8/26/17 ONCOLOGY NURSING: WHAT IS ALL THE BUZZ AROUND NAVIGATION, SURVIVORSHIP AND DISTRESS SCREENING IN ONCOLOGY? WELCOME AND DISCLOSURES OBJECTIVES:

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1 ONCOLOGY NURSING: WHAT IS ALL THE BUZZ AROUND NAVIGATION, SURVIVORSHIP AND DISTRESS SCREENING IN ONCOLOGY? 2nd Annual Ellis Fischel Cancer Symposium: Holistic Approach to Cancer Care August 25-26, 2017 The Lodge of Four Seasons Lake Ozark, Missouri WELCOME AND DISCLOSURES I do not have any disclosures Welcome to LOTO and the 2 nd annual Ellis Fischel Symposium OBJECTIVES: Understand the difference between lay patient navigators and nurse navigators. Define survivorship and understand the rationale for delivering survivorship care plans. Distress Screening- the 6 th vital sign, discuss ideas to incorporate distress screening into your cancer program. 1

2 NAVIGATION: COC STANDARD 3.1 For COC accredited cancer programs there must be a clearly defined patient navigation process, driven by the triennial Community Needs Assessment, that is established to address health care disparities and barriers to cancer care. Resources to address identified barriers may be provided either on-site or by referral So, what does that all mean?? MAKING THE MOST OF YOUR NAVIGATION PROGRAM 6 questions program leaders need to ask themselves Do you have clearly defined goals for your navigation program? Are your navigator responsibilities aligned with the goals of your navigation program? Does everyone in your organization, including executives and clinicians, understand the benefits of your navigation program? Are navigators responsibilities clearly delineated and communicated to other members of the care team? Do you track the impact of navigation on your program s revenues, costs and quality of care? Do you regularly evaluate the navigator role to ensure top of license practice TWO MODELS OF NAVIGATION: LAY/PATIENT NAVIGATORS Non- clinical staff that is an experienced staff member with the organization and has in depth knowledge of the services and systems of your facility and is equipped to assist patients and families with a broad range of needs. What are some services a lay/patient navigator can assist with? Training/Education 2

3 NAVIGATION: NURSE NAVIGATION Nurse Navigators- clinical staff that coordinate the care of the patient from entry into the facility through the continuum of care What does that look like in your program? Training/Education SURVIVORSHIP: COC STANDARD 3.3 For COC accredited facilities the following standard has been set forth: The cancer committee develops and implements a process to disseminate a treatment summary and follow-up plan to patients who have completed cancer treatment. Based on the 2005 IOM Report From Cancer Patient to Cancer Survivor ELEMENTS TO INCLUDE IN SURVIVORSHIP CARE PLAN Treatment summary ( treating providers contact info, diagnosis, stage, surgery, chemotherapy, radiation therapy, ongoing toxicity/ses, genetic risk factors Follow-up care plan: expected follow up plans, intervals, cancer surveillance tests for recurrence, cancer screening for early detection, possible symptoms of recurrence, list of rare but significant late/long term side effects, list of local and national resources to assist patients in getting the support they need ( emotional, mental health, parenting, work/employment, financial issues and insurance). General statement emphasizing the importance of healthy diet, exercise, smoking cessation and alcohol use reduction. 3

4 SURVIVORSHIP CONT. SURVIVORSHIP CONT. EXAMPLES OF SURVIVORSHIP TEMPLATES-ASCO 4

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6 JOURNEY FORWARD TEMPLATE 6

7 DISTRESS SCREENING- 6 TH VITAL SIGN Standard 3.2- Each calendar year, the cancer committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care Temperature, respiration, heart rate, blood pressure, pain and DISTRESS DISTRESS SCREENING 35-45% of cancer patients report significant levels of distress NCCN recommends a more rigorous approach than the COC Oncology roundtable Quick Poll- states 15% of cancer programs are not screening for distress Distress screening can improve communication between patients and providers 7

8 COC DISTRESS SCREENING REQUIREMENTS All cancer patients must be screened for distress a minimum of one time at a pivotal medical visit as determined by the program. Method of screening is left to site Cancer Committee approves tool Assessment and referral Documentation ( # of patients screened, number referred, and where ( on site or off-site) DISTRESS SCREENING Elements of Distress 1. Emotional 2. Spiritual 3. Practical 4. Social 5. Physical 6. Psychological DISTRESS SCREENING Improved Outcomes Improved Treatment Adherence Address Psychosocial barriers Improve symptom management Improve the patient experience Educate patients on symptom management Increase awareness of support services Open communication with care team Reduced ED visits Decrease hosptializations Reduce appointment no-shows 8

9 STEPS TO IMPLEMENTING DISTRESS SCREENING Design a screening process that works for your work flow Choose a screening tool Decide who will perform screening Decide where patients will be screened Determine how often to screen patients SAMPLE DISTRESS SCREENING TOOL DISTRESS SCREENING TOOL EXAMPLE 9

10 DISTRESS SCREENING TOOL SAMPLE WE ALWAYS HAVE OPPORTUNITIES TO IMPROVE THE PATIENT EXPERIENCE J QUESTIONS?? 10