In complex medical world, new nurses can be breast-cancer patient's GPS
Navigator's job is to explain breast cancer, arrange appointments, and counsel.
CHARLOTTE, N.C. — An hour before surgery, as she lay waiting in a hospital bed, Sue McKenzie smiled with relief when nurse Mary Keefe walked into her room.
They held hands and talked through last-minute questions.
"You'll check on me Thursday and Friday if I'm here?" McKenzie asked hopefully.
"Oh, yeah," the nurse said.
Making sure breast-cancer patients get what they need is Keefe's job.
She's a pioneer in the growing health care field known as patient navigation.
With advances in cancer treatment, patients face far more complex decisions today than the past. As a result, hospitals across the country are hiring nurses or other professionals to help patients navigate their way through the medical system.
The job of a navigator is not only to explain breast cancer, answer questions and arrange doctors' appointments, but also to counsel patients through the terror of a cancer diagnosis, show them how they can survive it, and guide them through their journey.
There is no extra charge for the service. It's part of the health care package.
Barbara LiPira, vice president of oncology services at Presbyterian Cancer Center in Charlotte, N.C., said it's worth the cost. "It's more than a feel-good program," she said. "It's a better way to care for patients."
One of three breast-health navigators at Presbyterian, Keefe met McKenzie the day she was diagnosed. She was there when McKenzie had CT and bone scans before chemotherapy. And she'll be there as long as McKenzie wants to stay in touch.
Since 2006, Keefe has done this for hundreds of patients, some of whom have referred friends, sisters or mothers.
"We connect with them on day one, and we spend as much time as they need," Keefe said. "I tell them, 'I don't work for the doctors. I work for you first of all, as your educator, your supporter and your coordinator."'
Patient navigation started in 1990 at Harlem Hospital Center in New York, where Dr. Harold Freeman hoped to reduce health disparities by improving access to cancer screening and reducing barriers faced by low-income, African-American women.
Many studies support the use of navigators, said Angelina Esparza of the American Cancer Society. "Patients really do feel that they are able to better cope with the diagnosis and the cancer.
"There are significant differences in outcomes in terms of stress, fatigue and quality of life. For many years, these psycho social needs were often overlooked."
Accrediting bodies for cancer programs — not just breast cancer — are making patient navigation a required standard. The Commission on Cancer will require accredited cancer centers to offer navigation services by 2015.
Navigators don't have to be nurses. Some programs use social workers or even lay leaders. Navigator is the buzzword today, but some hospitals use the term coordinator.
"The name changes but the job is the same," said Susan Postell, breast program nurse coordinator with Levine Cancer Institute at Carolinas Medical Center. "I think all nurses are navigators. I've been in this role for over 30 years.
"A lot of what I do is crisis intervention, explaining the disease, the name of the cancer and what it means, offering hope more than anything else," she said. "This is an intimidating place to come. Every new cancer patient needs that person they know they can call."
Keefe, 56, was one of the first official breast-health navigators in Charlotte. She was working as an oncology nurse at Presbyterian when the position was advertised in 2005.
"I thought 'What a great thing to do for people,"' Keefe said.
But doctors weren't convinced at first that navigators were needed.
"I was ambivalent about it," confessed Dr. Peter Turk, a Presbyterian surgical oncologist. "I didn't know if she had the ability to make an improvement in what we were doing."
Today, he's a believer.
When Turk meets patients who have worked with a navigator, "The discussion can be much more focused. ... By the time they come to see me, a lot of the emotion has calmed down. They are able to synthesize and make decisions."
Patients who haven't met with a navigator are "still very much like a deer in the headlights," Turk said. "At the end of the meeting, they don't remember a thing. All they hear is the word 'cancer."'
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