Medical oncologist Richard J. LoCicero, MD, believes navigators fill in the patient care blanks offering their value as coordinators, shoulders of support, and negotiators.
The community of Gainesville, Georgia, is a small city of more than 33,000 people and is about an hour north of Atlanta. Much of the surrounding area is woodsy, with the Blue Ridge Mountains nearby and Lake Lanier bordering Gainesville.
Gainesville is served by 2 oncology practices and a community hospital. One of the oncology practices is The Longstreet Clinic, (pictured below) which is a multispecialty, multiprovider practice that is also a Commission on Cancer–accredited center.
This is a busy practice, and one of its medical oncologists is Richard J. LoCicero, MD, (pictured left) who understands the value of the navigators who support both Longstreet’s patients as well as the other oncology practice in town. LoCicero says they have a good relationship with the other oncology practice, sharing weekend calls and unassigned emergency department calls. The local hospital, Northeast Georgia Medical Center, provides the navigators for both practices. This unique situation has everyone pitching in to lend a hand, and LoCicero uses the term “community” often to describe how they all work together.
LoCicero recently spoke to AONN+ about the value of the navigators who work with his patients, and how they are filling in the blanks by addressing care coordination and lending needed support.
AONN+: How do you work with navigators in your practice?
LoCicero: The local hospital provides the navigator program, and all of the oncologists work closely with the navigators. We started with a breast cancer navigator, and we now have a thoracic head and neck navigator, a gastrointestinal navigator, and an American Cancer Society resource navigator.
We developed our navigator program to be embedded with all the clinicians in town as a way to connect patients with resources throughout their whole cancer experience. They don’t have a clinical role, but they are present for appointments. They accompany patients to surgery; they make contact before and after appointments; and they help connect patients to various resources.
They have helped the clinicians fill in those important gaps in many ways.
In a busy practice, we sometimes miss out on referrals to clinical trials, and the navigators remind the oncologists about them. They have helped with the development of our psychosocial distress program, and they have developed our survivorship model to be compliant with the standards.
Our current plan is to bring on new nurse and lay navigators to fill in gaps in other areas of cancer care. Our next step is to bring in a hematology nurse navigator.
AONN+: Are the nurse navigators onsite?
LoCicero: The navigators’ offices are at the hospital; however, their role is to meet the patients with the physicians during their first consults. There are many times during the course of treatment when the navigators are an integral part of our practice.
The nurse navigators provide education as well as a treatment plan. In that way, they use their clinical skill, but they are not providing clinical management.
The lay navigators are going to do more of the follow-up to determine patients’ needs and act as an extension of the nurse navigators to communicate what needs to be accomplished. For example, if a lay navigator learns that a woman is having wound issues postoperatively, the lay navigator may say, “That’s important to know. I’m going to let the nurse navigator get back in touch with you to help you deal with it.”
Our goal is to make sure that there is a constant point of contact to connect patients with resources or to provide assistance when needed.
AONN+: How do you communicate with your navigators?
LoCicero: The nurse navigators and the oncologists use an electronic health record system. We are able to document and communicate electronically.
AONN+: How would you characterize your relationship with your navigators?
LoCicero: I see them as tremendous assets to each patient’s overall care and experience. We are fortunate to have compassionate, capable, intelligent, professional navigators who make all of these patients’ lives better. We have a great relationship with our navigators, and that is very consistent throughout the community.
Our feeling is there are not enough of them! They are valuable as another set of ears when accompanying patients to appointments and providing connections to patient resources. For example, in the midst of a busy day, one patient having stress over a complication, or an emotional issue, can be difficult to manage during an appointment. Having a nurse navigator as a pop-off valve or able to scoop that person up and give them as much time as they need, as well as to provide necessary resources, makes all of us feel better about what we are trying to accomplish.
AONN+: How would you characterize your patient load?
LoCicero: In our community, we see about 1,800 analytic cases a year. There are 8 medical oncologists here, and we have a good relationship with the other oncology practice in town. We share weekend calls and unassigned emergency department calls.
AONN+: Why is it important to have physician buy-in for navigators and to endorse them?
LoCicero: At a time when we are looking at the way we deliver healthcare in general, we really focus on the patient experience. As we are trying to personalize cancer care, so many facets of care need navigators to provide the thread that ties together the entire patient experience. It has really helped us zero-in on necessary components of care. They have helped us think about things that might not be top of mind, and they have created a repository of resources that we would likely not be able to coordinate without them. For example, there are always unique situations that occur in cancer care, such as family planning. We talk about egg harvesting for women who may be concerned about treatment affecting their fertility. Our navigators have collected resources on fertility that patients can use, as well as address other unique or niche patient needs.
Another example is patient psychosocial needs, which can be complicated. Our navigator program has partnered with our psychiatric hospital in town, so we have access to counselors, psychologists, and psychiatrists, who are now loosely part of our center. We can get in touch with them through a quick phone call.
Little wins like that along the way have helped grow the confidence in the value of the navigation program and what it has brought to the community. In our practice, the navigators make our jobs that much easier. The end result is that the patient has a better experience, and it is great when patients say, “Wow, I didn’t know this was available.”
AONN+: How can physicians help in building a cohesive relationship with their navigators?
LoCicero: Once they understand the role the navigator plays, a natural, affable relationship develops because patients are so appreciative of the extra touch that navigators add to the experience.
Navigators demonstrate added value to your cancer program. They fill in some of the gaps that physicians may want to provide for their patients but don’t have the resources, time, etc, to do so. The ability to address psychosocial issues or having a survivorship program in place can provide a positive effect on patient outmigration, where they might say, “Your navigators really added something to my experience. I didn’t feel like I needed to go outside my community to get quality care.”
To learn more about Dr. LoCicero’s practice, The Longstreet Clinic, go here.