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Guidelines for the Role of the Registered Nurse Navigator in the Gastroenterology Setting

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Contributors

SGNA Practice Committee 2018-2019
Susan Bocian, MSN BSN RN, Chair
Midolie Loyola, MSN RN CGRN, Co-Chair
Marcela Benitez-Romero, MBA BSN RN CGRN
Cynthia M. Friis, MEd BSN RN-BC
Amy Granato, MSN RN CGRN CFER
Jeanine Penberthy, MSN RN CGRN
Susan Selking, BSN RN CGRN
Christine Wahinehookae, BSN RN CGRN CFER

Disclaimer

The Society of Gastroenterology Nurses and Associates, Inc. (SGNA) presents this guideline for use in developing institutional policies, procedures, and/or protocols. Information contained in this guideline is based on current published data and current practice at the time of publication. The Society of Gastroenterology Nurses and Associates, Inc. assume no responsibility for the practices or recommendations of any member or other practitioner, or for the policies and practices of any practice setting. Nurses and associates function within the limits of state licensure, state nurse practice act, and/or institutional policy. The Society of Gastroenterology Nurses and Associates, Inc. do not endorse or recommend any commercial products, processes, or services. A commercial product, process, or service is recognized as being consumed by or used on patients.

Preface

Health care systems are intricate and often hard to navigate. Patients and families with health care needs often find the system too challenging on their own due to limited resources and knowledge. Because of this, patients may fail to receive high-quality, well-coordinated care, with consequences ranging from low patient satisfaction to undertreatment to negative patient outcomes (Fashoyin-Aje, Martinez, & Dy, 2012). A navigator helps alleviate these consequences by providing innovative, patient-centered, and quality-focused care.

Navigation has its origins in oncology care management and is a relatively new term in gastroenterology. In the 1990s, Harold Freeman implemented a patient navigation program to decrease the barriers to health care for underserved populations (Dohan & Schrag, 2005; Francz, 2011). Cancer navigation has developed into assisting patients by coordinating diagnostic evaluations, providing disease-specific education and social support, managing symptoms, and ensuring adherence to quality treatment standards (Fashoyin-Aje et al., 2012).

Medical oversight is a critical component of the navigation model to develop the medical plan. A provider champion is necessary to facilitate a successful navigation program (May, Woldhuis, Taylor, & McCahill, 2013) while the navigator implements the plan of care.

Although there is no standard definition for the navigator in the literature, this guideline will discuss the role of gastroenterology navigators and the impact they have in providing coordinated, evidence-based care.

Definitions

GI cancers refer to malignant conditions of the gastrointestinal tract and accessory organs of digestion, including the esophagus, stomach, biliary system, liver, pancreas, small intestine, large intestine, rectum, and anus.

GI refers to gastrointestinal.

Navigator refers to a health care professional with clinical expertise who guides patients along the health care continuum.

Background

In 2018, an estimated 1,735,350 new cases of cancer were diagnosed in the United States, and 609,640 people died from the disease. It is projected that GI-related cancer deaths will rank among the highest in estimated cancer deaths in 2019 (American Cancer Society [ACS], 2019). The 4th most common cancer (according to estimated new cases in 2018) is colorectal cancer. Historically, colorectal cancer death rates declined 53% from 1970 to 2016 among men and women because of increased screening and improvements in treatment. However, in adults younger than age 55, new cases of colorectal cancer have increased almost 2% per year since the mid-1990s (ACS, 2019).

The adoption of a gastroenterology navigator can help address – and possibly reverse – these trends. An evidence-based navigator program can positively engage patients, influence screening rates, and support the treatment plan of care.

The navigator transforms care through assessment and advocacy, decreasing barriers (i.e., insurance, language, prep compliance) to access, coordinating and utilizing appropriate resources, and providing a positive financial impact.

Beyond efficiently coordinating the treatment trajectory, the navigator promotes continuity of care by considering the needs of the patient as well as the system’s characteristics. The navigator facilitates various facets of care, including preventative health education, screening, maintenance and follow-up in accordance with the patient’s needs throughout the entire health continuum. As the treatment plan changes, it may become necessary to hand off care to a navigator in a different specialty in order to meet the patient’s needs.

Role Description

An effective gastroenterology navigator possesses skills in communication, organization, problem-solving, critical thinking, collaboration, advocacy, time management, and multi-tasking. He/she must possess knowledge and experience in the GI specialty and have a broad understanding of the health care system.

The role of the gastroenterology navigator enhances quality care and is driven by the needs of both the community in general and the specific health care organization. It involves, but is not limited to, the following functions:

  • - ​Providing clinical education;
  • - Assessing patient care needs;
  • - Advocating for the patient;
  • - Supporting/addressing psychosocial needs of the patient, family, and community;
  • - Coordinating care using a multidisciplinary approach;
  • - Promoting continuity of care;
  • - Expediting access to services and resources;
  • - Handing off to appropriate resources as necessary;
  • - Trending data and outcomes as established for the navigation program (Centers for Disease Control and Prevention [CDC], 2016);
  • - Identifying gaps to improve patient care across the care continuum;
  • - Implementing evidence based changes; and
  • - Evaluating the effectiveness of the program.

Summary

A gastroenterology navigator is empowered to transform and improve the patient care experience by coordinating services in a manner that is collaborative, holistic, inclusive, and responsive to patient care needs and preferences (Murray & Cooper, 2015).

The responsibilities and functions of the navigator in the gastroenterology setting are inherent to the RN scope of practice. SGNA recommends that the professional who assumes the role of navigator be a registered nurse with experience in gastroenterology. Refer to SGNA Standards of Clinical Nursing Practice and Role Delineations in the Gastroenterology Setting.

References

American Cancer Society (ACS). (2019). Key statistics for colorectal cancer. Retrieved from https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html

Centers for Disease Control and Prevention (CDC). (2016). New Hampshire Colorectal Cancer Screening Program: Patient navigation model for increasing colonoscopy quality and completion: A replication manual. Atlanta, GA: National Center for Chronic Disease and Health Promotion, Division of Cancer Prevention and Control, CDC. Retrieved from https://www.cdc.gov/cancer/crccp/pdf/nhcrcsp_pn_manual.pdf

Dohan, D. & Schrag, D. (2005). Using navigators to improve care of underserved patients. Cancer. 104, 848-55. doi.org/10.1002/cncr.21214

Fashoyin-Aje, L., Martinez, K., & Dy, S. (2012). New patient-centered care standards from the Commission on Cancer: Opportunities and challenges. The Journal of Supportive Oncology. 10, 107-11. DOI: 10.1016/j.suponc.2011.12.002

Francz, S. (2011). The emergence of nurse and patient navigation. Retrieved from https://www.cancerexecutives.org/assets/acenews11-july.pdf

May, M., Woldhuis, C., Taylor, W.K., & McCahill, L.E. (2013). Gastrointestinal nurse navigation: Implementation of a novel role. Clinical Journal of Oncology Nursing, 18(2), 193-198. DOI: 10.1188/14.CJON.193-198

Murray, A. & Cooper, H. (2017). The nurse navigator: An evolving model of care. Collegian. 24, 205-212. Retrieved from https://www.collegianjournal.com/article/S1322-7696(16)00003-2/pdf

Recommended Reading

Green, B.B., Anderson, M.L., Wang, C.Y., Vernon, S.W., Chubak, J., Meenan, R.T., & Fuller, S. (2014). Results of nurse navigator follow-up after positive colorectal cancer screening test: A randomized trial. Journal of the American Board of Family Medicine, 27(6), 789-795.

Elkin, E.B, Shapiro, E., Snow, J.G., Zauber, A.G., & Krauskopf, M.S. (2012). The economic impact of a patient navigator program to increase screening colonoscopy. Cancer, 118(23), 5982-8. doi: 10.1002/cncr.27595.

Fillion, L., de Serres, M., Lapointe-Goupil, R., Bairati, I., Gagnon, P., Deschamps, … Demers, G., (2006). Implementing the role of patient-navigator nurse at a university hospital centre. Canadian Oncology Nursing Journal. 16(1), 5-10.

Created March 2019. Approved by the SGNA Board of Directors on April 2019.

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