Patient Navigation Across the Cancer Continuum

1. Patient Navigation Across the Cancer Continuum Marlene A. Runyon, RN, BSN, OCN, CHTP Mayo Clinic Health System, Franciscan HealthcareLa Crosse, Wisconsin WICCC Summit, Madison, Wisconsin March 29, 2012

2. Current State/Roles Cancer Guide Social Worker Clinical trial referrals Advanced care planning Behavioral health referrals Coordination of care (schedules/appts) Psychosocial support Introduction to supportive services Symptom management Integrative therapies Mind/body tools for coping Drug assistance Coordination of care between settings (inpatient & outpatient) Finances Insurance Transportation

3. Navigation During Treatment • Facilitate chemotherapy education class • Provide support /assessment at first chemo treatment • Referral to social worker, dietitian, integrative therapies, support groups • Complete psychosocial assessment • NCCN distress tool at each chemo treatment and follow-up provider visits • Accompany providers for clinic /hospital visits • bad news, change in treatment plan , etc

4. Navigation During Treatment • Provide support during patient clinic appointments as needed/requested by pt/family • Initiate referrals to OT Cancer Fatigue Program, exercise programs, group acupuncture, etc. • Support nursing and other staff with difficult patient situations • Facilitate support groups

5. Successes of Current Program • Early support of patient and family • Support team collaboration • NCCN distress thermometer • Chemotherapy education class • Integrative therapies and mind/body skills • Survivorship program • Survivorship group • Survivorship care plans for breast patients • Team buy-in

6. Comparing Patient Navigation Model to Current State at MCHSFH MCHSFH Patient Navigator • Cancer care orientation • Advocating for patients • Arranging transportation • Referral for financial needs • and other community services • Scheduling appts. and • arranging diagnostic tests • Facilitating communication • between health care • providers, pts. and/or families • Coordinating multidisciplinary • services • Educating patient • Resource identification • Providing counseling • Emotional support • Follow up phone calls • Drug assistance • Coordination of care • between settings • (inpatient & outpatient) • Finances • Insurance • Transportation • Clinical trial referrals • Advanced care planning • Behavioral health referrals • Coordination of care • as needed (schedules/appts) • Psychosocial support • Symptom management • Integrative therapies • Assistance with coping Gaps • Continuous care coordination • Provide patient education surrounding disease and treatments • Facilitate communication with and between health care provider, patient and families • Follow up on appointments • Assuring ability to make appointments • Follow up on missed appointments • Main contact for patient • Follow up phone calls

7. Challenges During Transition • Communication of changes and processes in current model • Budget neutral? • Outcome measurement • Lack of training/role needs definition • Time: management of other issues and requests, constraints of time • Lack of clarity with navigator role nationally • Role transition for cancer guide and social worker • What happens with current roles (financial assistance, Healing Touch, volunteer involvement, etc)

8. Next Steps • Development of assessment tool • Determine how the flow process for the navigator role gains access to the patients • Conduct rapid cycle of change • Initial assessment • Measure outcomes • Distress tool scores • Patient satisfaction • Implement comprehensive patient navigation model