I have been asked frequently, “What exactly do you do??” The answer, quite frankly, is…..a little bit of everything!
Every day brings with it a different set of issues and challenges as I assist our patients through this very confusing and sometimes daunting maze of health care. On any given day you might find me in the Women’s Center recovery room at the bedside of a patient and her family after her breast cancer surgery…or in the chemo lab sitting with a patient as she is being given her treatment…perhaps at the Breast Care Center to be there for a woman that has just learned she has breast cancer, or in Radiation Oncology helping a patient apply for Medicaid or other financial assistance. Many times they are here from out of town and need assistance with lodging during their treatments. While a large part of my role is centered on the breast cancer patient, I also navigate our other cancer patients as they undergo radiation therapy treatments. Since this was a new role, it was a “learn as you go” experience in the beginning. Three years later, this role has expanded to include navigation of all of our cancer patients.
The role of cancer navigation may be new to our facility, but it has been a real concept for quite some time. The idea originated in 1990 by Dr. Harold Freemen at Harlem Hospital Center in New York City. The goal of the program, funded by an ACS grant, was to ensure that a patient with a suspicious breast cancer related finding would receive timely diagnosis and treatment. Additionally, the hospital provided free and low cost screening mammography, as well as outreach and public education efforts in the community. With all this in place, the 5-year survival rate for patients diagnosed with breast cancer at Harlem Hospital jumped to 70% in 2000 compared to 39% in 1986! From this pilot program, patient navigation has grown into a national movement and encompasses programs sponsored by ACS, NCI, and Centers for Medicare and Medicaid services.
So, what exactly does a Breast Cancer Patient Navigator do?
v A Coordinator of patient-care activities to support the transition from diagnosis to treatment.
v A provider of educational information and support to all patients concerned about their breast health.
v An educational and emotional consultant for women with benign breast diseases
v A supporter of the cancer patient and the family in understanding and coping with the strong emotions that accompany a cancer diagnosis. She remains a constant caregiver and overseer of the patient’s educational, emotional and social needs.
v A provider of educational resources for the patient and the family to answer their questions and address their fears during the cancer experience.
v A facilitator of physicians’ recommendations for patient care to help ensure patient compliance and understanding.
v A triage manager in assessing patients’ educational and social needs identifying healthcare barriers and appropriately referring to the proper source of help.
v An educator for other medical personnel in understanding benign and malignant diseases, their treatment and the patient’s emotional and social recovery from the disease.
v A public educator on the early detection of breast disease and breast self-exam skills.
v A public advocate for the needs of cancer patients and their families.
When the plans for our Breast Care Center were in early stages, it became evident that in order to be successful, this was how we needed to model our breast program--and so the role of navigator was established. Studies have shown that hospitals with navigators in place have increased patient satisfaction, increased physician referral, but more importantly, increased survival rates. I am proud to say we have accomplished the same goals set forth by Harlem Hospital 20 years ago. We offer free screening mammograms to the uninsured women of our community through our “Heroes ’n Heels” program. We have established a library of books for our patients to educate them on all aspects of cancer treatments, as well as prevention and nutrition. The education does not just exist for the patient; I also incorporate education and support for the family and caregiver of the patient. We have initiated a lymphedema program in the Physical Medicine department for our post mastectomy and lumpectomy patients.
Imagine being given a diagnosis of cancer…the shock, the fear, and the disbelief are numbing. You don’t know what to do next---who to call…what appointment should I make? Which doctor to make it with? What other tests do I need? How will my films and reports get there? What about disability? Can I receive financial assistance? Am I going to die? What about my children? How do I get to my treatments? Can I work through my treatments? Will I lose my hair? Where do I get a ...wig? These are just a few of the concerns my patients have when they are diagnosed.
When a patient at the Breast Care Center is given a diagnosis of breast cancer, I am there with the Radiologist to offer her a folder full of pamphlets and books, support group information, appointments, etc. Depending on which surgeon their referring physician prefers, an appointment has been made for them. A breast MRI is already ordered and, if necessary, an authorization is in process. She will get a personalized card in the mail from me, the first of many I send to my patients as they go through this journey. I follow this patient and her family through her entire experience--from surgery to treatment--into survivorship. I offer the same support for the already diagnosed cancer patient as they begin their radiation treatments.
By Theresa Winsey, CBPN-IC
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