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Jennifer Aversano, MSN, RN, OCN, BMTCN1; Leigh Boehmer, PharmD, BCOP2; Alexander Spira, MD, PhD3
1Advocate Lutheran General Hospital, Park Ridge, Illinois, USA; 2Association of Cancer Care Centers, Rockville, Maryland, USA; 3Virginia Cancer Specialists, US Oncology Research, Johns Hopkins Medicine, Fairfax, Virginia, USA
Oncology navigation, being a vital component of cancer care planning, coordination, and delivery, is an important consideration in the optimization of cancer care. Oncology nurses and navigators were, therefore, key advisors, along with other multidisciplinary team (MDT) members, to a national survey of cancer centers, which aimed to identify barriers to optimal care delivery for patients in the U.S. with advanced (stage III/IV) non-small cell lung cancer (NSCLC).
Insights of oncology MDT members (i.e., oncologists, pathologists, pulmonologists, thoracic surgeons, pharmacists, cancer center administrators, and oncology nurses and navigators) from a diverse set of U.S. cancer centers were gathered via a comprehensive, double-blind, web-based survey between January and April 2019. Subanalyses were performed to examine relationships between care delivery practices relevant to oncology nursing and navigation and treatment-related outcomes such as shared decision-making (SDM).
The survey included 639 complete responders from 160 unique oncology programs across 44 U.S. states, of whom 75 (11.7%) were oncology nurses, nurse navigators, or advanced practice nurses and 33 (5.2%) were financial advocates, navigators, or social workers who provide financial counseling and support patient access. Across programs, there was a deficiency of nurse or lay navigators (22.3% of respondents had neither, n=101) to assist patients with NSCLC.
Among cancer program types, Integrated Network Cancer Programs were significantly more likely to not have a navigator than to have one (7.9% vs. 3.1%; P<0.05). Most respondents (90.1%, n=100) reported no formal health literacy assessments in their programs. Presence of navigation services also has a significant impact on promoting and coordinating SDM, such as ensuring availability of pathology and biomarker reports when treatment options are being decided. Participants in programs with navigators had significantly higher (P<0.05) mean scores for (i) explaining SDM (3.82 vs. 3.29), (ii) asking patients if they wish to engage in SDM (3.55 vs. 3.11), (iii) explaining risks/benefits of treatment options (3.81 vs. 3.52), and (iv) use of educational resources (4.28 vs. 4.02) than those without navigators.
These insights highlight the need for further expansion of oncology navigation and should be used to inform resource development efforts to enhance high quality, patient-centered NSCLC care. Specific areas for process improvement may include increasing health literacy assessment use, improving patient education and engagement, and continued integration of navigators into MDTs.
ASCO Abstract: What Defines Quality Lung Cancer Care?
June 12, 2020
