Today, oncology navigation, and specifically oncology nurse navigation, is recognized as a vital component of the multidisciplinary oncology team. Cancer care is fragmented, and now, more than ever, patients face external barriers across the cancer care continuum that minimize access and adherence. Oncology nurse navigators help to identify those barriers, including health disparities and socioeconomic barriers (SOS), and solutions to minimize them.
What Is Oncology Navigation?
Oncology navigation is not a new concept. The first program, created and implemented by Dr. Harold P. Freeman in 1990, served to minimize healthcare disparities in Harlem, New York. This particular model was developed using patient navigators, or non-nursing individuals, more closely identifiable with the community population. The patient navigation model remains a viable one in use throughout the United States and other areas of the world; however, scope of practice can be limiting because patient navigators usually hold no clinical licensure. Since 1990, navigation programs have grown exponentially, and a vast body of research shows its positive impact on patient care, including increases in adherence and patient satisfaction, as well as decreases in emergency department visits and readmissions.
The navigation model has expanded to include nurses and other healthcare professionals, and clear oncology navigation standards of professional practice were recently created and published through a collaboration of national organizations such as the Academy of Oncology Nurse & Patient Navigators (AONN+), Oncology Nursing Society (ONS), Cancer Support Community (CSC), and members of the Biden Cancer Moonshot initiative. This group, collectively referred to as the Professional Oncology Navigation Taskforce, created these competencies to:
“Provide professional oncology clinical navigators and patient navigators with clear information regarding the standards of professional practice. This includes the knowledge and skills all professional navigators should possess to deliver high-quality, competent, and ethical services to people impacted by cancer. These standards also provide benchmarks for use by healthcare employers and information for policy and decision makers, as well as other health professionals and the public to understand the role of professional oncology navigators.”
What Is the Role of the Oncology Nurse Navigator?
The answer to this is complex because the role adapts to meet the needs of each individual patient, but at its core, oncology navigation serves 2 main purposes:
- Minimize patient barriers to care
- Assist in the coordination of and adherence to an oncology screening and/or treatment plan
Organizations such as the AONN+ serve as national leaders in oncology navigation, and the AONN+ Foundation for Learning offers oncology nurse navigation professional certification that is recognized by and can be used for both the American College of Surgeons Commission on Cancer (CoC) and the American Nurses Credentialing Center Magnet Recognition Program®.
How Do Oncology Nurse Navigators Improve Health Equity?
Oncology nurse navigators have a crucial role in identifying at-risk populations, developing strategies to reduce barriers, and working directly with patients and resources to minimize those barriers. There are multiple patient groups/populations at significant risk for healthcare disparities, including but not limited to:
- Racial and ethnic minorities
- LGBTQIA+ patients
- Geriatric patients
- Patients in geographically challenging areas such as rural/remote areas, reservations, and inner cities
- Low-income individuals
- Individuals with minimal or no insurance
- Low literacy or low health literacy populations
- Substance-dependent individuals
- Individuals within the penal system
- Individuals with significant mental or physical health challenges
By collaborating with other members of the multidisciplinary care team—physicians, nurses, social workers, palliative care, hospice care, financial services, genetics, etc.—oncology nurse navigators can provide a uniquely specialized practice that provides outreach, coordination, and education at a much deeper level than most practitioners have the time to provide. The oncology navigator does not replace the clinic nurse but instead provides an avenue for greater communication between the patient and the multidisciplinary team. The navigator, by spending time speaking with the patient and caregiver(s), understanding family dynamics and patient wishes, and completing a significant number of follow-ups regarding treatment planning, side effects, and psychosocial concerns, becomes a key differentiator for both practitioners and patients.