Oncology Nurse Navigators (ONN)

THEMES:

• Patient Navigation

• Patient Information & Education

• Psychosocial Support

SUMMARY

The Canadian Association of Nurses in Oncology (CANO) is a national professional association. One of their roles is supporting oncology nurse navigators (ONN) in offering a wide range of healthcare supports to patients and their families throughout the various stages of the cancer continuum. With more integration of this profession into the cancer care system in most provinces and territories, ONNs have provided a better harmonization of healthcare services and better patient and family support systems.

During the diagnosis stage, the main role of the ONN is to act as a primary point of contact, linking patients and their relatives with the multidisciplinary healthcare team, cancer facilities, and community resources (Cook et al., 2013). This role continues throughout the entire care pathway.

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In the initial stage of cancer diagnosis, the nurse navigator may begin communicating the significance of further testing while offering information, psychosocial support, and education to patients and caregivers.
During diagnostic testing, when patients undergo a set of tests to determine the presence and the extent of cancer, the ONNs help patients understand the medical procedures, navigate through different parts of the health system, and empower patients to take an active role in managing their health during the diagnostic phase.
Once the results of the tests are available, the ONN communicates the findings to the patients and their families, providing information and support as needed.
During staging and treatment planning, the ONN assists with coordinating appointments, facilitating communication between healthcare providers, and helping the patient understand their treatment options.

"Such a wide variety of services were available... I certainly got all my needs met. I was not lacking in anything."

- Patient Assisted by an ONN

Overall, oncology nurse navigators help patients and their families navigate the complex trajectory of cancer diagnosis in Canada. By providing education, emotional support, coordination of care, and patient advocacy, oncology nurse navigators help patients feel more informed, supported, and in control of their care throughout the diagnosis stage.

ISSUES

Although nurse navigation is acknowledged as a fundamental element of an integrated system of cancer care, it is not yet delivered nationally in a standardized way (Cancer Care Ontario, 2010). In some regions across Canada, nurse navigators may function differently, which can lead to inconsistencies in patient care. To address this issue, there have been calls for a standardized approach that could streamline practices and improve care consistency.

Specialized oncology nurses in Canada may experience a range of issues in their practice, some oimplicated by thef which include: workplace bullying; burnout and ccase studyompassion fatigue; shortages and workforce challenges; and limited access to resources and education.

Although survivorship research and programs are receiving significant attention and funding, this focus could overshadow the critical importance of the diagnostic phase, which often lacks adequate support and resources. This highlights the need for comprehensive support throughout the cancer journey, starting from before diagnosis and continuing to survivorship.

Other challenges include delays in accessing PET scans or timely CT-guided biopsies.

SOLUTIONS

Overall, addressing these issues requires ongoing advocacy, education, and support for oncology nurses, as well as collaboration with healthcare leaders and policymakers to address workforce and system-level challenges.

The Oslo Manual Conceptual Framework of Innovation inspired the idea of change in prospective oncology nurses’ roles, corroborated by the Canadian Association of Nurses in Oncology’s Standards of Practice and Competencies (Zanchetta et al. 2015).

Patient education and psychosocial support;
Research and quality improvement: oncology nurse navigators can participate in research studies and quality improvement initiatives to help identify best practices and improve patient outcomes.

For example, ONNs in New Brunswick are keeping up to date with the latest advancements and best practices in cancer diagnosis through various means:

Monthly meetings with the New Brunswick Cancer Network;
Participation in the Canadian Association of Nurses in Oncology Special Interest Group (CANO SIG) for cancer navigators;
Attending webinars through CANO and other platforms. Participating in online and in-person conferences, such as the Colorectal Cancer Conference;
Regular involvement in cancer centre activities such as weekly rounds, workshops, and journal clubs.

These activities provide continuous education and updated information to ensure the navigator is equipped with the most recent knowledge and best practices in oncology.

ACHIEVEMENTS

Oncology nurse navigators play a critical role in involving patients in their own healthcare decision-making. They have promoted empowerment for patients and their families during the diagnostic phase of cancer in one community-based cancer center (Jeyathevan, G. et al., 2017). During the diagnosis stage, the main role of ONNs is to act as a primary point of contact, linking patients and their relatives with the multidisciplinary healthcare team, cancer facilities, and community resources (Cook et al., 2013).

NEXT STEPS

In order to improve these inefficiencies, collaboration among healthcare providers, professional organizations, and policymakers can share best practices and promote consistent, high-quality care for cancer patients during the diagnosis phase. By working towards standardizing the roles of ONNs, healthcare systems can ensure that patients receive consistent, evidence-based care and support during the critical cancer diagnosis phase.

Understanding the fundamental competencies and practice domains of ONNs, as well as the comprehensive nurse navigation framework, could benefit decision-makers, administrators, and healthcare professionals in creating analogous roles for nurses who tend to patients with conditions like mental health disorders and cardiovascular diseases. (Jeyathevan, G. et al., 2017). In addition, there is a paucity of research on the effectiveness of the nurse navigator in improving patients’ experiences (Cantril & Haylock, 2013).

Sources:

1 Canadian Association of Nurses in Oncology. 2006. Practice Standards and Competencies for the Specialized Oncology Nurse. Retrieved from http://c.ymcdn.com/sites/cano.malachite-mgmt.com/resource/resmgr/standards/CONEP_Standards2006September.p df

2 Cantril, C., & Haylock, P.J. (2013). Patient navigation in the oncology care setting. Seminars in oncology nursing, 29(2), 76–90). WB Saunders.

3 Cook, S., Fillion, L., Fitch, M., Veillette, A.M., Matheson, T., Aubin, M., & Rainville, F. (2013). Core areas of practice and associated competencies for nurses working as professional cancer navigators. Canadian Oncology Nursing Journal, 23(1), 44–52.

doi:10.5737/1181912x2314452

4 Jeyathevan, G. et al., (2017).The role of oncology nurse navigators in enhancing patient empowerment within the diagnostic phase for adult patients with lung cancer. Canadian Oncology Nursing Journal, 27 (2)

5 Zanchetta et al. (2015). Prospective roles for Canadian oncology nurses in breast cancer rapid diagnostic clinics.