I often have people stare at me blankly when I introduce myself as the patient navigator for the breast care centre. One of my dear friends asked if I stand in front of the hospital and direct people to the department they’re looking for. I couldn’t help but chuckle as I started to explain my role in the breast unit. Clearly the title can be misleading and often times misused, and since it’s a fairly new role in South Africa, I wanted to take this opportunity to explain what a navigator is, and why it’s crucial to have one in all oncology units.
Many years ago, when patient navigation was first introduced, its initial purpose was to address the health disparities amongst women with breast cancer. Dr. Harold P. Freeman started an official patient navigation program at Harlem Hospital in New York City to reduce the rates of women coming in with advanced stage breast cancer. Once he implemented the program, navigators worked with women in the surrounding community by educating them on breast health, sending them for mammograms and following up if further evaluation was needed due to any abnormalities. The result of this program significantly reduced the number of women coming in with late stage cancer and in turn increased survival rates.
As the position evolved, the expectations of the navigator have increased. Coordination of services and liaising with the multidisciplinary team (radiologists, surgeons, oncologists, and other therapists) is vital to decrease fragmentation of care for the patient. Counseling patients who are dealing with any emotional, mental or physical distress related to breast cancer is also a huge component of navigation. The goal of the navigator should be to decrease as much stress as possible during the patient’s course of treatment. Simply put, navigators walk with patients from cancer diagnosis all the way to recovery to ensure a smooth transition in their clinical journey. It has not only become a critical role in cancer clinics, but other chronic illnesses such as diabetes and heart disease as well.
To elaborate on this further, I felt it would be a good idea to provide an example of how I would work with a patient who is newly diagnosed. Once a patient is diagnosed, I will reach out by either setting up an appointment or calling the patient to introduce myself and explain my role in the clinic. Since my preference is to meet my patients face-to-face, I partake in ward rounds everyday to meet the patients undergoing sentinel lymph node biopsies, as this is typically done very soon after diagnosis. I will then coordinate an appointment for the patient to see the specialist for the treatment that’s recommended by the team after the biopsy. Regardless of which step in the clinical pathway is next, it is my duty to ensure that the patient is well informed and ready to partake in treatment. Some examples include: re-explaining the type of surgery the patient is to undergo, counseling on how to cope with side effects of chemo, radiation and endocrine therapy, or simply assisting the patient if they’re experiencing any form of distress.
As the patient continues their journey, I will ensure that their specialist appointments following the first treatment are made in a timely manner. I will frequently follow up with both the doctor and the patient to make sure there aren’t any issues along the way.
With the way health care systems are being set up in this day and age, it is vital that there is one individual tracking the journey of the cancer patient. In hospitals all over the world, each specialist could potentially work in a different facility, which can create a confusing and stressful journey for the patient. Not only do they end up dealing with their diagnosis, but now trying to coordinate the many doctors and therapists they have to be treated by. With a patient navigator, this journey is simplified and more tolerable as the patient has an advocate to walk them through to recovery.