Nurse Navigators

Speaker 1: Welcome to Bench to Bedside, a weekly series of live conversations about recent advances in cancer, from the research bench to treatment at the patient's bedside. Now, your host and the director of the University of Kansas Cancer Center, Dr. Roy Jensen.

Dr. Roy Jensen: Hi. I'm Dr. Roy Jensen, and with me is Teri Banman, manager of nurse navigation at the University of Kansas Cancer Center. Nurse navigation has been around for about 30 years now and plays a critical role in the care of our patients. Could you tell us a little bit about how the nurse navigator helps a patient?

Teri Banman: Mm-hmm (affirmative). You can really can describe the nurse navigator role in three different buckets. The first one is we help patients get scheduled with the right providers, whether that's a surgeon or a medical oncologist, radiation oncologist, or all of the above. We help make sure that all the testing that's needed, to either diagnose their cancer, or not, hopefully, or stage the cancer, is obtained in a timely manner. So the mission of our program is to really help decrease the time from initial presentation to start of therapy. Then another big part of our role is we help collect all the information that's needed for the provider to make treatment planning. Whether that's medical records or pathology slides, radiology films, we want all of that information to be available at the patient's first visit so they can have a really meaningful visit with their provider. The second bucket is we identify barriers to care for a particular patient, whether that's transportation, lodging, financial concerns. The navigator does an assessment on every patient and just helps resolve whatever barriers are identified or helps connect them to necessary support services. Then the third bucket is our tumor conference coordination. We have 13 disease-site specific tumor boards that a navigator is part of at The University of Kansas Cancer Center. The navigator role is to make sure that all the coordination takes place ahead of time, to make sure the physicians can have a very productive discussion about the patient. We attend the tumor board and we document outcomes of the discussion, including what the recommendations are, and then we make sure that everything gets done, that all the recommendations are carried out so that can get the patient started on treatment as soon as possible.

Dr. Roy Jensen: If you're just joining us, we're talking about the important role of nurse navigators at the University of Kansas Cancer Center in helping to guide patients through cancer treatment. Alesha Miller is here with us this morning in the studio to take your question. Remember to share this link with patients who you feel might benefit from this discussion. Use the hashtag #benchtobedside.  Teri, do your nurse navigators, do they specialize according to the type of cancer? Tell us about the group that you have.

Teri Banman: Yeah. We have 24 oncology nurse navigators who are disease-site specific. They really are nursing experts in a particular area, such as breast cancer, or GI cancer, or hematologic malignancies. They are really part of this multidisciplinary team, which includes all types of different physicians, clinical nurse coordinators, nurse practitioners. The navigator's role is to get the patient into the door as quickly as possible, have all of the testing coordinated upfront, and then when a particular treatment is started then they become a resource for the patient throughout their journey at KU. We can help identify support services that they need and do education, a lot of education is done upfront about what is adenocarcinoma, what does it mean to be HER2-positive. I think probably one of the most important things that we do is provide that emotional support though a very trying time in a patient's life. We are that patient's nurse, no matter which provider they're seeing.

Dr. Roy Jensen: Mm-hmm (affirmative). If you're just joining us, we're talking with Teri Banman, manager of nurse navigation, about the important role of nurse navigation in cancer care. Teri, how do patients connect with a nurse navigator? How does that come about?

Teri Banman: Upon referral to a cancer provider, or potential cancer provider, we connect with that patient. Whether we get a fax from a referring provider, or a family member, or a patient calls in and asks to schedule an appointment with a provider, the nurse navigator then talks to the patient and we do our assessment and figure out what are the best next steps for that patient as part of this multidisciplinary care team. Occasionally, the patient needs to see a non-cancer provider, such as a dermatologist or a pulmonologist, and we help connect them to that right practice and then follow through to make sure that whatever has happened, if they do get cancer, then we make sure we get them plugged into the right providers next. We are here to talk to all the patients as soon as possible, as soon as we can get that referral.

Dr. Roy Jensen: That's a really tremendous service for our patients. Is this covered by health insurance?

Teri Banman: It is not. Today it's not billable through health insurance, but it is a service that our Cancer Center feels is very important for our patients so we don't bill the patients for the service either. Our program was started largely due to some funding from community members that had had a personal experience with cancer, a family member or them personally. So they made a donation to the Cancer Center to start the nurse navigation program.

Dr. Roy Jensen: Yeah. Alesha Miller is here in the studio to take your questions. Alesha, I believe we have a question from our audience?Alesha Miller: Yes. We have two questions. The first is from Danielle and she asks, "Can you explain more about what a tumor board is?"

Teri Banman: Sure. A tumor board is a meeting, it's a conference where different physicians come from all different specialties, pathology is represented there, radiology, the surgeons, the medical oncologists, radiation oncologists, and they present a particular case that may be an unusual case that they want to all put their heads together and come up with the best plan of care for the patient. So they review the pathology, the actual tissue on a slide, they look at the films, they discuss the plan amongst each other and come up with an agreement for what is best to treat the patient going forward.

Dr. Roy Jensen: And the second question, Alesha?Alesha Miller: The second question is from Ashley and she asks, "Are navigation services available for all cancer types of KU's Cancer Center?"

Teri Banman: Yes, it is, Ashley. We do have every disease group is covered now with a nurse navigator. We also have navigators are talking to patients at multiple locations all across the city. All of our community cancer centers throughout the metro, our cancer center at Westwood, and also some of our clinics here at the main hospital that see cancer patients, we have navigators available for all of those patients.

Dr. Roy Jensen: Well, Teri, thank you so much for being here today. As you know, my office is a frequent user of your services. It's really been a great enhancement, I think, for the benefit of our patients, getting all of these things coordinated and making that first visit as productive as possible and really trying to get an answer for our patients.

Teri Banman: Yeah.Dr.

Roy Jensen: So I am very appreciative of your efforts and all the folks in your office.

Teri Banman: Thank you.

Dr. Roy Jensen: That's all for today. We'll see you next Wednesday at 10:00 a.m., when we'll be bringing you Bench to Bedside. Thank you very much.