(l-r) Liz Bessette, RN, Carol Bush, RN, Jennifer Gray, RN
When Liz Bessette, RN, was asked to help guide patients through their cancer care at St. Francis Hospital in Topeka, she had no idea she was making Kansas nursing history.
Bessette, a nurse at St. Francis since 1968, had spent many years in critical care administration and was involved in staff education when the CEO of St. Francis at the time, Sister Loretto Marie, asked her to help Cancer Center patients get through the maze of appointments, treatment and insurance when the Center opened in 2003.
Cancer care navigators first came to the attention of the general public in 1990 when Dr. Harold Freeman, who was then president of the American Cancer Society, developed the Harlem Cancer Education and Demonstration Project to help the poor in New York City get access to the health care they needed in order to prevent or detect and treat cancer. A disproportionate number of poor were dying from cancer and Dr. Freeman's research indicated a need for trained staff to help uninsured and under-insured get the care and follow-up they needed to survive the disease. Freeman believed no person with cancer should spend more time fighting their way through the system than fighting the disease.
But navigation had not yet been introduced in Kansas so it was new not just to Bessette but to health care professionals throughout the state. However, Bessette's years of nursing experience helped her quickly assume her new responsibilities as the state's first known Patient or Nurse Navigator.
Bessette says, "It didn't take long to see how navigation was critical in achieving better outcomes." She recalled working with patients diagnosed with cancer who faced additional challenges like drug addiction, poverty and physical disabilities. "These were people who struggled to get through a normal day, much less having to stay on track with medications, insurance and appointments. But, thanks to navigational assistance, even patients facing numerous obstacles were completing treatment," she explained.
By 2006 Bessette was sharing her knowledge about navigation with the Kansas Department of Health & Environment and developing nurse navigation tools for the Kansas Cancer Partnership's www.cancerkansas.org website. Interest in nurse navigation began picking up steam across the state as word of improved outcomes spread in the health care community.
In fact, less than two years after Bessette began providing navigation in Topeka, Dorothy Austin, RN, OCN, was hired by Douglas Girod, M.D., in the Head and Neck Oncology Department at The University of Kansas Hospital.
Austin recalls that, although she was serving as a Navigator, at first she was called a Clinic Nurse Coordinator because the term Navigator was not widely known at the time. "Regardless of what we called it,' says Austin, 'it was clear that the navigational assistance was decreasing wait times and increasing patient satisfaction."
Results like these were instrumental in the creation of The Patient Navigator Outreach & Chronic Disease Act that was signed by President Bush in 2005 to help fund implementation of patient navigation programs in cancer treatment centers. Successful outcomes also spurred NCI to establish Patient Navigator Research programs in nine centers across the country that same year.
By the time the Midwest Cancer Alliance (MCA), the outreach arm of The University of Kansas Cancer Center, was formed in 2008 to help extend research and trials across the Heartland, health professionals in Kansas had a much better idea of how critical the navigation role was in improving treatment and outcomes. "One of the first positions we filled was for a nurse navigator because we knew how crucial it would be in helping to improve access to the latest care and treatment across the state," explains Hope Krebill, the executive director of the MCA.
Carol Bush, RN, had experience as an infusion nurse and had been a complex cancer and transplant case manager when she was hired by The Midwest Cancer Alliance through an endowment provided by the Kansas Masonic Foundation. Bush spent some time shadowing Bessette as she learned about her new role with the MCA.
According to Bush, five years in navigation have taught her that success as a nurse navigator requires broad clinical experience, exceptional communication skills and the ability to collaborate and broker relationships. As the link between patients and the services and information they need, she says, "Like Dad said, 'It's not always what you know, Carol - sometimes it's who you know.' "
With guidance from Bessette and other Navigators she has met across the country, Bush has helped build a network of navigators in rural Kansas that includes Terri Leschuk, RN. at Via-Christi-Wichita, Anne Nicole Spray, ARNP, at Hays Medical Center; Lynn Marshall, RN, at the Tammy Walker Cancer Center in Salina; Beth Brown, RN, who has replaced the recently retired Bassett at St Francis - Topeka . Two of the newest navigators in the MCA network include Maggie Ward, APRN at Via Christi-Wichita, who was recently asked to help navigate insurance-related concerns, and Heather Wright-Renick, BSN, at St Catherine Hospital in Garden City. A nurse for 15 years, Wright-Renick is a recent graduate from the KU School of Nursing and a breast cancer survivor and brings her own unique perspective to the care she provides.
"I don't mind sharing my own cancer experience with patients," says Wright-Renick. "It helps some patients feel a connection to me."
Marshall, the patient navigator at Salina Regional Health Center's Tammy Walker Cancer Center, points out that navigators not only have to connect with patients, they also serve as a bridge to services and resources. She says that, as a navigator working for a facility that was part of the MCA, she was able to help set up a 2nd opinion consultation for Stephen Pearce of Wells, Kan, a melanoma patient who needed a treatment that was not available in Salina. Pearce was able to see Gary Doolittle, M.D., at KU Cancer Center for a 2nd opinion and be admitted for treatment in a matter of days - a process that could have taken weeks without navigation and I-TV services.
"Lynn was instrumental in guiding us through my husband's treatment plan," says Polly Pearce, wife of Stephen. "She helped us with everything from his second opinion appointment to recommendations on hotels and maps and directions at KU Cancer Center. Lynn has also been available for questions now that my husband is back home and getting his follow-up care with Dr. Ahmed in Salina."
KU Cancer Center has a growing team of navigators headed by Teri Banman, RN, BSN, OCN and includes Austin and Jennifer Gray, RN and a current graduate student at the KU School of Nursing.
"As a navigator," explains Gray, "I put many of the things I've learned both on the job and in school to use every day."
Gray is one of 11 navigators at KU Cancer Center. "We've gone from one navigator to nearly a dozen in less than three years," says Banman. "I wouldn't be surprised to see our team expand further, as the Cancer Center treats increasing numbers of patients."
KU Cancer Center records show that, since hiring navigators, patients no-show rates have dropped from 18% to 5% and palliative care outpatient visits have doubled.
Based on outcomes like these, it's not surprising that patient navigators who help consumers work their way through insurance options -- like Ward at Via-Christi, Wichita -- are a critical component of the Affordable Care Act
The expansion of navigators in the region and the increasingly important role they play in cancer treatment are evidence of how valuable navigators have become to health care in Kansas. As far as the value they hold for patients is concerned, perhaps Pearce's wife, Polly, explains it best.
"Dealing with cancer is never easy. But having someone like Lynn on your side certainly makes it more bearable."