On December 13th the NNRT submitted feedback to the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) regarding a potential new model for value-based payment to support high-quality oncology care. The NNRT supports the continued inclusion of patient navigation services as a requirement in the model, while encouraging CMS to strengthen the requirement and its implementation – while still maintaining flexibility for the participating oncology practices. Full details can be found in the letter submission.
We would like to thank the NNRT Policy Task Group and the NNRT member organizations who provided review and input to the letter. Thank you to the Academy of Oncology Nurse & Patient Navigators (AONN+), American Cancer Society & American Cancer Society Cancer Action Network, Cancer Support Community, GW Cancer Institute and National Patient Advocate Foundation.
The National Navigation Roundtable (NNRT) sat down with Oncology Nurse Navigator (ONN), Darcy Burbage, MSN, RN, AOCN, CBCN to learn more about her experiences in the field. Darcy is an ONN at the Helen F Graham Cancer Center & Research Institute and an active member of the Oncology Nursing Society (ONS). Read on to learn more about her experiences.
Tell us more about your role. What is an ONN?
I was the first nurse navigator hired at my Cancer Center in 1999 to coincide with the opening of our Breast Center. The interview process was lengthy and at the time, I didn’t have a formal job description. I was simply told to “fix it.” The “it” being reducing the length of time between biopsy recommendation to biopsy and to improve patient satisfaction throughout the breast cancer continuum.
The impetus for this role was that patients expressed a need for a single point of contact that knew them and could provide education specific to their recommended treatment plan as well as provide psychosocial support throughout the continuum of care.
To paraphrase the 2017 ONS ONN Core Competencies “… An ONN is a professional RN with oncology-specific, clinical knowledge who offers individualized assistance to patients, families and caregivers to help overcome healthcare system barriers using the nursing process as well as provides education and resources to facilitate informed decision making throughout the cancer continuum…”
Why is it helpful to have an ONN?
It is essential for patients with cancer or an increased risk of cancer to have an oncology nurse navigator. In addition to the benefits to patient care and improved patient satisfaction, there are also benefits to the healthcare system. Outcome measures such as helping to reduce emergency visits, preventable admissions and readmissions as well as decreased length of stay can be attributed to having an oncology nurse navigator.
What is the best part of your job?
Over the past twenty years as an ONN, I’ve had the privilege of getting to know and care for a large volume of patients. Some of whom still stay in contact with me and it is probably one of the best parts of my job. They call me with questions or concerns, to share good news about their “cancerversary”, negative test results or even celebrations like the birth of a child or a grandchild.
What about the most challenging part?
Sometimes the calls are heart-wrenching, especially when my previous patients share that their cancer has recurred or tell me about a new diagnosis of cancer in a family member. However, this is also part of the honor of being an oncology nurse – being present with and for the patient and their families as they go through the ups and downs of living with cancer.
One of the most challenging parts of my roles is helping patients who have long-term effects of their cancer treatment. Sometimes, it takes much longer to heal and recover from the physical and psychosocial effects of treatment and I wish that I could do more to help. Also, for my patients who are facing the end of life, it’s hard to see their families struggling with what is coming next.
Do you do any special things for your patients that are not necessarily part of your job description?
Yes, I once found out that a patient of mine had grown up near the same small town that my husband did. The town is famous for a certain cake and it was close to her birthday so I arranged for this cake to be delivered coinciding with an appointment so we could celebrate with her – to say she was ecstatic would be an understatement!
What is something most people don’t know about patient navigation?
One thing that most people don’t know about ONN is that it combines all of your skills and expertise in addition to your “nurses 6th sense”. Along with the unique relationships that you establish with your individual patients, you have the opportunity to improve the care of the population by leading quality improvement projects, educating the public and your peers through professional presentations and through publications. You have to be on your ‘A game’ every day, multitask, prioritize and re-prioritize constantly and there is always a patient to help or a colleague to mentor. The best-kept secret about ONN is that there are so many opportunities for professional growth and development.
History of Patient Navigation
Patient navigation has evolved tremendously in the past few decades. Take a look at some of the courses of events that have helped shaped the industry today.
1971 – Cancer Act Signed
Around this time, the second leading cause of death among Americans was cancer, which prompted President Richard Nixon’s “war on cancer” and resulted in legislation dedicating $1.6 billion of federal funds to help eradicate the disease.
1989 – Report to the Nation on Cancer and Feedback
After a series of conversations and hearings with low-income cancer patients, the American Cancer Society released a report finding many additional challenges contributing to the disparity among cancer survival rates.
1990 – First Patient Navigation Program launched by Dr. Harold Freeman
As a result of these findings and after receiving support from the American Cancer Society, Harold P. Freeman started the first patient navigation program at the Harlem Hospital Center.
1994 – Native American Cancer Research Corp (NACR) Native Sisters Program and Training launched
NACR has been conducting community-based participatory research, cancer screening and early detection for nearly 30 years. In the early 90s, they expanded to support patients across the cancer continuum through their Native Sisters Program and Training.
2005 – American Cancer Society launches Patient Navigator Program
The American Cancer society launched their first Patient Navigator Program in 2005 and today, they have over 60 sites across the country supporting cancer patients and their families through their diagnosis and treatment.
2007 – NCI Community Cancer Centers Program Established
What started off as a pilot program in 2007 serving minority populations with research, patient navigation and quality care has now grown to over 21 sites providing patient navigation across the country.
2007 – Harold P. Freeman Patient Navigation Institute launches
After pioneering the concept of patient navigation in the early 90s, Harold P. Freeman later went on to launch the Harold P. Freeman Patient Navigation Institute for the effective training of patient navigators.
2009 – Academy of Oncology Nurse & Patient Navigators (AONN) formed
Ten years ago, professionals across the cancer continuum came together to establish what has now become the largest national organization outlining, promoting and improving the roles of oncology nurses and patient navigators.
2010 – The Oncology Nursing Society (ONS), the Association of Oncology Social Work (AOSW), and the National Association of Social Workers (NASW) Release a Joint Position
Setting up the foundation for a more collaborated effort in cancer care, the ONS, AOSW and NASW worked together to release a joint position statement on the role of oncology, nursing and oncology social work in patient navigation.
2012 – Commission on Cancer releases Patient Navigation Process Accreditation Standard 3.1
The Patient Navigation Process Accreditation Standard served as an important first step in providing comprehensive cancer control professionals and cancer program administrators the right tools to close the health gap among cancer patients. This roadmap served as a guide to establish an effective patient navigation process.
2013 – ONS releases Oncology Nurse Navigator Core Competencies
After observing that oncology nurses also served as navigators working with other healthcare staff, the ONS released the Oncology Nurse Navigator Core Competencies to better define their roles and skills.
2015 – George Washington Cancer Institute Publishes Core Competencies for Oncology Patient Navigators
Featuring interactive web-based presentations and discussions, the George Washington Cancer Institute created the first consensus-based competencies for Oncology Patient Navigators.This training was supplemented by their Guide for Patient Navigators.
2016 – AONN launches Oncology Nurse Navigator and Oncology Patient Navigator Certification Exams
To ensure a standard of practice and care, the AONN established certification that created a baseline of knowledge, best practices and expertise for oncology nurse and patient navigators.
2017 – Launch of the National Navigation Roundtable (NNRT)
NNRT, a national coalition of over 50-member organizations and invited individuals, launched in 2017 with the goal of achieving health equity and improving access to quality care across the cancer continuum through effective patient navigation.
We recently celebrated our first-year accomplishments at our 2018 NNRT Annual Meeting. Watch and read the recap of the event here.