We Know Oncology Nurse Navigators Improve Patient Experience, but Measurement Is Difficult
In February 2019, my colleagues and I published a retrospective analysis of patient-reported satisfaction comparing those who had contact with an oncology nurse navigator (ONN) and those who did not. We analyzed surveys from patients with outpatient oncology infusion or radiation oncology visits in a 24-month period. First, we sorted the surveys into two groups—self-reported ONN contact (n = 315) and self-reported no contact with an ONN (n = 172)—and compared satisfaction.
We narrowed our analysis to questions that reflected the differences ONNs were making by first conducting a literature review and then applying that knowledge to identify survey items that measured an ONN’s influence. These questions covered nursing care, patient education and counseling, timeliness of care, care coordination, and overall satisfaction.
Patients in both groups were highly satisfied (https://doi.org/10.1188/19.CJON.76-81), but satisfaction was higher in the group with ONN contact. Mean scores for all 15 items included in the analysis were higher in the group with ONN contact as compared to the group without ONN contact. Other benefits of nurse navigation include (https://www.ons.org/make-difference/advocacy-and-policy/position-statements/ONN) shorter time to diagnosis and treatment, increased patient and caregiver knowledge, better adherence to care, and improved quality of life.
From a nursing perspective, we should always be concerned about measuring outcomes. That’s especially true for relatively new ONN roles and for nursing roles that don’t have billable services. Without a billable service, we can’t easily measure productivity of a position or distinguish the work of that position from those of other positions. ONNs work in a variety of ways, which also makes outcome measurement difficult. ONNs working to increase screenings will have different outcomes than ONNs working with patients going through chemotherapy for gynecologic cancer, for example.
Unfortunately, outcome metrics of contact with navigators have been underdeveloped and the variety of approaches to navigation creates a situation in which measuring outcomes is even more difficult. Studying outcomes of navigation separate from outcomes related to other resources in a cancer program is also difficult. In more recent years, work in the role delineation of ONNs (which ONS conducted in 2016 (https://doi.org/10.1188/17.CJON.43-50)) and the specific expertise and knowledge brought to the position by nurses has become important to study.
We need to continue to define and develop the metrics and have nurses to do that independently because they know the role best. We also need to continue focusing research on outcomes for these roles, particularly for the distinction of oncology nurses as navigators and what they specifically bring to the patient experience.