Nurse navigation in the ambulatoryoncology clinic: Patient-centered findings from a survey of50 breast cancer patients

Introduction A nurse navigator is a registered nurse who serves as a patient advocate, educator, and coordinatorfor newly referred cancer patients Nurse navigators assist with the coordination of care before a patient's firstappointment with their provider In some healthcare centers, they are also the point-person throughout a patient'sentire treatment process The nurse navigator role is designed to promote cancer patient empowerment throughadvocacy, educational support, resource navigation, and psychosocial care Our study attempted to assess theimpact of a newly implemented nurse navigator program, in an academic setting, and measure the effect on patientknowledge, 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 withNavigators (PSN-I) to UCSF Breast Care Center patients before their first appointments with a breast oncologyprovider After survey completion, patients were asked to participate in an open-ended interview about their patientexperience 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 priornurse 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 ans wered before their visit, 11 out of 22 (50%) of patients with nursecontact strongly agreed compared to 4 out of 28 (14 3%) of patients without nurse contact In response to thestatement, “my care is coordinated effectively in the Breast Care Center,” 15 out of 22 (68%) of patients with nursecontact 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 and2) better deal with stressful emotions Among 22 patients with nurse contact, 16 (73%) of patients with nurse contactstrongly agreed to statement 1, and 20 (91%) agreed with statement 2 Patients without nurse contact were asked topredict 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 carefrom nurse navigators Patients reported that they appreciate not only a nurse navigator's facilitation in coordinationand education but also their companionship during their cancer journey Conclusions Nurse navigators can play a vital role in improving patient knowledge, workflow/care coordination, andemotional well-being at cancer centers A greater proportion of patients with initial nurse contact felt informed beforetheir 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 andstress Based on this study, we will fully implement initial contact with patients to provide information and coordinateservices for in-person visits Given the changes brought by COVID, that first contact could also be with a nurse orphysician via video consult prior to an in-person appointment Future studies should investigate the impact of alongitudinal nurse navigator in providing continuity of care beyond the first referral