Home / Learn / Resource Detail

Navigating Cancer Diagnostics – A Closer Look at the Role of the Precision Medicine Steward– [VIDEO PODCAST] Ep 22

November 11, 2022

pocketcasts-badge applepodcasts-badge

While advancements in cancer diagnostics and genomics continues to accelerate, the need to centralize and improve coordination around biomarker testing is more important than ever. Hear how precision medicine stewards are helping to bridge the gaps and challenges associated with cancer diagnostics and biomarker testing. In this episode, CANCER BUZZ speaks with Crystal Enstad, MBA, BSN, RN, OCN at Sanford Health in Sioux Falls, SD, about the role of precision medicine stewards and Sanford’s experience with implementing this unique role in the multidisciplinary cancer care team.


Crystal Enstad, MBA, BSN, RN, OCN
Oncology Nurse Navigator Genomics
Sanford Health
Sioux Falls, SD

“We really needed to educate patients, educate our staff, create streamlined processes, and ensure that we were getting testing at the right time and getting those results back to the patients to make sure we were impacting patient services and patient care when it was crucial...”



Funding and support provided by Astra Zeneca and Blueprint Medicines





CANCER BUZZ: Welcome back to CANCER BUZZ TV. I'm your host, Summer Johnson. Today improving care coordination and patient outcomes with a precision medicine steward. Sanford Health has introduced the role of an oncology nurse navigator of genomics to help navigate patients through biomarker testing. With us today is Crystal Enstad, a registered nurse in Sioux Falls, South Dakota, who has served in this role for Sanford Health.

Crystal, let's dive right into it. Can you tell us about the circumstances that led to the development of this role?

Crystal Enstad, MBA, BSN, RN, OCN: Yes, absolutely. So this journey began probably in around 2018 when genomics really started to become clinically approved in cancer care. And in that journey there were multiple vendors that were offering some type of genomic testing for our patients and we were integrating and obtaining those type of orders and working with our staff.

What we started to find is that our patients were getting some surprise bills that they hadn't expected, that they didn't quite understand the reason for the testing, and that really the staff weren't really fluid in the branding or vendor naming conventions for the testing. So there became a collection of barriers to streamlining and implementing the standard of care. In January of 2021, we began to open that opportunity for a new role called the oncology nurse navigator genomics role.

And really the test that was put out to me and being given that opportunity to create this role was We really needed to educate patients, educate our staff, create streamlined processes and ensure that we were getting testing at the right time and getting those results back to the patients to make sure we were impacting the patient services and patient care where it was crucial. And that is at time of progression and at time where they are meeting the physician to go over what options they have next.

CANCER BUZZ: Describe the role of the oncology nurse navigator of genomics.

Crystal Enstad, MBA, BSN, RN, OCN: Absolutely. So the oncology nurse navigator role at Sanford Health is an oncology certified nurse that really physician meets with the patient, identifies a patient that would be eligible for genomics and then invites the nurse navigator to meet with the patient, provide education on the genomic testing, the reason why we're ordering the testing, and then the vendor options along with payment options or payment assistance options.  

And so that is where my role comes in. I meet with the patient, I explain to them what genomics is and the process, the timeline. I complete the orders on behalf of the physician process, any type of insurance prior os, and then get that if it's tissue that needs to be sent or if it's a blood sample that needs to be sent. If it is a blood sample, I'll do that right there with the patient, get that drawn and sent for that vendor kit, and then get those orders submitted same day along with any supporting documentation needed within that.

Once that order is submitted, I keep communication with the vendor ensuring that we have a proper sample, that the testing is running smoothly, that there are no barriers or restarts if there are any quality concerns with the testing sample that's been sent. Then working with our internal pathology department to see if there's alternative options to send for that. And then monitoring for the results and really ensuring that the results of the testing come back in a time that aligns with the patient's follow up with the provider.

So if for any reason we don't have those test results in time for the next appointment or when we were anticipating realigning that appointment or that connection with the physician in patient, so when they do sit down to review the genomic testing, it's a purposeful and meaningful appointment and all of the options can really be presented to the patient and family at that crucial moment.

CANCER BUZZ: How has having this role improved testing coordination and patient care?

Crystal Enstad, MBA, BSN, RN, OCN: Absolutely. It not only allowed us to double the amount of patients getting testing, but really I think more importantly, it's helped us align our practice with the standards and allowed a streamline workflow that gets genomic testing to the patient at the clinically approved time and really more consistently, more streamlined and more efficiently.

CANCER BUZZ: For practices who want to introduce a steward to precision medicine, what do they need to look for?

Crystal Enstad, MBA, BSN, RN, OCN: Absolutely. I think that this role could look differently in different programs, and I think it's getting an inventory of the current state of affairs, so who's doing the genomic testing and what are the touch points that are happening through each one of those departments? Because Genomics is multi-departmental. It starts at patient facing, it's going from provider to their support team to the patient to billing and then to pathology and the vendor, and then a return cycle.

And so each one of those touch points really just process mapping that, identifying how to streamline that, and then how do you keep your staff current. So if you have a smaller body of staff, you might be able to just create a more streamlined process. If you have a larger institution, it's really difficult to keep everyone competent and up to date. So really trying to streamline, create that workflow and then give them the opportunity to have that content expert to guide that patient through the experience and then ensure all of those key touchpoints are happening timely.

CANCER BUZZ: Thank you, Crystal. You could find more resources related to today's discussion in the show notes, you will also find links there to ACCC's comprehensive precision medicine education program. Until next time, on behalf of all of us here at CANCER BUZZ TV, thank you for watching. I'm Summer Johnson.

The views and opinions expressed herein are those of the author(s)/faculty member(s) and do not reflect the official policy or position of their employer(s) or the Association of Community Cancer Centers.