• Cancer, a terrifying and life-altering disease, is a major concern in today’s health care field.

    In 2012, it was reported that there were approximately 186, 400 new cases of cancer and 75, 700 cancer deaths in Canada.1

    Cancer is a process- a chain of events that begin at the molecular level in the human body and persist through a journey that the patients and healthcare providers must take to deal with the personal and medical effects of this disease. The diagnostic phase of cancer care, from suspicion to diagnosis, is a time characterized by countless number of tests and treatments, high levels of uncertainty, and patient anxiety.2

    The lengthy waits create anxiety among patients, may delay treatment and increase the possibility of disease progression, which in turn leads to poor patient outcomes. Navigating through the healthcare system and knowing what services are accessible can be very challenging during a restless time when patients are making major life decisions. Both patients and healthcare providers find it rather complex to access any information they may need during this period. In fact, primary healthcare providers often need assistance to coordinate the care and support their patients through the diagnostic process.3

    What is the solution to this complex need?

    file000192352681Nurse navigation is a solution and an approach to attending to informational and psychosocial needs of the cancer patients to facilitate and advance the diagnostic processes. It is a proactive process where oncology nurse navigators (ONN) collaborate with a patient and his/her family to provide support as they go through the maze of treatments, services and potential barriers throughout the cancer journey. The roles of the nurse navigators include (but not limited to): reducing barriers to timely access of diagnostic services; initiating and maintaining an ongoing relationship with patient during the diagnostic phase; enhancing the patient’s sense of self-care and self-determination through education and support; facilitating problem solving and decision making; helping the patients understand their diagnosis and available treatment options; discussing symptom management due to treatment and recovery; and conducting comprehensive supportive care needs.

    Why is the concept of nurse navigation important?

    As the world evolves, science evolves simultaneously. What does this mean?

    As the number of reported cancer cases increasing each year, we are faced with much uncertainty- as a patient, as a caregiver, as a family member. We are dedicated to find the answer to the most important question we have ever been asked, “How do you cure cancer?” Although this is a complex process, and dedicated researchers and scientists all over the world have been trying to answer this question for many years, uncertainty still exists. So we must focus on the branch questions; “How can I cope with my disease?”; “What are the steps to self-management to chronic illness?”; “How can I help my husband manage his symptoms?”; “Where can I go to get supportive services?” Even though we have not found a cure for cancer yet, we can certainly take active measures to prolong the quality of life, manage the symptoms, decrease the anxiety, and ease the pain of an individual living with cancer.

    The implementation of a nurse navigator program greatly increases efficacy within the diagnostic phase of cancer care. This efficacy can be seen through the studies showing improvement in screening rates, co-ordination of care, adherence to diagnostic services, and initiation of treatment after the introduction of nurse navigators. There have also been confirmations that nurse navigators improve the patient experience by providing information where needed and reducing anxiety and stress levels. In addition, nurse navigation is designed to reduce health disparities by addressing specific barriers to obtaining timely, quality healthcare. However, there is limited published evidence that showed the impact nurse navigators have during the diagnostic phase of cancer care.

    Future Research

    Although nurse navigation is recognized by many provinces as a key element of an integrated system of cancer care, it has been reported that nurse navigation is not yet delivered in a uniform way across Canada, and is rather limited to certain types of cancer such as breast and colorectal cancer. However, the reasons behind these issues were not considered or studied. More studies should be conducted to determine how the nurse navigator program impacts other types of cancer care such as lung (thoracic) which is considered the leading cause of mortality in cancer. Furthermore, there is a need for further testing of various program designs on access to care and patient outcomes which focuses on geography, scarcity of qualified human resources, and the lack of appropriate gender and culture-specific programs.

     

    References:

    1. Canadian Cancer Society. (2012). Lung cancer statistics at a glance. Retrieved from http://www.cancer.ca/Canada-wide/About%20cancer/Cancer%20statistics.aspx?sc_lang=en
    2. Psooy, B.J., Schreuer, D., Borgaonkarm, J., & Caines, J.S. (2004). Patient navigation: improving timeliness in the diagnosis of breast abnormalities. Canadian Association of Radiologists Journal 55, 145–150.
    3. Cancer Care Ontario. (2009). Organized Diagnostic Assessment Demonstration Projects: Summary Report. Toronto, Canada.

     

    About the Author: Gaya Jeyathevan, BHSc, MHSc (candidate) is currently completing a Master’s degree in Health Sciences at the University of Ontario Institute of Technology, focusing on program evaluation and oncology care.



    1. karen millen (Reply) on Wednesday 6, 2013

      Thanks for another wonderful post. I have a presentation subsequent week, and I’m on the search for such information.