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2021 AONN+ Conference Highlights: Part 3

Conference Highlights - 2021 Annual Conference

AONN+ Poster Awards

At each AONN+ conference, the awarding of recognition for exceptional posters created by members is a highly anticipated event. The poster awards are given to evidence-based navigation research studies, quality improvement projects, and best-practices projects that enhance professional understanding of key navigation and survivorship care issues. All submissions received a peer review, and accepted posters are exhibited at the conference.

Entering your project into the poster awards is an exciting way for your research to be presented to a larger audience and provides an opportunity to discuss your work. The work of the committee is difficult, as it requires narrowing down to just a few the many wonderful projects we receive, and this meeting was no exception.

Prizes are awarded in 9 categories of research and practice. Consider preparing an abstract for the next conference. See the website for more information about preparing your abstract and poster. While there you will find some helpful resources.

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Professional Oncology Task Force

The Professional Oncology Navigation Taskforce (PONT) is a collaborative group of oncology professional practice associations that includes the Academy of Oncology Nurse and Patient Navigators (AONN+), Association of Oncology Social Work (AOSW), Association of Pediatric Hematology/Oncology Nurses, Oncology Nursing Society (ONS), the Cancer Support Community (CSC), and the Smith Center for Healing and the Arts. In this panel, Lisa Simms Booth, Susie Burke, Monica Dean, Elizabeth Franklin, Danelle Johnston, and Brenda Nevidjon tackled the job of conveying a comprehensive account of the history of the task force and the development of a set of professional standards.

PONT arose out of the Biden Cancer Initiative (BCI), a nonprofit cancer foundation set up by the then-former Vice President Joe Biden. (BCI discontinued its work when President Biden announced his intention to seek the presidency.) Although BCI did not go forward, an informal coalition had formed, and the members decided to continue meeting and to concentrate on educating the general population regarding the role of the navigator. This work would focus on creating a set of standards that would establish navigation as a profession and an emphasis on individual career development. An underlying concern of the task force was to ensure that any organization with a stake in navigation would be “at the table.”

From the beginning, the guiding philosophy was that if nurse and patient navigation was going to be defined and codified, it should be done by those in the profession, not from the outside. Mindful of this, and the varied roles of the many caregivers involved in oncology navigation, they were “very careful around definitions—navigator, patient navigator, and so forth—want to focus on a unity of definitions so that they are standardized.” In addition, they wanted to define the professional navigator vis-à-vis the lay navigator. Ms Johnston remarked, “the delineation of the role of the navigator was so important because it tends to be a catchall.”

As to the history of patient navigation, the profession emerged following the 1989 American Cancer Society National Hearings on Cancer in the Poor. The Hearings highlighted the substantial barriers, pain and suffering, personal sacrifices, and discrimination many people with limited financial means face when confronted with cancer. In 1990, Dr Harold Freeman launched the first patient navigation program in the United States based in Harlem, New York, as a partial solution to these problems. Since the founding of that first program, patient navigation has evolved, expanded, and grown. Some landmark events in the development of navigation include:

  • 2005 American Cancer Society launched patient navigator program
  • 2009 AONN+ founded
  • 2010 ONS, AOSW, NASW joint position on the role of Oncology Nursing & Oncology Social Work in Patient Navigation
  • 2013 ONS published Oncology Nurse Navigator (ONN) Core Competencies

The definition of navigator has also come to include unlicensed, nonclinical navigators, as well as those with clinical nurse or social work licenses. In addition, many individuals fill vital roles alongside navigators in both clinics and hospitals. These include community health workers, promotores/promotoras de salud, and financial navigators, along with many other individuals and roles who help to navigate patients across the cancer care system. After 3 decades, however, there was not a uniform set of standards that would create a basis for the profession.

The task force identified a set of 19 measures specific to the navigation discipline and scope-of-work to isolate and include in the final standards. PONT began drafting the standards in October 2020, meeting twice a month and working on defining 2 of the 19 indices per month. The objectives of the professional standards are to:

  • Enhance the quality of professional navigation services provided to people impacted by cancer.
  • Advocate with and on behalf of cancer patients, survivors, families, and caregivers to protect and promote the needs and interests of people impacted by cancer.
  • Encourage navigator participation in the creation, implementation, and evaluation of best practices and quality improvement in oncology care.
  • Promote navigator participation in the development, analysis, and refinement of public policy at all levels to best support the interests of people impacted by cancer and to protect and promote the profession of navigation.
  • Educate all stakeholders about the essential role of navigators in oncology systems.

The standards are intended to serve as guidance for professional practice (regardless of setting). Exceptions may be necessary and should be determined on an individual- or institutional-basis.

After the draft was completed, the task force then entered the next stage in the work when they subjected the standards for public review and responded to comments. The committee is anticipating publication in early 2022.

In some breaking news, Monica Dean responded to an attendee’s question about possible mentorships and said that AONN+ plans to launch one in the future. It is “a huge priority,” said Ms Dean.

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Using Technology in Disparate Populations

This panel, presented by Matthew Manning, MD; Samuel Cykert, MD; Dana Herndon, RN; and Christina Yongue, MPH, MCHES took a critical look at a timely subject. The presentation, “Technology Innovation Integration to Address Underserved Disparate Patient Populations,” opened with Dr Cykert stating that, “Navigators are doing God’s work,” and he praised the professionalism and dedication they have exhibited, especially during a period of national crisis. He went on to say that, unfortunately, the racial disparities in healthcare don’t seem to be improving and have only worsened during the pandemic. The topic was framed as “An Intervention to Achieve Equity in the Healthcare System.”

Using quantitative studies, evidence was presented demonstrating that the racial healthcare disparities are present across a variety of quality measures. Arguing that the consequences of illness for black patients tend to be more severe, he remarked, “When white America gets a cold, black America gets pneumonia.” As an example, a study in 1990 saw an improvement in survival among white women, however, it was not until 10 years later that black women saw a similar improvement.

Data show that among people of color who contract COVID-19, life expectancies were significantly affected between January 1, 2020 and December 31, 2020:

  • US whites experienced a decrease of 1.2 years
  • US blacks experienced a decrease of 2.9 years
  • US Latin-X experienced a decrease of 3.0 years
    (Source: National Center for Health Statistics (CDC).

And despite the explosion of precision medicine and the wonderful new horizons that have opened, researchers are already finding that black patients are being tested for genetic variations less often than white patients and are offered biologic treatments less often.

As a partial solution, they argued, it should be the role of healthcare providers to offer solutions that close the racial gap. They suggest that instead of looking at patients individually, because individual patients are not reflective of the whole, it is more useful to look at the entire system to see the gaps and disparities.

One way to address this is through community involvement programs where local leaders of communities of color can pair with healthcare providers to reach out. People are more likely to trust a local leader with whom they have a relationship than to see the white healthcare worker as trustworthy.

They cited as a case history the Greensboro Health Disparities Collaborative clinic. The mission of the clinic is to “establish structures and processes that respond to, empower, and facilitate communities in defining and resolving issues related to disparities in health.” In creating the neighborhood clinic, there had been a deliberate effort to bring together professionals of different racial, religious, and age cohorts with professional specialties. They then trained together and have developed a common language in order to work and make decisions together. In an analysis of the community, clinic researchers concluded that the factors necessary to ensure success were:

  • - Transparency
  • - Accountability
  • - Enhanced communication.

One observation, gleaned from this clinic experience, was that through using enhanced communication, eg, avoiding healthcare lingo with the patient (and the patient’s family) they had more success in meeting benchmarks.

They employed other accountability interventions using technology, for example, if a patient missed an appointment, the electronic health records (EHR) system was programmed to trigger the navigator to take action. If a scheduled patient milestone was not met, there would be a warning, and the navigator could then follow-up on the cause. In sum, if a gap in care occurred, there would necessarily be accountability, with the navigator taking a proactive role.

The panel also discussed other test-cases that used similar measures to close the healthcare gap, relying on EHRs to help ensure transparency, accountability, and communication deemed essential. In conclusion, the presenters said:

  • Real-time digital data provided by EHRs can be used to remedy cancer treatment disparities
  • Innovative technology doesn’t work unless dedicated trained navigators act on the technology and add the human touch
  • For system-based intervention to succeed, navigators, clinical teams, and health system leaders must keep the community engaged in working through barriers and ensuring accountability.

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Understanding the Commission on Cancer

The Commission on Cancer (CoC) is now a century old. As it recognizes this significant milestone anniversary in 2021, it celebrates 100 years of quality improvement and the 59 organizations which comprise it. Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG, Distinguished University Professor of Breast Cancer, Johns Hopkins University School of Medicine, and Frederick L. Greene, MD, FACS, Levine Cancer Institute, Charlotte, NC, Past Chair, Commission on Cancer, conducted this in-depth discussion of the CoC. They said their objectives for the session were to:

  • Describe the philosophy and principles governing development of CoC Accreditation Standards
  • Discuss specific 2020 CoC Standards and their implications for Oncology Patient Navigators and Oncology Nurse Navigators
  • Identify opportunities for patient enhancement and clinical research utilizing CoC-generated data

As explained by Dr Greene, the CoC is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care. The CoC is an effective mechanism for impacting cancer care, as it has a direct impact on patient navigation, palliative care, and survivorship. The fact that it is not stagnant, and instead revises standards in an ongoing process based on evidence and best practices contributes to its continued relevance and prestige.

There are 1540 CoC-accredited cancer programs (about 24% of acute care hospitals) in the United States, and they care for about 75% of all cancer patients. The benefits of CoC Accreditation include recognition as an accredited cancer program, ability to participate in cancer standards development, and other institutional benefits. In addition, the CoC Accreditation provides institutions other tangible and intangible benefits. As to the tangible benefits, said Dr Greene, it offers organization and infrastructure to cancer programs and supplies data in order to assess patterns of care and outcomes.

The 2020 CoC Standards revision introduced a number of changes, some of which will impact the way navigators work. They were crafted to support and enhance efforts to improve patient care. There is currently a phase-in to section 4 of the standard that focuses on oncology nursing. This applies mainly to the process of acquiring and maintaining oncology nursing credentials and is pertinent to nurses, registered nurses, and advanced practice nurses who must provide direct oncology care in an accredited facility for at least an entire calendar year.

Lillie Shockney then spoke about changes in the survivorship section. She emphasized that in conjunction with the outlines provided by the CoC standard, navigators should think about adding a discussion of family planning in a long-term survivorship plan, which should be thought of as a “life plan.” Even if it seems premature, this discussion will give the patient an opportunity to consider preserving fertility.

A notable asset of the CoC is the incredibly rich NCBD database. The “participant user file” with its 39 million cases is available to all for use in research for peer-reviewed or plenary papers. With site-specific cases and deidentified data, it is an incomparable research source. Navigators are urged to include this data in their evidence-based research.

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