WINSTON-SALEM, N.C. – When you receive a life-altering diagnosis, such as breast cancer, it’s easy to become overwhelmed processing the whys and hows. After serving 20 years as a nurse at Novant Health Forsyth Medical Center and its cancer center, Sharon Gentry, RN, MSN, AOCN, CBCN, knows how to answer those questions. As the organizer of the Novant Health Derrick L. Davis Cancer Center’s nurse navigation program, one of the first navigation programs in the state, she has consoled dozens of patients and their families.
Considering her broad experience, Gentry is one of a growing number of nurses who guide cancer patients around complex obstacles often found in a cancer care system, such as a lack of information, gaps in care, need for financial assistance, social support, and transportation to and from the cancer center.
The concept of a nurse navigator originated in the 1990s when Dr. Harold P. Freeman created the first program at Harlem (New York) Hospital Center after realizing that many cancer patients did not return for follow-up care. The program’s success spread and grew in popularity. In 2005, President George W. Bush signed the Patient Navigator Outreach and Chronic Disease Prevention Act, which provided funds for navigation programs at U.S. cancer centers.
“Our navigator program began in 2001 and was driven by breast cancer patients,” said Gentry. “Patients voiced concern that they were overwhelmed with information and choices as newly diagnosed breast cancer patients. We listened to our patients and it was determined that there was a need for a central source of information and for improving the flow of breast care across the local healthcare system.”
Gentry said it took 18 months to solidify the program and put it in motion. “I began by spending the first year in the breast clinic, observing how patients enter the system — where they come in, where they go next. Some come from the breast clinic, but others come from surgical offices and even emergency departments. Each patient was unique,” said Gentry.
As she continued to observe the process, she began to gain a perspective on the whole system, understanding the process of care within it, and identified resources to tap into within the larger community. Most importantly, she saw exactly what patients and their families were experiencing and what their needs were.
Gentry observed that patients were frustrated on the day of their surgery because they had to make two stops at two different facilities before they could check in for surgery. After bringing this to the attention of the cancer center committee, changes were made to simplify processes. “With feedback from patients, we develop a stronger breast cancer care program,” Gentry said.
Gentry said that once the navigation program began, the results were quite positive. Gentry said evidence-based studies now show physicians spend less time for consultation now. “When the patient is educated and prepared, they don’t have as many questions. That’s a payoff for doctors as well as patients because it allows our providers to see more patients in a given day.”
Nine other cancer navigators have joined Gentry since the program began. They now support patients with thoracic, gastrointestinal, gynecologic and other cancers. “The navigators chose to be on call for our patients 24 hours a day, and we follow patients through all aspects of care, beginning with diagnoses and through the treatment phase even if it includes radiation, chemotherapy and/or hormonal therapy.”
Most breast cancer patients enter this system of care at the Novant Health Breast Clinic, where the breast nurse navigator, Jamie Calcutt-Flaherty, RN, meets them as soon as they are told their breast cancer diagnosis. Those that enter the system outside of the breast clinic receive a call or visit from Gentry or Sarah Crowell, RN, another breast nurse navigator. As soon as they are notified that a patient has received a breast cancer diagnosis, the navigators explain their role and say, “Let’s talk about what the doctor just told you.”
Gentry said that sometimes they need to redirect the patient on what she has heard or has not heard. For example, one patient told Gentry right after the diagnosis that she was beginning to create her will. Since Gentry had her pathology report, she knew that the patient had a very early form of breast cancer and that it was highly curable. “It was very rewarding for me to be able to tell her what she could expect. Right upfront I can make a difference by clarifying a patient’s condition for her. My aim is to empower the patient and help them feel in control.”
The nurse navigators also try to learn about the patient’s family situation to see if they have a spouse, children or insurance coverage. The navigators can help the patient tell her children and spouse, and the patient can be referred with other resources and patient assistance programs.
The navigators emphasize continued care but do not make decisions for the patient. “We give information and support her in whatever decision she makes,” Gentry said.
Surveys regarding the nurse navigator program validate the patients’ appreciation. “The security knowing she could be reached anytime, and her caring phone calls were reassuring to me,” one patient wrote. “Whenever I had a question or concern, she was always available. Her physical presence during chemo and radiation was very reassuring, and she seemed like a close friend who truly cared about me and my family.”
This fall, the first certification for patient and nurse navigation will be released by the national organization, the Academy of Oncology Nurse Navigators+. Gentry has been on the leadership council of this organization since its inception in 2009 and witnessed the evidence-based growth of this nursing classification. The organization advances the role of navigation in cancer care and survivorship care planning by providing a network for collaboration and development of best practices to improve patient access to care, evidence-based cancer treatment, and quality of life during and after cancer treatment.
For more information about Novant Health’s nurse navigator program, call 1-866-611-3722.
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