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Does a Breast Cancer NurseNavigator Program Change theTime Elapsed Between Steps in theTreatment Plan?

Overview of Project Three Measures regarding breast cancersurgery and the Nurse Navigator program2 quantitative measures1.2.Time from diagnosis to surgeryTime from surgery to radiation1 qualitative survey1.Patient satisfaction2

Oncology Nurse Navigator RoleWhy is there a Nurse Navigator?COC, NAPBC/ American College of SurgeonsWhat is the role of the nurse navigator in breast cancer treatment?3

Oncology Nurse Navigator Role Educate, explain,answer questions Support Coordinate betweenproviders Connect with resources4

Oncology Nurse Navigator Role Typical pathway for early-stage Breast CancerImaging Breast Biopsy Pathologyresult showscancerAppointmentwith BreastSurgeon Surgical options Surgery DateLumpectomy See Med Oncand Rad Onc AdjuvantRadiation5

Why look into the data? Difficult to quantify intangible effects There is a need for metrics in the navigatorcommunity6

3 Measures for breast cancer care at LUH1. DiagnosisSurgery Time from diagnosis to surgery– with and without navigator intervention timeframe: 2015 – 20177

3 Measures for breast cancer care at LUH2. SurgeryRadiation Time from surgery to adjuvant radiation,– with and without navigator intervention timeframes: 2015- 20178

3 Measures for breast cancer care at LUH3. Satisfaction with the Nurse Navigator program9

Time from Diagnosis to SurgeryResults: 7-58 days with navigator 13-83 days without navigator10

Time from Diagnosis to Surgery At LUH: Benchmark NQMBC NationalQuality Measures forBreast Centers: timefrom biopsy to initialsurgery is up to 50 days. 49/51 meet thebenchmark with Nav 48/51 meet thebenchmark w/o Nav Of total 102: 95%meet the qualitybenchmark.11

DiagnosisSurgeryWithout NavigatorWith 1212120202020202020201818161616161315103050697012

Time from Diagnosis to Surgery Mean with navigator: 24.6 days Mean without navigator: 28.9 daysNot statistically significantP value 0.93N 5113

Time from Diagnosis to SurgeryWhat else would we like to know from the data? Patient age Does the time of year effect the timeframe? Compare to subsequent years Consider reporting/ publishing/ publicizingthe high quality14

Time from Surgeryto Adjuvant Radiation Benchmark? Couldn’t find a consensus. Institutional Standard: 4-6 weeks (28-42 days) Time must be allowed for healing post-surgery Many variables affect this timeframe15

Time from Surgery to AdjuvantRadiationResults: 19-63 days with navigator 12-93 days without navigator Institutional Standard: 28-42 daysNot statistically significantP value 0.33N 3016

Time from Surgery to AdjuvantRadiationWith NavigatorWithout 02530350510152025303517

Time from Surgery to AdjuvantRadiationWhat else would we like to know? Patient age Does the time of year effect the timeframe? Compare to subsequent years Process improvements needed How does the timeframe affect outcomes?18

Statistical analysis Sample sizeFinding the right analytical toolsStatistical significanceStatistical analysis to be continued .19

Implications for Navigator As metrics to evaluate the navigator programthese two measures may or may not bepertinent.Therefore . Patient satisfaction was also evaluated.20

Patient Feedback for Navigator:Method Surveys were conducted by phone, by LUHvolunteers. Collection is ongoing.21

Evaluating the navigator program1. Navigator improved overall comfort93% gave highest response2. I would recommend the service to others89% gave highest response3. Navigator provided helpful info, resources78%4. Navigator kept me and my family informed69%22

Evaluating navigator services1. Navigator accessibility during treatment93.7% responded Really Helpful2. The navigator being present at biopsy93.3% responded Really Helpful3. Notes taken during physician appointment92%4. The Health Organizer/Binder information81%5. Follow-up/Reminder Phone Calls from ONN78%23

Patient Satisfaction Scores- 96% positive overallstrongly agree/veryhelpful- 85%0%1%3%11%agree/helpful- 11%neutraldisagree/unhelpful85%strongly disagree/veryunhelpful- zero24

Patient Satisfaction Overall Using 1 to 5 scale, 120 of 141 responses acrosscategories, or 85%, gave the highest rating. Average: 4.8 out of 5 Very satisfied patients25

Future research Needed: Could not find a benchmark for the timeframe foradjuvant radiation. Is there a difference in outcomes? Needed: Continue to measure quantifiable impacts ofnavigator. Bigger sample sizes, measuring similar metrics,might reach statistical significance? Other ways to look at the same data: differences by age, timeof year, insurance status, etc. Continue to gather patient feedback for the navigatorprogram.26

Limitations Sample sizesSingle institutionLack of clear benchmarks for comparisonCoaching of volunteers in conducting phonesurveys27

Acknowledgements Josh Hu Lynn Snell Shawn Bonner Longmont Breast CancerCare team Shawnna Snodgrass28

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Does a Breast Cancer Nurse Navigator Program Change the Time Elapsed Between Steps in the . 2 quantitative measures 1. Time from diagnosis to surgery 2. Time from surgery to radiation 1 qualitative survey 1. Patient satisfaction 2. Oncology Nurse Navigator Role Why is there a Nurse Navigator? . Finding the right analytical tools .