Abstract PS9-17: Nurse navigation in the ambulatory oncology clinic: Patient-centered findings from a survey of 50 breast cancer patients
Authors: Wang Tianyi , Huilgol Yash , James Jennifer , Belkora Jeff , Black Janet , D'Andrea Carrie , Esserman Laura 
Published: February 2021

Introduction A nurse navigator is a registered nurse who serves as a patient advocate, educator, and coordinator for newly referred cancer patients. Nurse navigators assist with the coordination of care before a patient’s first appointment with their provider. In some healthcare centers, they are also the point-person throughout a patient’s entire treatment process. The nurse navigator role is designed to promote cancer patient empowerment through advocacy, educational support, resource navigation, and psychosocial care. Our study attempted to assess the impact of a newly implemented nurse navigator program, in an academic setting, and measure the effect on patient knowledge, care coordination, and emotional well-being before their breast oncology appointment.

Methods A mixed-methods approach was implemented. We provided an Institutional Review Board-approved 9-question survey created from items adapted from Patient Satisfaction with Interpersonal Relationship with Navigators (PSN-I) to UCSF Breast Care Center patients before their first appointments with a breast oncology provider. After survey completion, patients were asked to participate in an open-ended interview about their patient experience with a member of the study team.

Results 50 patients were surveyed. 22 (44%) patients surveyed had nurse contact and 28 (56%) did not have prior nurse contact before their appointment. With regards to patient knowledge prior to the oncology appointment, 16 out of 22 (73%) of patients with nurse contact felt informed compared to 16 out of 28 (57%) of patients without nurse contact. With regards to having initial questions answered before their visit, 11 out of 22 (50%) of patients with nurse contact strongly agreed compared to 4 out of 28 (14.3%) of patients without nurse contact. In response to the statement, “my care is coordinated effectively in the Breast Care Center,” 15 out of 22 (68%) of patients with nurse contact strongly agreed compared to 12 out of 28 (43%) of patients without nurse contact.

Patients with nurse contact were asked whether speaking with a nurse did 1) improve their patient experience and 2) better deal with stressful emotions. Among 22 patients with nurse contact, 16 (73%) of patients with nurse contact strongly agreed to statement 1, and 20 (91%) agreed with statement 2. Patients without nurse contact were asked to predict whether nurse contact would 1) improve their patient experience and 2) better deal with stressful emotions. Out of 28 patients, 14 (50%) strongly agreed to both statements.

From our open-ended interviews, we found the following themes: appreciation for preliminary knowledge, identification of knowledge gaps, appointment scheduling, and insurance coverage barriers, and humanistic care from nurse navigators. Patients reported that they appreciate not only a nurse navigator’s facilitation in coordination and education but also their companionship during their cancer journey.

Conclusions Nurse navigators can play a vital role in improving patient knowledge, workflow/care coordination, and emotional well-being at cancer centers. A greater proportion of patients with initial nurse contact felt informed before their appointment and believed their care was effectively coordinated than those without nurse contact. The majority of patients with nurse contact believed their nurses improved their patient experience and relieved anxiety and stress. Based on this study, we will fully implement initial contact with patients to provide information and coordinate services for in-person visits. Given the changes brought by COVID, that first contact could also be with a nurse or physician via video consult prior to an in-person appointment. Future studies should investigate the impact of a longitudinal nurse navigator in providing continuity of care beyond the first referral.

Citation Format: Tianyi Wang, Yash Huilgol, Jennifer James, Jeff Belkora, Janet Black, Carrie D'Andrea, Laura Esserman. Nurse navigation in the ambulatory oncology clinic: Patient-centered findings from a survey of 50 breast cancer patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-17.