Documentation by oncology patient navigators can play an important role in your cancer program’s efforts to comply with the new Commission on Cancer (CoC) Standards that became effective in 2015. This blog reviews documentation-tool compliance—in other words—how your documentation tools can help you demonstrate compliance with CoC Standard 3.1 Patient Navigation Process and Standard 3.2 Psychosocial Distress Screening.
Let’s start with a review of key elements of these standards:
Standard 3.1: Patient Navigation Process
A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations. The navigation process is evaluated, documented, and reported to the cancer committee annually. The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment . . . .
Prior to establishing the navigation process, the Cancer Committee conducts a community needs assessment to identify the needs of the populations served, opportunities to improve cancer health disparities, and decrease gaps in resources. This assessment reoccurs at least once during the three-year survey cycle.
Standard 3.2: Psychosocial Distress Screening
The Cancer Committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care . . . .
The psychosocial representative on the Cancer Committee (oncology social worker, clinical psychologist, or other mental health professional trained in the psychosocial aspects of cancer care) is required to oversee this activity and report to the Cancer Committee annually.
Timing of screening: Patients with cancer are offered screening for distress a minimum of one time per patient at a pivotal medical visit to be determined by the program. Some examples of a “pivotal medical visit” include time of diagnosis, pre-surgical and post-surgical visits, and first visit with the medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or post-chemotherapy follow-up visit. Preference is given to pivotal medical visits at times of greatest risk for distress, [emphasis added] such as at time of diagnosis, transitions during treatment (such as from chemotherapy to radiation therapy), and transitions off treatment.
Method: The mode of administration (such as patient questionnaire, clinician-administered questionnaire) is to be determined by the program.
Tools: Preference is given to standardized, validated instruments with established clinical cutoffs; however, facilities may use a measure of their choice.
The complete CoC Cancer Program Standards: Ensuring Patient-Centered Care (2016 Edition) is available on the CoC website here.
Navigation Tools & Reports Can Support Compliance
Here are five tips for creating your navigation tools and reports so that they support CoC standard compliance:
- Ensure that the fields in your tools are specific to the standard. Many navigation programs tend to overcollect information that is not needed to be compliant with the standard, resulting in additional work for the staff and/or patient and possible confusion about what information needs to be reviewed at cancer committee.
- Keep your documentation tools and reports simple. Be sure to define your documentation fields on your tools and reports; this will ensure that the navigators are collecting the information in a consistent manner.
- Create evidenced-based tools. For compliance with the CoC standards, tools should be evidence-based. For distress screening, examples include the NCCN psychosocial distress screening tool or the FACT (Functional Assessment of Cancer Therapy) tool.
- Use your EHR or an Excel file. Since the navigation program needs to be reviewed at the cancer committees on a yearly basis, using your EHR or an Excel file makes it easy to aggregate information for these presentations.
- Make the most of your Community Needs Assessment (CNA). Your CNA is essential because it helps identify your population of patients and their specific needs and barriers. The CNA can also be used to identify performance improvement activities for your program. Further, it provides an excellent review for the navigators, as well as all cancer program support services, to more fully understand their patients.
Community Needs Assessment (CNA): A Valuable Resource
Cancer programs are not as familiar with creating CNAs; however, there are great resources to help you identify the data you will need. For example, the information and data needed for your CNA can come from: American Cancer Society Facts and Figures, American College of Surgeons Commission on Cancer, Academy of Medicine (formerly known as Institute of Medicine), the Centers for Disease Control and Prevention Cancer Data and Statistics, U.S. Census Bureau, State Health Department and Internal Revenue Service, and National Cancer Institute Surveillance Epidemiology and End Results.
As you develop your tools: Make sure they work for YOU, and that you are NOT working for your tools.