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TRANSCRIPT
Ruth E. Doerfler-Evans RN, BA, OCNInterventional Pulmonology Nurse Navigator
MedStar Franklin Square Medical CenterBaltimore, Maryland
At the end of this presentation the audience will be able to:
State the types of Patient Navigation State the clinical roles Nurse Navigators play State the rapid access pathway used in
navigating patients with suspected lung cancer
Accounts for over 200,000 annual deaths Leading cause of cancer death in men and
women combined Critical role for a Nurse Navigator
1990’s Dr. Harold Freeman and Harlem Hospital
2001 NCI report 2005 Patient Navigator Outreach and Chronic
disease Act 2012 ACS Commission on Cancer
Lay Navigators Access Navigators Disease/Solid Organ Nurse Navigators
Clinical Expertise in Oncology Nursing Patient Resource Active Listening Skills Ability to Multi-function
Internal ForcesThoracic Tumor Board
Interdisciplinary RelationshipsSocial Work
Patient Education
External ForcesOncology Nursing Standards of
Nursing (ONS)Community ResourcesHospice ServicesPalliative Care
Survivorship
Staging
Interventional Pulmonology Services
Survivorship
Multidisciplinary Team Care Delivery
Primary Care Physician
2014 study 11 month period with 110 patient sample
size Study methods Results
• Lung cancer accounts for over 160,000 deaths annually and is the leading cause of cancer death in men and women. A 52 % 5 year survival rate is realized when localized disease is discovered but only 15% of lung cancer is detected at this early stage (American Cancer Society, 2012).
• Prompt initiation of cancer treatment depends on the diagnostic confirmation of a lung cancer tissue type and staging. Unlike the standard set for patients with breast cancer that recommends a 5-day breast lump discovery to treatment timeline studies remain unclear as to whether timeliness of care in non-small cell lung cancer (NSCLC) improves patient outcomes (Olsson, Schultz, Gould, Sept 2009).
• Nurse Navigators play a critical role in cancer screening and coordination of patient services. Literature is replete with studies demonstrating the value of their role. However, care coordination guidelines are lacking for nurse navigators to measure their efficiency in providing timely care for newly diagnosed patients with lung cancer.
Ruth E. Doerfler Evans RN, BA, CNOR, OCN
The objectives of this quality improvement project were twofold:
• To ascertain whether a “Gold Standard” exists for rapid access throughput for patients (from discovery to diagnosis and handoff for treatment) exhibiting an abnormal chest CT scan and suspicious finding.
• To evaluate the efficiency of nurse navigator led throughput process for interventional pulmonary patients requiring evaluation and diagnosis for a suspicious lung nodule or lung mass.
Objectives
Methods
• Multiple databases including PubMed, OVID, Cochran, CINAHL, and Google Scholar were searched to identify if a recommended timeline existed for lung cancer diagnosis and treatment.
• MeSH terms included: Delivery of Care/Standards, Lung Neoplasms/Therapy/Mortality, Early detection of Cancer/Methods, Carcinoma/Non-small cell lung/Mortality/Therapy, Advanced Practice Nursing, Quality Assurance/Healthcare/Methods, Referral and Consultations/Standards, Primary Health Care/Standards, Delayed Diagnosis/Statistics and Numerical Data, Practice Guidelines as Topic/ Standards, Adenocarcinoma/Diagnosis/Surgery, Critical Pathways/Organizations and Administration, and Health Services Accessibility.
• Thirty studies met the inclusion criteria and were reviewed. No evidence was found supporting consistent, standardized throughput guidelines from symptom onset to treatment for patients with lung cancer. Rather the studies focused on unacceptable delays along this trajectory.
• Based on lack of research evidence, we conducted a quality improvement project in real time to identify our organization’s current practice.
• Data were collected in real time on 10 randomly selected patients per month during an 11-month period. A total of 110 patient records were reviewed.
• The following data points were recorded by the Nurse Navigatori. Date of referral/notification to the Nurse Navigatorii. Date of surgical intervention bronchoscopyiii. Date the pathology results were shared with the patientiv. Date the patient handoff occurred to the next discipline/provider for treatment
Results demonstrated:• Mean of 5 days for patients to undergo bronchoscopy after accessing the Nurse Navigator• Patient notification of their results within 3 days of their procedure date• Total throughput from initial access to handoff to treatment discipline was a mean of 8 days
Results and Findings
Internal Forces• Thoracic Tumor
Board• Interdisciplinary
Relationships• Social Work• Patient Education
External Forces• Oncology Nursing • Standards of Nursing (ONS)
Community Resources• Hospice Services• Palliative Care
Survivorship
Staging
Interventional Pulmonology ServicesMultidisciplinary Team Care Delivery
Primary Care Physician
Conclusions• Although no national guideline or “Gold Standard”
exists addressing timely throughput for cancer patients, our program’s results were consistent with those identified in the literature for patients with breast cancer.
• Oncology Nurse Navigators strive to decrease barriers to access and provide customized care delivery for lung cancer patients. This quality improvement project illustrates a model and method Nurse Navigators can use to measure their efficiency in providing timely care coordination for the newly diagnosed patient with lung cancer.
References
Recommendations
As a health care concierge, Nurse Navigators enable a rapid access throughput process from initial detection to diagnosis and treatment. In this role they can be instrumental in quantifying timely care to develop future benchmarks.
Cancer Facts and Figures 2012. (2012) American Cancer Society, 15-16.
Case, M., (2011, Feb.) Oncology Nurse Navigator: Ensuring Safe Passage. Clinical Journal of Oncology Nursing, 15, 33-40.
Horner, E., Ludman, E., McCorkle, R., Canfield, E., Flaherty, L., Min, J., Miyoshi, J., Lapham, B., Bowles, E., Wagner, E. (2013, Feb). An Oncology Nurse Navigator Program designed to Eliminate Gaps in Early Cancer Care. Clinical Journal of Oncology Nursing, 17 (1), 43-48.
Hunnibell, L., Slatore, C., Ballard, E. (2013, Oct). Foundations for Lung Nodule Management for Nurse Navigators. Clinical Journal of Oncology Nursing, 17 (5), 29-36.
Olsson, JK., Schultz, EM., Gould, MK. (2009, Sept). Timeliness of Care in Patients with Lung Cancer; A Systematic Review. Thorax, 64 (9), 749-56.
Contact Information
Navigating Lung Cancer Patients Toward a TimelyDiagnosis: A Quality Improvement Study
Ruth E. Doerfler Evans RN, BA, CNOR, OCNJoan I. Warren, PhD, RN-BC, NEA-BC
Introduction and Background
Nurse Navigator Professional Practice Model
Navigating Lung Cancer Patients Toward A Timely Diagnosis: A Quality Improvement Study
Smoking Cessation Patient/Family Education Lung Nodule Screening Program Database Collection
Plays a central role in patient rapid access pathway
Pivotal role in delivery of quality patient care Provides holistic care Oncology certified RN well positioned for role