1. Oncology Nurse Navigation in Rural ND

2. C-Change definition of “What is Cancer Patient Navigation?”  “individualized assistance offered to patients, families, and caregivers to help overcome healthcare system barriers and facilitate timely access to quality health and psychosocial care…from pre- diagnosis through all phases of the cancer experience”  C-Change, n.d..,”What is Cancer Patient Navigation?” section, para. 1

3. Oncology Nurse Navigation in Rural North Dakota  Objectives:  1. Describe the history of and support for Oncology Navigation.  2. Describe and discuss Oncology Navigation types.  3. Describe and discuss Oncology Navigation in rural North Dakota.

4. History of Navigation  American Cancer Society beginnings in 1913  National Cancer Act of 1937 established National Cancer Institute (NCI)  1962 President Kennedy supported consumer rights of safety, information, choice, and justice. And in 1971 Nixon signs National Cancer Act  1986,1989 ACS reports on Cancer in poor  1990 Harold P. Freeman, MD used findings as catalyst of 1 st navigation program at Harlem Hospital Center in NYC.

5. History of Navigation  1999 Institute of Medicine (IOM) “The Unequal Burden of Cancer”  2000-2005: President’s Cancer Panel Reports by Freeman, NCI pilot navigation program, IOM continued reports, Presidential appropriations supporting navigation groups, including C-Change

6. Supporting and Describing Oncology Navigation  C-Change  American College of Surgeons Commission On Cancer (standard 3.1 phase in by 2015)  Nat’l Coalition of Oncology Nurse Navigators (NCONN)  Academy of Oncology Nurse Navigators (AONN) (AONN+)  Oncology Nursing Society (ONS)

7. AONN+  A medical professional whose clinical expertise and training guides patients and their caregivers to make informed decisions, collaborating with a multidisciplinary team to allow for timely cancer screening, diagnosis, treatment and increase supportive care across the cancer continuum.

8. ONS, AOSW/C-Change  Individualized assistance offered to patients, families, and caregivers to help overcome healthcare system barriers and facilitate timely access to quality health and psychosocial care…from pre- diagnosis through all phases of the cancer experience.

9. American College of Surgeons Commission on Cancer New Program Standards for Cancer Care  Standard 3.1 Patient Navigation Process: A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations. The Navigation process is evaluated, documented, and reported to the cancer committee annually. The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment.

10. Types of Patient Navigation Programs  Site specific navigation programs  Breast, prostate, etc. Usually center around a specific point of entry for the cancer diagnosis.  Setting specific navigation programs  Center around improving patient experience and outcomes in practice/community/region.  Combination  Always important to be navigating for the patient’s and not the system’s benefit.

11. Site specific navigation programs  Breast Cancer  Gastrointestinal Cancer  GU Cancer*  GYN Cancer  Head and Neck Cancer  Thoracic Cancer  Prostate*

12. Setting specific navigation programs  Practice  Community  Region

13. Patient Navigation Considerations (site or setting specific) Patient- and Family-Centered Care  PATIENT-CENTERED NEEDS ASSESSMENT  PATIENT-CENTERED PROCESSES  PATIENT-CENTERED RESOURCES

14. Patient Navigation Considerations (site or setting specific) Patient- and Family-Centered Care  PATIENT-CENTERED NEEDS ASSESSMENT  Community surveys: NDCC, ACoS, hospital  Patient assessments  Coping  Stress  Learning needs  Resource needs

16. Patient Navigation Considerations (site or setting specific) Patient- and Family-Centered Care  PATIENT-CENTERED PROCESSES  Intake process: access point (screening, consult or recurrance)  Adequate records  Encourage family at intake  Assess patient needs

17. Patient Navigation Considerations (site or setting specific)  Working with other disciplines:  Tumor Boards  Multidisciplinary clinics  Specialties (dentist, ENT, Surgeons, speech therapy, rehabilitative services)  Cancer Committees  multidimensional communities

18. Patient Navigation Considerations (site or setting specific)  Scheduling processes:  Testing  Treatment  medical home (care coordination and reimbursement concerns  Timing needs for care prescribed  Timing needs between specialties/centers  Prioritizing and communications

19. Patient Navigation Considerations (site or setting specific)  Services available to meet patient needs  Continuum of care connectedness (SOFTWARE)  Qualified specialty oncology staff (treatment needs)  Rehabilitative services  Palliative services (ongoing care, end-of- life, hospice

20. Patient Navigation Considerations (site or setting specific )  Patient- and Family-Centered Care  PATIENT-CENTERED RESOURCES  Financial  Information  Online access  Support  ETC.  State of flux: People want to support cancer patients, just about everyone knows someone close to them in some way who has cancer.

21. o North Dakota Cancer Coalition has assisted in the assessment of the oncology community of rural ND with the 2013 and 2015 Surveys: o Fear of cancer o Transportation barriers o Financial barriers Describing Oncology Navigation in Rural North Dakota

22.  Fear of Cancer  Patient Information  ACS info  NCCN booklets online or Amazon  NCI online free to print  medical sites, industry information, clinical trial information, referrals, programs like look good…feel better, resource information, etc.

23. Describing Oncology Navigation in Rural North Dakota  Transportation Barrier support  Foundation support, local support (tribal support and cars, city transport services)  gas stamps  NDCAP gas cards  ACS ride to recovery  Lodging resources

24. Describing Oncology Navigation in Rural North Dakota  Financial barriers  Cost of travel, lodging, food, time off work, time off work for drivers  ADL assist, caretakers in the home,  Accessing reimbursement whether it be insurance coverage or disability/medicaid

25. Describing Oncology Navigation in Rural North Dakota Patient Barriers  Financial  Insurance  Fear  Transportation  Health Care System  Housing  Family Issues  Communication  Language

26. Describing Oncology Navigation in Rural North Dakota Patient Resources  Social Services  Psychiatric counseling  Education need  Nutrition counseling  Coping/painting class, yoga, support group, Look Good…Feel Better  Pastoral Care services  Translational services  Clinical Research access

27. Describing Oncology Navigation in Rural North Dakota  Thorough knowledge of assessment, processes, and resources to assist in managing barriers and referrals for patient-centered care.

28. Describing Oncology Navigation in Rural North Dakota “Navigators must possess skills to effectively collaborate with multiple providers and disciplines, excel at meeting and exceeding patient expectations, and have comprehensive knowledge of all cancer treatment modalities, side effects, and evidence-based interventions.” Blaseg, K.D., Daugherty, P., and Gamblin, K.A. (2014). Oncology Nurse Navigation. Pitsburgh, PA. Oncology Nursing Society. Pg. 8.

29. American College of Surgeons Commission on Cancer. (2012). Cancer program standards 2012: Ensuring patient- centered care[v.1.2.1, released January 2014].Retrieved from http://www.facs.org/cancer/coc/programstandards2012.pdf Blaseg, K.D., Daugherty, P., and Gamblin, K.A. (2014). Oncology Nurse Navigation. Pitsburgh, PA. Oncology Nursing Society. C-Change: http://c- changetogether.org Institutes of Medicine Report (IOM). (2007). Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, D.C.: National Academies Press. http://www.nap.edu.

30. HAVE FUN !!! and Thank You.