Charting The Course

Nurse navigators help patients find the care they need

When Linda Lindberg learned she had stage IV colon cancer it wasn’t what she expected. After all, she was scheduled for a hysterectomy to treat what she and her doctor thought was uterine cancer that same morning. One last test, a colonoscopy the previous day, revealed colon, not uterine cancer.

Not only was it a different kind of cancer than she expected, but the cancer had spread. Emotions were high.

“My diagnosis was an emotional roller coaster,” Lindberg remembers.

nurse navigationLiving in Stockton, Mo., a town of 2,000 people, meant Linda’s access to treatment was limited. The nearest big city, Springfield, was more than an hour away. While she could start basic chemotherapy, her physicians advised her to seek advanced care.

“My option was to try multiple rounds of chemotherapy, but then the party would be over,” Lindberg says. “They said if I was willing to travel I could go to a place where they could do surgery and clinical trials.”

The many treatment options sent Lindberg on another roller coaster ride. She didn’t know where to start. She needed an advocate.

Her son, a physical therapist in Colorado, knew she could get good care on the University of Colorado Anschutz Medical Campus, but he needed to find the right contact. An internet search led him to Julie Banahan, RN, BSN, OCN, a nurse navigator for the gastrointestinal oncology program at the University of Colorado Cancer Center.

“Julie was a critical contact person,” Lindberg says. “I didn’t have a lot of faith in how fast things would start moving with treatment, but I wanted things taken care of right away.” Julie Banahan helped make that happen.

A few days later, Lindberg traveled 750 miles for her first appointment—a feat that wouldn’t have taken place without Banahan, her nurse navigator.

The Right Connection

Originally created more than 20 years ago to help reduce patient barriers to healthcare, patient navigation now includes not only helping patients find the best treatment, but following patients along the care continuum, from diagnosis to survivorship.

While the concept is not new, CU Cancer Center did not have a nurse navigator until five years ago when it hired one focused on breast cancer. Three years later, as patient referrals increased, the Center added two more navigators—Banahan, in gastrointestinal cancer, and Christine Frodella, RN, BSN, OCN, in blood cancer and bone marrow transplant.

“We were getting so many new patients, but we weren’t getting them where they needed to be in a timely manner,” Banahan says. “We needed to rein in the program.”

At no additional charge, Banahan and Frodella are the first point of contact for all new patients in their clinics. Beyond scheduling appointments and collecting medical records, they offer tips on dealing with treatment side effects, referrals to support services, and clarity to the treatment plan. In short, as navigators, they provide roadmaps for patients’ cancer journeys.

“I’ve been told we’re the concierge of nursing,” Banahan says.

Frodella agrees. “I’m their welcoming committee. Those first few days after diagnosis are one of the most important times for patients,” she says. “I hear patients’ sighs of relief when they finally contact someone who can walk them through the process step by step.”

On average, Banahan and Frodella navigate 12-16 new patients into their clinics each week. In order for a new patient to be seen quickly, they ensure all blood work, scans and staging have been done prior to patients seeing a physician. And, instead of seeing one physician at a time, new patients meet with a multi-disciplinary team of medical, surgical and radiation oncologists, pharmacists and nutritionists all in one visit.

That timely coordination was what patients like Lindberg need.

Calming Frustrations

By the time Lindberg left Missouri for treatment in Colorado, she was frustrated with the medical system. Her health records were stuck at two different hospitals. Phone calls seemed to go nowhere. Without records, she’d potentially miss her first appointment.

nurse navigation, cu cancer centerBanahan wasn’t going to let that happen. She picked up the phone and called both hospitals. The records were transferred. A daunting task was completed. Lindberg could relax.

“When she said she’d do something, she did it,” Lindberg says.

Banahan knows Lindberg’s frustrations and anxieties firsthand. She, too, is a cancer survivor. She’s been through the shock, worry and daunting task of making treatment decisions.

“I’ve been in the same place as my patients,” Banahan says. “I know how scared they are and I know what it’s like to just want answers.”

After all, it’s the reason she became a nurse navigator in the first place.

“I wanted to help our patients transition into the Cancer Center,” she says. “They need a friendly face in an extremely difficult time, and I want to bring them comfort when they need it most.”

No matter the caseload, each patient is treated individually. Banahan and Frodella take the time to figure out what each patient needs. Some have language barriers and need translation. Others aren’t sure what to eat and need a dietician. Each patient is different.

“I want patients to feel that we know them. They’re not just a number in our clinic,” Frodella says. “We want them to feel comfortable, educated and supported—that’s my job.” It turns out nurse navigators not only ease patient frustration, they also improve care.

Increased Patient Satisfaction

According to a 2013 study published in the Journal of Clinical Oncology, patients who were supported by nurse navigators early in their diagnosis reported fewer problems with care, especially in the areas of health information, care coordination and psychosocial support.

Nearly 90 percent of navigated patients in the study said a doctor, nurse or social worker went out of their way to make them feel better emotionally, while only half of those not navigated reported the same findings.

Under a new requirement for accreditation by the American College of Surgeons Commission on Cancer, cancer centers must provide patient navigation services by 2015. University of Colorado Health hospitals have started the process by developing a navigator affinity group.

The group, comprising nurses with varying navigation responsibilities, is working to define systemwide navigation standards so that all patients receive the same level of service regardless of which location they receive care. Additionally, they are working to fill the gaps in other cancer types without navigation services.

“We’ve seen the importance of navigation in our center,” says Jamie Bachman, executive director of oncology services at the University of Colorado Hospital. “Patients and physicians benefit from coordinated multidisciplinary care, a consistent introduction to supportive services and guidance through a complex health system. It also adds a personal touch and response to each patient’s changing needs throughout his or her cancer journey.”

Since arriving in February, Lindberg has started chemotherapy and enrolled in a clinical trial. While she is beyond her initial diagnosis and need for a first appointment, Banahan still visits her during all her appointments and is there to answer questions as needed.

“She was so supportive of what I had been through prior to coming to the Cancer Center and really understood what I was going through,” Lindberg says. “She is still an advocate for me.”

As for Banahan, she continues to be the “voice of reason” for UCH patients. “Every day I get to be a part of patients’ lives when they’re in a state of turmoil,” she says. “While I may not always have the answers, I know where to get them. It’s a privilege to help each one of my patients through this journey.”

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About the author: Kim Chriscaden

Kim Chriscaden is the former communications manager for the University of Colorado Cancer Center.

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