ATUAÇÃO DO ENFERMEIRO NAVEGADOR NO ACOLHIMENTO AO PACIENTE ONCOLÓGICO

A ideia de navegação partiu de um estudo no Harlem Hospital Center, nos Estados Unidos da América, pelo Dr. Harold Freeman. Os enfermeiros navegadores são treinados para antecipar e entender o impacto que o diagnóstico de câncer tem para os pacientes e seus familiares, direcionar suas necessidades e reduzir barreiras de acesso a assistência oncológica. Objetivo: Conhecer através das produções científicas sobre o enfermeiro atuando na oncologia com a função de navegador de pacientes, Nurse Navigator. Método: Revisão bibliográfica da literatura com buscas nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature, Analysis and Retrievel System Online (MEDLINE). Resultados: O papel do enfermeiro navegador está centrado em minimizar as barreiras de acesso ao sistema de saúde, que impeçam o paciente de ter o cuidado que ele necessita. São habilitados para antecipar e entender o impacto que o diagnóstico de câncer tem para os pacientes e seus familiares. Conclusão: Este estudo revelou alguns aspectos relevantes sobre a atuação do enfermeiro navegador no acolhimento ao paciente oncológico. Esses profissionais melhoraram consideravelmente a visão do paciente acerca do seu tratamento. Os pacientes sente-se mais protegidos, mais envolvidos e empoderados com o seu tratamento, consequentemente mais bem preparados para o futuro, por adquirir conhecimento sobre a forma como o câncer afeta suas vidas.

Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

ObjectivesTo summarise the current evidence regarding interventions for accurate and timely cancer diagnosis among symptomatic individuals.DesignA scoping review following the Joanna Briggs Institute’s methodological framework for the conduct of scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Data sourcesMEDLINE (Ovid), CINAHL (EBSCOhost) and PsycINFO (Ovid) bibliographic databases, and websites of relevant organisations. Published and unpublished literature (grey literature) of any study type in the English language were searched for from January 2017 to January 2021.Eligibility and criteriaStudy participants were individuals of any age presenting at clinics with symptoms indicative of cancer. Interventions included practice guidelines, care pathways or other initiatives focused on achieving predefined benchmarks or targets for wait times, streamlined or rapid cancer diagnostic services, multidisciplinary teams and patient navigation strategies. Outcomes included accuracy and timeliness of cancer diagnosis.Data extraction and synthesisWe summarised findings graphically and descriptively.ResultsFrom 21 298 retrieved citations, 88 unique published articles and 16 unique unpublished documents (on 18 study reports), met the eligibility for inclusion. About half of the published literature and 83% of the unpublished literature were from the UK. Most of the studies were on interventions in patients with lung cancer. Rapid referral pathways and technology for supporting and streamlining the cancer diagnosis process were the most studied interventions. Interventions were mostly complex and organisation-specific. Common themes among the studies that concluded intervention was effective were multidisciplinary collaboration and the use of a nurse navigator.ConclusionsMultidisciplinary cooperation and involvement of a nurse navigator may be unique features to consider when designing, delivering and evaluating interventions focused on improving accurate and timely cancer diagnosis among symptomatic individuals. Future research should examine the effectiveness of the interventions identified through this review.

Cancer Provider and Survivor Experiences With Telehealth During the COVID-19 Pandemic

PURPOSE The COVID-19 pandemic led to rapid shifts in cancer survivorship care, including the widespread use of telehealth. Given the swift transition and limited data on preferences and experiences around telehealth, we surveyed oncology providers and post-treatment survivors to better understand experiences with the transition to telehealth. METHODS We distributed provider (MD, PA or NP, nurse, navigator, and social worker) and survivor surveys through the American College of Surgeons Commission on Cancer in mid-October 2020. Survivor surveys were also disseminated through patient advocacy organizations. We included questions on demographics, experiences with telehealth, and preferences for future telehealth utilization. RESULTS Among N = 607 providers and N = 539 cancer survivors, there was overwhelmingly more support from providers than from survivors for delivery of various types of survivorship care via telehealth and greater comfort with telehealth technologies. The only types of appointments deemed appropriate for survivorship care by both > 50% of providers and survivors were discussion of laboratory results or imaging, assessment and/or management of cancer treatment symptoms, nutrition counseling, and patient navigation support. Only a quarter of survivors reported increased access to health care services (25.5%), and 32.0% reported that they would use telehealth again. CONCLUSION Although there have been drastic changes in technological capabilities and billing reimbursement structures for telehealth, there are still concerns around delivery of a broad range of survivorship care services via telehealth, particularly from the patient perspective. Still, offering telehealth services, where endorsed by providers and if available and acceptable to cancer survivors, may provide more efficient and accessible care following the COVID-19 pandemic.

Feasibility and preliminary effectiveness of a cancer survivorship care delivery intervention.

19 Background: A large and rapidly increasing number of US cancer survivors who have completed active treatment continue to seek oncology care. Low-risk survivors who continue to seek oncology care incur greater costs but experience worse care quality and outcomes than those who seek primary care. In this study, we assessed the feasibility and preliminary effectiveness of START (Supporting Transitions AfteR Treatment), a theory-driven, stakeholder-engaged intervention intended to improve the transition of low-risk survivors to primary care. Methods: To pilot START, beginning in August 2020, we engaged oncology providers (n = 5) and staff (n = 4) at a small community affiliate of our academic comprehensive cancer center. We worked with a nurse navigator, office manager, and physician champion to refine START’s content and delivery to accommodate the needs of a busy community cancer center. We queried electronic health records (EHRs) to assess the feasibility of identifying low-risk survivors and measuring key outcomes (i.e., receipt of recommended health maintenance services). In a formal meeting, we introduced providers to START and helped them to identify survivors whom they agreed should be transitioned to primary care. Front desk staff flagged these survivors to remind providers to transition them in upcoming appointments. Beginning in July 2021, we will conduct in-depth, semi-structured interviews with oncology providers and staff and survivors regarding their perspectives on START’s acceptability, appropriateness, and feasibility. Results: We successfully identified survivors using EHRs and engaged the nurse navigator and providers in identifying the subset of survivors whom they deemed eligible for transitioning to primary care. Preliminary results indicate that START helped providers to transition eligible survivors to primary care. We have successfully engaged cancer center data managers in measuring relevant outcomes using EHRs. Informal provider and staff feedback suggests that START is an acceptable, appropriate, and feasible approach to transitioning survivors. Conclusions: At the conference, we will report on oncology provider and staff and survivor perceptions of START’s acceptability, appropriateness, and feasibility for improving survivorship care delivery and preliminary findings regarding START’s effectiveness in increasing survivors’ receipt of recommended health maintenance services. Findings will be used to refine START and form the basis of a clinical trial to evaluate its effectiveness in improving survivorship outcomes.

Piloting the REDUCE score to decrease acute care utilization.

252 Background: Emergency department visits and hospitalizations are common in patients with cancer, with nearly three quarters of patients with advanced disease hospitalized at least once in the year after their diagnosis. Efforts to prospectively identify patients at highest risk for this acute care utilization (ACU) are needed. While many risk scoring systems have been developed for this purpose, few have been effectively integrated into clinical practice. We piloted a prospective risk assessment tool using a quality improvement framework. Methods: We utilized our previously published REDUCE score (Reducing ED Utilization in the Cancer Experience) to pilot clinical interventions to reduce ACU using PDSA cycles. Cycle 1 included a chart review and targeted outreach by a nurse navigator to high risk patients identified by REDUCE. Outreach resulted in communication of patient needs to the care team, which may or may not have resulted in additional interventions. Cycle 2 involved initial identification by REDUCE followed by further assessment with a distress screening. Those who were high risk and had high distress (score ≥4) were discussed by an interdisciplinary team (including supportive medicine physicians, social work, nurses, nurse practitioners) to determine an appropriate intervention. Results: Of the patients in Cycle 1 (N = 138), 26.1% had ACU after outreach by a nurse navigator, while in Cycle 2 (N = 169) 7.1% had ACU after the intervention determined by the interdisciplinary team. The average distress score among all patients in Cycle 2 was 6.0 and the REDUCE score was 2.87, while the subset of patients who experienced ACU had an average distress score of 6.4 and a REDUCE score of 3.22. Conclusions: The REDUCE score may be a valuable tool to assist in identifying patients at risk for ACU. We found that combining the risk score with a biopsychosocial screening tool and multidisciplinary team discussion may prove more valuable than the risk score alone, with Cycle 2 findings suggesting that there is a directional correlation between REDUCE score and distress screening results. More work is needed to understand the relative impact of the REDUCE score and the biopsychosocial screening and team discussion on decreasing ACU.