Tricia Strusowski, MS, RN Director, Cancer Care Management Helen F. Graham Cancer Center Christiana Care Health System Sharon Gentry, RN, MSN, AOCN, CBCN Breast Health Navigator Derrick L. Davis Forsyth Regional Cancer Center

1. Best Practices:Needs Assessment ProcessData/Metric Tracking Tricia Strusowski, MS, RN Director, Cancer Care Management Helen F. Graham Cancer Center Christiana Care Health System

2. Needs Assessment Process Objective To assess the needs of your navigation program To assess the needs of the patients and the families in your navigation program To assess and create navigator job responsibilities

15. Needs Assessment Process Anyone want to share their intake processes? Barriers? Challenges?

16. Data/Metric Reporting Objectives To review the documentation of support services provided by the navigator To review performance improvement outcomes for a navigator program To document patient and physician satisfaction with a navigation program

23. Helen F. Graham Cancer CenterNurse Navigation/Support Service Satisfaction Survey Example questions The nurse navigator was friendly and helpful to me The nurse navigator answered all my questions in a manner I could easily understand The nurse navigator helped me to understand my course of treatment The nurse navigator informed me of services available through the Cancer Care Management (CCM) program

24. Helen F. Graham Cancer CenterNurse Navigation/Support ServiceSatisfaction Survey Were you seen by any of the following support services? ___Social Worker ___Dietitian ___Financial/Transportation Coordinator ___Health Psychology ___Wellness Team ___Survivorship Team ___Pain/Palliative Care Team Was friendly and helpful to me? Answered all my questions in a manner I could easily understand?

25. Helen F. Graham Cancer CenterNurse Navigation/Support Service Satisfaction Survey CCM has the resources and tools to provide the best care/services to my patients CCM is committed to continuous quality improvement The staff from CCM whom I interact with are competent in their role CCM demonstrates a concern for patient safety Communication by CCM with me regarding my patients is timely and clear

26. Data/Metric Tracking Anyone want to share their tracking or reporting programs? Concerns with reporting? Questions regarding reporting?

27. Patient Testimonials “Having my nurse navigator was critical to keeping my brain focused on healing and not on all the little worries that kept popping up.” “Whenever I had a question or concern I’d call and she would always get me an answer.”

28. Always remember that you make the journey for the patients and their families so much easier. YOU DA BEST!!

29. Best Practices:Survivorship Care Planning Sharon Gentry, RN, MSN, AOCN, CBCN Breast Health Navigator Derrick L. Davis Forsyth Regional Cancer Center

30. Survivorship Care Planning Definition Where does definition fit in care continuum?

31. Who Is a Survivor? The National Cancer Institute considers a person to be a survivor from the time of diagnosis until the end of life Includes others who are affected Family Friends Caregivers

32. US Population of Survivors Is Medically Diverse 15% 22% 4% 7% 7% 19% 8% 9% 8%

33. Patient Navigation Is Part of the Cancer Care Continuum Survivorship Transition Multiple Transitions Transition Patient Navigation

34. Sample Questions for Needs Assessment How do you define cancer survivorship? How do patients within your practice currently obtain survivorship services? What types of survivorship services do your patients currently utilize? What types of survivorship services would you like to provide within your clinical practice? If you need to refer a patient for survivorship services, what are some of the local resources you utilize?

35. Survivorship Care Planning Physical effects Psychosocial effects

36. Medical and Physical Effects of Cancer Treatment May Persist Neuropathy Osteoporosis Second primary tumors Lymphedema Chronic pain Menopausal symptoms Lung disease Cataracts Infertility Heart disease Kidney failure Endocrine issues (thyroid)

37. Significant Psychosocial Concerns May Persist Depression Heightened sense of vulnerability Fear of recurrence, death Adjustment to physical problems (eg, infertility) Sexual function/sexuality Parenting Alterations in social support Concerns about finances, employment, disability, insurance

38. Patient Navigation Supports Patients with Assessment, Education, and Coordination

39. Survivorship Care Planning American Society of Clinical Oncology National Comprehensive Cancer Network

40. Patient Navigation Can Help Survivors Receive the Care They Need Facilitate recommended surveillance for development of new cancers Risk 14% higher than in general population Risk highest in first 5 years after diagnosis Risk higher in females Survivors of childhood cancer at highest risk

41. Patient Navigation Can Help Survivors Receive the Care They Need Facilitate recommended surveillance for spread or recurrence of cancer Example – For all breast cancer survivors: Careful history and physical examination every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5, and yearly thereafter Example – For survivors who have undergone breast-conserving surgery: Posttreatment mammogram 1 year after the initial mammogram, at least 6 months after completion of radiation therapy, and yearly thereafter, unless otherwise indicated

42. Patient Navigation Can Help Survivors Receive the Care They Need Provide personalized support Help educate survivors about health needs and concerns Ensure adherence to treatment and follow-up activities Connect survivors with appropriate resources Track delivery of care and payment for services

43. Initiate the Program Take stepwise approach Begin with services/programs likely to demonstrate success Perform Outreach Utilize referral pathways and report back to those referring Collect data on all outcomes variables Patients served, referrals Services utilized Cost Involved providers

44. Community Outreach DC City-wide Patient Navigation Research Program University of Medicine and Dentistry of New Jersey