During the COVID-19 pandemic, more navigation support was associated with a higher likelihood of protocol adherence and timely treatment after quarantine in patients with cancer, according to a recent study.
Morgan Nestingen, PhD, APRN, AGCNS-BC, NEA-BC, OCN, ONN-CG, of Baptist Health Miami Cancer Institute, conducted the research and presented her findings during the Academy of Oncology Nurse & Patient Navigators 14th Annual Navigation & Survivorship Conference.
Dr. Nestingen conducted the research because “the COVID-19 pandemic increased the complexity of cancer care, forcing clinicians to balance patients’ risk of infection versus cancer progression,” she said, noting that “in 2020, little was known about the virus and the [US Centers for Disease Control and Prevention] initially recommended а conservative, test-based clearance strategy.” However, she explained that this approach, “when coupled with uncertainty and limited access to testing… meant quarantined patients with cancer were at significant risk for delayed cancer treatment and decreased well- being, treatment benefit, and survival.”
Due to this, nurse navigators at Miami Cancer Institute used a digital patient engagement platform to promote patient activation and improve outcomes. Nurses monitored quarantined patients at a population level, assigned digital care plans, provided ongoing guidance, and ensured patients “experienced timely and clinically appropriate clearance to return to cancer care,” according to Dr. Nestingen.
The study examined patient activation and engagement with nurse navigations, protocol adherence and whether clearance followed guidelines, and time to clearance and next treatment. These metrics were evaluated in 119 quarantined patients with cancer during the first 6 months of the pandemic.
The patients were grouped by their engagement with nurse navigators within the mobile app and classified as active users, passive users, or routine care, with those classified as active users having the most support of the 3 groups.
The study showed that more navigation support was associated with a higher likelihood of protocol adherence (P<.001) and timely treatment after quarantine (P=.046). Frequent messaging by nurses was “weakly” associated with higher patient engagement (P=.034). The study found no consistent clinical or demographic factors that emerged as predictors of poor patient outcomes. However, of the variables evaluated, lack of navigation support was the “best predictor of poor outcomes,” according to the presenter.
These findings have multiple implications for practice, including that navigators can “use telehealth tools and their experience guiding patients to improve timeliness of care and clinical adherence in quarantined patients,” Dr. Nestingen explained.
Navigators can also promote patient engagement by initiating patient messages in a mobile app. These findings make it important for navigators to be fluent in the use of electronic health tools and leaders should re-evaluate navigation models, metrics, and outcomes in the context of electronic health tools, the presenter concluded.
Nestingen M. Examining the Relationship Between Oncology Nurse Navigation, Protocol Adherence and Timely Return to Cancer Care During the Pandemic. Presented at the Academy of Oncology Nurse & Patient Navigators 14th Annual Navigation & Survivorship Conference; November 15-19, 2023; San Antonio, Texas.