment through the patient’s personal priorities.

Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG

Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG, University Distinguished Services Professor of Breast Cancer and Professor of Surgery at Johns Hopkins University School of Medicine, Editor-in-Chief of CONQUER magazine, Co-Founder of the Academy of Oncology Nurse & Patient Navigators, and as a 2-time breast cancer survivor, offers a unique perspective on the role of nurse navigators.

At a recent web series on breast cancer, Ms. Shockney said:

“Nurse navigators are responsible for patient education, psychosocial support, identification of barriers to care and treatment.” Nurse navigators, she explained, can help patients by:

  1. Ensuring that the patient’s priorities are being respected
  2. Helping to eliminate any barriers so the patient can receive the best treatment
  3. Helping patients to get accurate and timely information they need.

Accurate, Timely Information

When facing a breast cancer diagnosis, patients are inundated with information, which is exacerbated by having to see many healthcare professionals. Without knowing the details of planned procedures and potential treatment side effects, a patient may not be able to appreciate the potential risks and may be unaware of newer, more patient-centered care options.

Understanding the new and improved techniques that are available today, and the differences between them, can offer patients important choices. One example involves wire-free localization of a breast tumor that is used during a lumpectomy.2 It involves implanting a tiny, safe marker to help surgeons remove the tumor with pinpoint accuracy (for more information see http://mollisurgical.com). The alternative involves guide-wires requiring women to sit for hours with long metal pieces protruding from their breasts.

Comparing treatment options and understanding the risks and benefits of each option can help a patient to select the best treatment option.

A nurse navigator can discuss the different treatment alternatives with patients, help them weigh their options, and make better-informed decisions that take into account their personal circumstances and preferences.

Emotional Well-Being

Despite the support of friends and family members, a breast cancer diagnosis can lead patients down a difficult and lonely road, by feeling misunderstood or worrying about being treated in a different way because of their diagnosis. Emotional support can be confused with maintaining positivity and optimism rather than open acceptance of the full gamut of thoughts and feelings the patient experiences.

In addition to guiding treatment, a nurse navigator can also support the patient at times of having positive and negative emotions, while fostering an environment of emotional acceptance. Understanding a patient’s history of emotional well-being is also important in developing treatment follow-up and long-term planning.

Communication

When weighing the option of a lumpectomy versus a mastectomy, for example, a surgeon will consider the risks and benefits of each procedure, but would that decision be altered if the patient is averse to the necessary radiation therapy after a lumpectomy?

If a patient is concerned about self-image but has extreme anxiety about additional surgery, should she have reconstruction after a mastectomy? And, despite impressions they may have to the contrary, are patients aware that the cancer recurrence rates for mastectomy and lumpectomy are nearly the same?3

“A nurse navigator can advocate for a patient and provide ongoing feedback to the oncologist and other members of the care team,” says Ms. Shockney. “Without a path for clear communication, a patient may be unaware, uncomfortable, or unable to articulate these preferences, leading to the possibility of missed appointments, or even negative feelings of dissatisfaction and regret with surgical outcomes.”

Total Patient Care

The patient’s psychosocial needs and concerns are every bit as important as medical treatment throughout the process and in follow-up interventions.

By spending time with the patient to develop a relationship based on trust, a nurse navigator has better access to the information and the recommendations the patient should receive, based on how different treatment options can affect the patient, as well as the patient’s well-being, family, and overall situation. Familiarity and continuity of care, even after treatment is over, are critical for the long-term outlook for the patient.

Breast cancer treatment is far from simple, and is not independent of outside influences or circumstances. As the treatment options continue to evolve with the advances in medicine and the development of more patient-centered approaches, nurse navigators are necessary for guiding patients toward better outcomes and improved quality of life.

To improve the mental and physical well-being of patients based on their individual circumstances, institutions need to expand the role of nurse navigators. And, although nurse navigators are sometimes being eliminated to save money, studies show that nurse navigators save more than they cost.4,5 Ms. Shockney believes that the healthcare system must recognize the value of nurse navigators and empower others to pursue this specialization.

“When a healthcare system has to find efficiencies, and they sometimes do, the first position that gets cut is often the nurse navigator. The data show that’s exactly wrong,” she said. “We have an obligation to get nurse navigation enshrined in the curriculum, and teach it as a stand-alone nursing profession,” she emphasized.

All patients should ask to talk to a nurse navigator during their cancer treatment, to make sure that they receive the best care available to them.

References

  1. Spinks T, Albright HW, Feeley TW, et al. Ensuring quality cancer care: a follow-up review of the Institute of Medicine’s 10 recommendations for improving the quality of cancer care in America. Cancer. 2012;118(10):2571-2582.
  2. Law W, Cao X, Wright FC, et al. Adequacy of invasive and in situ breast carcinoma margins in radioactive seed and wire-guided localization lumpectomies. The Breast Journal. 2021;27(2):134-140.
  3. Johns Hopkins Medicine. Mastectomy versus lumpectomy: 3 questions to ask your doctor. www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/mastectomy-versus-lumpectomy-3-questions-to-ask-your-doctor.
  4. Phillips JLH, Rondon AJ, Vannello C, et al. A nurse navigator program is effective in reducing episode-of-care costs following primary hip and knee arthroplasty. The Journal of Arthroplasty. 2019;34(8):1557-1562.
  5. Rocque GB, Pisu M, Jackson BE, et al; for the Patient Care Connect Group. Resource use and Medicare costs during lay navigation for geriatric patients with cancer. JAMA Oncology. 2017;3(6):817-825.

Key Points

  • Navigating the complexity of the healthcare system can be very challenging
  • Therefore, nurse navigators are assigned to the patient to provide consistent care from screening and diagnosis through to treatment and follow-up
  • A nurse navigator can discuss the different treatment options with patients and help them make better-informed decisions that take into account their preferences
  • Breast cancer treatment is not simple; as the treatment options continue to evolve, nurse navigators are needed to guide patients toward improved outcomes and quality of life

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