Title: Breast Care Navigation: Ensuring Breast Care Patients Receive the Education and Support They Need
Abstract Text Submission for 2009 AWHONN Convention
Lisa Shalkowski, BSN, RN

It is widely recognized that the diagnosis and treatment of breast cancer involves a complex and fragmented process of initial testing, clinical management, and follow-up that is additionally complicated by a disjointed and poorly configured health care system (Freeman, 2004).  When individuals are first confronted with the information that they may have or do have breast cancer, they plunge into an unfamiliar and challenging world that requires them to deal with: (1) decision-making tasks that involve difficult and confusing choices, all of which must be enacted in a condensed period of time and lead to additional decisions and challenges; (2) practical tasks, such as scheduling and following through with multiple required appointments, often over an extended period of seven to nine months of active treatment; and, (3) psychological tasks, such as the processing of new information and integrating the clinical tasks with the emotional aspects of breast cancer.

Oncology nurses help these patients navigate their cancer journey. The overarching objectives of the initiative to develop a breast care navigation service were to enhance patient access to information about cancer diagnosis, facilitate timely access to health care services, reduce delays and missed appointments, and to provide information on the location of appropriate social services, with the ultimate goal to improve cancer care in Southern New Jersey. Patient navigation considerably improves timeliness in the diagnosis of breast abnormalities and can potentially improve quality of life with more timely reassurance for women with benign conditions and earlier treatment for those with malignancy ((Psooy, Schreuer, Borgaonkar, & Caines, 2004).

The breast care navigation program is focused on two types of patient navigation: access navigation (for abnormal screening results) and care navigation (from cancer diagnosis through post-treatment surveillance). The “access navigator” is a dedicated scheduler who is responsible for making sure patients with an abnormal mammogram result are able to quickly access diagnostic consultations and procedures with specialists to ensure timely resolution. The “care navigator” is an oncology nurse who follows patients from cancer diagnosis through active treatment, often lasting up to nine months, and into surveillance.

This presentation will detail the drive for this project as well as information related to the development and implementation of the program. The outcomes of the pilot for the care of women who receive abnormal mammogram results and newly diagnosed women who are in need of assistance from a nurse navigator during such a stressful juncture. The elements which have been critical to the success of the breast care navigation program including the Design for Six Sigma methodology utilized to design the new service to meet customer requirements and improve the patient and caregiver experience.