When you’re first diagnosed with breast cancer, the number and range of decisions you’ll have to make and doctors you’ll need to meet with can be thoroughly overwhelming. In an effort to help new patients find their way, many hospitals and treatment centers now offer the services of a health navigator, also sometimes called a nurse navigator or a patient navigator. This person is part of your care team, and his or her job is to help you get from point A to B to C with the least amount of hassle, just like your GPS navigator might do on a long drive.
Navigation programs can take a number of forms. Some prioritize screening to arrive at an early diagnosis, while others help patients once they’ve arrived at the hospital for treatment. Tesha Coleman, program director for the Capital Breast Care Center, a patient navigator program at the Georgetown University Medical Center in the District of Columbia, says her team of navigators focuses heavily on getting women from impoverished areas of the metro-D.C. area in for screening. And they do that by driving a specially branded van to these areas and conducting grassroots community outreach to round up women for annual mammograms at the MedStar Washington Hospital Center, which is affiliated with the Georgetown University Medical Center. Because the navigators are involved right from the start, they can identify the patients who may need more assistance later on if they’re diagnosed with breast cancer. “They hold the patient’s hand all the way,” Coleman says.
[See: A Tour of Mammographic Screenings During Your Life.]
There can also be wide variation in who is performing the role of navigator. Some programs employ nurses while others staff their teams with social workers. Chasity M. Washington, program director of the Center for Cancer Health Equity at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, leads a mixed team of nurses and social workers who help patients in the hospital, and a small group of community health workers who conduct outreach in the community to get women in for screening. Depending on the stage of breast cancer, patients may work with one or more navigators during their time at the James.
Although not all of the navigators who work at the James have a clinical nursing background, they are well versed in what breast cancer patients need and barriers that some of these patients will face in accessing care and following through on their treatment plan. Some of these may be relatively simple logistical problems such as how to get to and from the hospital for treatment sessions. But other barriers are much bigger issues, such as paying for care.
“Although women may have insurance coverage for screening, they have these plans that they didn’t realize have really high deductibles,” Washington says. “They come back for diagnostics and discover they’ve got to meet this huge deductible. Many women don’t want to spend that money just for a diagnostic, because nine times out of 10 it’s probably going to be fine. And I think some women know that and they don’t want to spend that money,” she says. That’s where philanthropic bodies like the Susan G. Komen organization can help by offering grants to help patients pay for follow-up diagnostics.
Another issue that Washington says navigators can help with is getting patients over their fear. “In a lot of cultures, getting a cancer diagnosis means ‘that’s it.’ They don’t have a lot of positive stories about people with cancer, so getting them to come back has been a little hard.” In nearly all cases, a little education can go a long way, it’s just a matter of having someone who can explain things to the patient in an understandable way.
[See: 7 Innovations in Cancer Therapy.]
In addition to helping the patient, navigators can also help doctors and nurses focus on what they’re best at: treating patients. “Someone at the nurse level, you want them operating at the level of their skill set. You don’t want them spending hours on the phone to get the patient enrolled in insurance,” Washington says.
Although many navigation programs are based in the hospital or care facility, not all are. Some navigation services can be effectively delivered remotely, via phone, email or video conference, and some companies are now offering these types of services to specific patient sets. Dr. Cindi Slater, chief medical officer at ConsumerMedical — a company that offers patient navigation services as an employee benefit to other companies — says when an employee accesses the service, which is paid for by that patient’s employer, he or she will speak with a nurse navigator who confidentially advises the employee on the diagnosis and what treatment options are available. This relationship can go on for any length of time, as dictated by the patient’s needs.
Slater says the employee and the navigator, who is a registered nurse typically with lots of clinical experience, often develop a “trusted relationship. You attack together the issue at hand,” and the navigator can research doctors in the company’s health plan or the local area and offer information and resources to help patients make other decisions about their care. Unlike a hospital-centered navigation program, companies like ConsumerMedical are independent, and not affiliated with a specific care facility of insurance carrier, so the patient would have to initiate the contact, rather than being approached by someone at the hospital.
[See: What Not to Say to a Breast Cancer Patient.]
No matter where the assistance comes from or what shape it takes, having some help and guidance along the way when you’re dealing with a breast cancer diagnosis and treatment can be a godsend for some patients, but not everyone needs it. Washington says that although her team would love to work with every patient, limits to time and resources mean they focus on “people we know may have issues,” particularly with the financial aspects of treatment. These patients can come from all walks of life, but often they are dealing with other issues such as unemployment, poverty, a lack of education or a lack of English language skills. Navigators can help them find their way through the complicated system they get dropped into with a breast cancer diagnosis.
Health care in general is complicated, and because of the vast range of individual variation in breast cancer treatment and individual insurance coverage, having someone knowledgeable to lend a hand can be a real benefit for many patients. If you feel like you could use a hand and a navigator hasn’t approached you yet, ask a member of your care team if such services exist at your hospital and how to access this support.
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A Health Navigator Can Prove Helpful for Breast Cancer Patients originally appeared on usnews.com
