Clinical outcomes of patient navigation performed by nurses in the oncology setting: an integrative review

Rodrigues, Rodrigo Lima; Schneider, Franciane; Kalinke, Luciana Puchalski; Kempfer, Silvana Silveira; Backes, Vânia Marli Schubert

doi:10.1590/0034-7167-2019-0804

Rodrigo Lima Rodrigues

Centro de Pesquisas Oncológicas. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0002-4963-2661

Franciane Schneider

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0002-7187-0906

Luciana Puchalski Kalinke

Universidade Federal do Paraná. Curitiba, Paraná, Brazil.

http://orcid.org/0000-0003-4868-8193

Silvana Silveira Kempfer

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0003-2950-9049

Vânia Marli Schubert Backes

Universidade Federal da Bahia. Salvador, Bahia, Brasil.

http://orcid.org/0000-0002-8898-8521

Corresponding author: Franciane Schneider E-mail: franciane_06@yahoo.com.br

EDITOR IN CHIEF: Antônio José de Almeida Filho

ASSOCIATE EDITOR: Priscilla Broca

MEDLINE via PUBMED	"oncology nursing" OR ("oncology" AND "nursing") OR "oncology nursing" AND ("patient navigation" OR ("patient" AND "navigation") OR "patient navigation") OR ("nurses" OR "nurse") OR ("nurses" OR "nurse" AND "navigators") AND ("treatment outcome" OR ("treatment" AND "outcome") OR "treatment outcome") OR ("evidence-based nursing" OR ("evidence-based" AND "nursing") OR "evidence-based nursing" OR ("evidence" AND "based" AND "nursing") OR "evidence based nursing") OR ("outcome assessment (health care)" OR ("outcome" AND "assessment" AND ("health" AND "care") OR "outcome assessment (health care)" OR ("outcome" AND "assessment") OR "outcome assessment") AND ("delivery of health care" OR ("delivery" AND "health" AND "care") OR "delivery of health care" OR ("health" AND "care") OR "health care") OR ("outcome assessment (health care)" OR ("outcome" AND "assessment" AND ("health" AND "care)") OR "outcome assessment (health care)" OR ("outcomes" AND "assessment") OR "outcomes assessment") OR ("case management" OR ("case" AND "management") OR "case management") OR ("continuity of patient care" OR ("continuity" AND "patient" AND "care") OR "continuity of patient care")
LILACS	(Oncology Nursing) AND (Patient Navigation OR Nurse Navigator OR Nurse Navigators) AND (Treatment outcome OR Evidence-Based Nursing OR Outcome Assessment (Health Care) OR Outcomes Assessment OR Case Management OR Continuity of Patient Care)
Web of Science	(Oncology Nursing) AND (Patient Navigation OR Nurse Navigator OR Nurse Navigators) AND (Treatment outcome OR Evidence-Based Nursing OR Outcome Assessment (Health Care) OR Outcomes Assessment OR Case Management OR Continuity of Patient Care)
Scopus (Elsiever)	("Oncology Nursing" AND "Patient Navigation" OR "Nurse Navigator" OR "Nurse Navigators" AND "Treatment Outcome" OR "Evidence-Based Nursing" OR "Outcome Assessment (Health Care)" OR "Outcomes Assessment" OR "Case Management" OR "Continuity of Patient Care")
CINAHL	Oncology Nursing AND (Patient Navigation OR Nurse Navigator OR Nurse Navigators) AND (Treatment outcome OR Evidence-Based Nursing OR Outcome Assessment (Health Care) OR Outcomes Assessment OR Case Management OR Continuity of Patient Care)

Title, Authors	Year, country, level of evidence (AHRQ)	Outlining/ profile of participants	Intervention	Outcomes/ main conclusions
Implementing the role of patient-navigator nurse at a university hospital centre Fillion and collaborators⁽¹¹11 Fillion L, de Serres M, Lapointe-Goupil R, Bairati I, Gagnon P, Deschamps M, et al. Implementing the role of patient-navigator nurse at a university hospital centre. Can Oncol Nurs J [Internet]. 2006 [cited 2019 Apr 29];16(1):11-7. Available from: http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/296 http://www.canadianoncologynursingjourna... ⁾	2006, Canada, VI	Qualitative, descriptive and longitudinal study Head and neck cancer, family members, health professionals and care network partners	Implementation of the role of nurse navigators	Patients reported improvement in communication, health education, adaptation to the health and disease process, better understanding of the disease and coping with treatment. Navigators also encouraged a healthy lifestyle and reduced anxiety related to fear of recurrence of the disease. The main impact was on improving the quality and continuity of care, both clinically and relationally. Nurse navigators facilitates the process of adaptation to the process of illness and treatment, as well as improves interdisciplinary work and continuity of care.
The role of the oncology nurse navigator in distress management of adult inpatients with cancer: a retrospective study Swanson and Koch⁽¹²12 Swanson J, Koch L. The role of the oncology nurse navigator in distress management of adult inpatients with cancer: a retrospective study. Oncol Nurs Forum. 2010;37(1):69-76. https://doi.org/10.1188/10.ONF.69-76 https://doi.org/10.1188/10.ONF.69-76... ⁾	2010, USA, VI	Retrospective study (medical records) Gastrointestinal cancer; lung cancer; breast cancer; and leukemias and lymphomas	Assessment and follow-up with nurse navigators	The presence of nurse navigators did not significantly affect the stress levels of hospitalized patients, despite presenting an average stress reduction. A decrease in stress was observed in rural patients when compared to patients in the urban area. Patients who received more than three visits from navigators had a greater reduction in stress than those with less than three visits. On average, the intervention of navigators showed a reduction in the scores of distress of all patients.
Effects of nurse navigators on health outcomes of cancer patients Lee and collaborators⁽¹³13 Lee T, Ko I, Lee I, Kim E, Shin M, Roh S, Yoon D, Choi S, Chang H. Effects of nurse navigators on health outcomes of cancer patients. Cancer Nurs. 2011;34(5):376-84. https://doi.org/10.1097/NCC.0b013e3182025007 https://doi.org/10.1097/NCC.0b013e318202... ⁾	2011, South Korea, IV	Study with control group, quantitative approach	Systematized coordination of patient care, from initial assessment and admission to discharge or home care. 1. Guidance on treatment and diagnostic tests; 2. Education and advice; 3. Nurses as a reference of care in the interdisciplinary team; 4. Management of administrative processes that interfere with clinical outcomes; 5. Continuous assessments, with monitoring of symptoms, care and progress.	The experimental group had higher physical and social conditioning, less financial expenses and constipation than the control group. The length of hospital stay was longer in the control group, on average 9.11 days beyond the experimental group. Significant differences found in quality of life, satisfaction with care and length of hospital stay between the experimental and control groups suggest that care coordination provides a useful model for the effective treatment of cancer.
A Breast Navigator Program: Barriers, Enhancers, and Nursing Interventions Korber and collaborators⁽¹⁴14 Korber SF, Padula C, Gray J, Powell M. A breast navigator program: barriers, enhancers, and nursing interventions. Oncol Nurs Forum. 2011;38(1):44-50. https://doi.org/10.1188/11.onf.44-50 https://doi.org/10.1188/11.onf.44-50... ⁾	2011, USA, VI	Qualitative study, with focus group and telephone interviews Breast cancer	Breast Health Navigator Program - the role of navigators is to provide breast cancer care, adapting to their needs and cultures	Navigators were seen as a link between team and patient, mainly improving communication. The management of symptoms was fundamental for the success of coping with treatment, as well as knowledge and preparation for pre- and post-therapy effects. Navigators are the source of suggestions, assessment, and management. Role clearly integrated from beginning to end of care. Source of information and support (emotional and physical).
Do depressed newly diagnosed cancer patients differentially benefit from nurse navigation? Ludman and collaborators⁽¹⁵15 Ludman EJ, McCorkle R, Bowles EA, Rutter CM, Chubak J, Tuzzio L, et al. Do depressed newly diagnosed cancer patients differentially benefit from nurse navigation? Gen Hosp Psychiatry[Internet]. 2015 [cited 2019 Sep 4];37(3):236-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442728/pdf/nihms-668570.pdf https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	2015, USA, II	Controlled randomized clinical trial Breast, colon, and lung cancer	Intervention group: weekly contacts with a nurse navigator for 16 weeks	Most participants had little or no depression at the beginning of the study. Patients in the intervention group had higher improvement scores than those in usual treatment. The percentage of patients who reported care problems increased with the severity of depressive symptoms. Nurse navigators helped newly diagnosed patients cope with treatment barriers.
Impact of nurse navigation on timeliness of diagnostic medical services in patients with patients newly diagnosed lung cancer Kunos, Olszewski, Spinal⁽¹⁶16 Kunos C, Olszewski S, Espinal E. Impact of nurse navigation on timeliness of diagnostic medical services in patients with newly diagnosed lung cancer. J Community Support Oncol. 2015;13(6):219-24. https://doi.org/10.12788/jcso.0141 https://doi.org/10.12788/jcso.0141... ⁾	2015, USA, VI	Retrospective study Lung cancer	Coordination of diagnostic procedures and consultations	Navigation significantly increased the proportion of patients undergoing more complex staging and diagnostics. Reduced the time interval between exams and medical consultations. Significantly reduced the time for the first treatment by 19 days. Improved overall access and treatment opportunity.
The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study Mertz and collaborators⁽¹⁷17 Mertz BG, Dunn-Henriksen AK, Kroman N, Johansen C, Andersen KG, Andersson M, et al. The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study. Acta Oncol. 2017;56(12):1682-9. https://doi.org/10.1080/0284186X.2017.1358462 https://doi.org/10.1080/0284186X.2017.13... ⁾	2017, Denmark, II	Randomized controlled pilot study Breast cancer	Navigation sessions based on cognitive behavioral therapy strategies (screening and symptom counseling)	Experimental group: significantly lower levels of distress, anxiety and depression. There was no significant effect on quality of life related to physical or emotional health, or symptoms. Significantly higher satisfaction with treatment and rehabilitation and lower levels of distress, anxiety and depression. Screening before surgery, combined with navigation, can be effective to identify and manage distress in the most vulnerable patients.

•	Decreased anxiety⁽¹¹11 Fillion L, de Serres M, Lapointe-Goupil R, Bairati I, Gagnon P, Deschamps M, et al. Implementing the role of patient-navigator nurse at a university hospital centre. Can Oncol Nurs J [Internet]. 2006 [cited 2019 Apr 29];16(1):11-7. Available from: http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/296 http://www.canadianoncologynursingjourna... ^,¹⁷17 Mertz BG, Dunn-Henriksen AK, Kroman N, Johansen C, Andersen KG, Andersson M, et al. The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study. Acta Oncol. 2017;56(12):1682-9. https://doi.org/10.1080/0284186X.2017.1358462 https://doi.org/10.1080/0284186X.2017.13... ⁾
•	Improvement in physical conditioning⁽¹¹11 Fillion L, de Serres M, Lapointe-Goupil R, Bairati I, Gagnon P, Deschamps M, et al. Implementing the role of patient-navigator nurse at a university hospital centre. Can Oncol Nurs J [Internet]. 2006 [cited 2019 Apr 29];16(1):11-7. Available from: http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/296 http://www.canadianoncologynursingjourna... ^,¹³13 Lee T, Ko I, Lee I, Kim E, Shin M, Roh S, Yoon D, Choi S, Chang H. Effects of nurse navigators on health outcomes of cancer patients. Cancer Nurs. 2011;34(5):376-84. https://doi.org/10.1097/NCC.0b013e3182025007 https://doi.org/10.1097/NCC.0b013e318202... ⁾
•	Decreased distress⁽¹²12 Swanson J, Koch L. The role of the oncology nurse navigator in distress management of adult inpatients with cancer: a retrospective study. Oncol Nurs Forum. 2010;37(1):69-76. https://doi.org/10.1188/10.ONF.69-76 https://doi.org/10.1188/10.ONF.69-76... ^,¹⁷17 Mertz BG, Dunn-Henriksen AK, Kroman N, Johansen C, Andersen KG, Andersson M, et al. The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study. Acta Oncol. 2017;56(12):1682-9. https://doi.org/10.1080/0284186X.2017.1358462 https://doi.org/10.1080/0284186X.2017.13... ⁾
•	Improved symptom management and control⁽¹³13 Lee T, Ko I, Lee I, Kim E, Shin M, Roh S, Yoon D, Choi S, Chang H. Effects of nurse navigators on health outcomes of cancer patients. Cancer Nurs. 2011;34(5):376-84. https://doi.org/10.1097/NCC.0b013e3182025007 https://doi.org/10.1097/NCC.0b013e318202... ^,¹⁴14 Korber SF, Padula C, Gray J, Powell M. A breast navigator program: barriers, enhancers, and nursing interventions. Oncol Nurs Forum. 2011;38(1):44-50. https://doi.org/10.1188/11.onf.44-50 https://doi.org/10.1188/11.onf.44-50... ⁾ (e.g., less constipation)
•	Decreased depression⁽¹⁵15 Ludman EJ, McCorkle R, Bowles EA, Rutter CM, Chubak J, Tuzzio L, et al. Do depressed newly diagnosed cancer patients differentially benefit from nurse navigation? Gen Hosp Psychiatry[Internet]. 2015 [cited 2019 Sep 4];37(3):236-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442728/pdf/nihms-668570.pdf https://www.ncbi.nlm.nih.gov/pmc/article... ^,¹⁷17 Mertz BG, Dunn-Henriksen AK, Kroman N, Johansen C, Andersen KG, Andersson M, et al. The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study. Acta Oncol. 2017;56(12):1682-9. https://doi.org/10.1080/0284186X.2017.1358462 https://doi.org/10.1080/0284186X.2017.13... ⁾
•	Decreased fear⁽¹¹11 Fillion L, de Serres M, Lapointe-Goupil R, Bairati I, Gagnon P, Deschamps M, et al. Implementing the role of patient-navigator nurse at a university hospital centre. Can Oncol Nurs J [Internet]. 2006 [cited 2019 Apr 29];16(1):11-7. Available from: http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/296 http://www.canadianoncologynursingjourna... ⁾
•	Improvement in quality and continuity of care⁽¹¹11 Fillion L, de Serres M, Lapointe-Goupil R, Bairati I, Gagnon P, Deschamps M, et al. Implementing the role of patient-navigator nurse at a university hospital centre. Can Oncol Nurs J [Internet]. 2006 [cited 2019 Apr 29];16(1):11-7. Available from: http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/296 http://www.canadianoncologynursingjourna... ⁾
•	Decreased stress⁽¹²12 Swanson J, Koch L. The role of the oncology nurse navigator in distress management of adult inpatients with cancer: a retrospective study. Oncol Nurs Forum. 2010;37(1):69-76. https://doi.org/10.1188/10.ONF.69-76 https://doi.org/10.1188/10.ONF.69-76... ⁾
•	Improvement in quality of life⁽¹³13 Lee T, Ko I, Lee I, Kim E, Shin M, Roh S, Yoon D, Choi S, Chang H. Effects of nurse navigators on health outcomes of cancer patients. Cancer Nurs. 2011;34(5):376-84. https://doi.org/10.1097/NCC.0b013e3182025007 https://doi.org/10.1097/NCC.0b013e318202... ⁾
•	Time interval reduction between exams and medical appointments ⁽¹⁶16 Kunos C, Olszewski S, Espinal E. Impact of nurse navigation on timeliness of diagnostic medical services in patients with newly diagnosed lung cancer. J Community Support Oncol. 2015;13(6):219-24. https://doi.org/10.12788/jcso.0141 https://doi.org/10.12788/jcso.0141... ⁾
•	Time reduction to start treatment⁽¹⁶16 Kunos C, Olszewski S, Espinal E. Impact of nurse navigation on timeliness of diagnostic medical services in patients with newly diagnosed lung cancer. J Community Support Oncol. 2015;13(6):219-24. https://doi.org/10.12788/jcso.0141 https://doi.org/10.12788/jcso.0141... ⁾
•	Increase in the number of patients in staging and diagnostic tests⁽¹⁶16 Kunos C, Olszewski S, Espinal E. Impact of nurse navigation on timeliness of diagnostic medical services in patients with newly diagnosed lung cancer. J Community Support Oncol. 2015;13(6):219-24. https://doi.org/10.12788/jcso.0141 https://doi.org/10.12788/jcso.0141... ⁾

[1] Corresponding author: Franciane Schneider E-mail: franciane_06@yahoo.com.br

Brasil

Brasil

Clinical outcomes of patient navigation performed by nurses in the oncology setting: an integrative review

ABSTRACT

Objective:

Methods:

Results:

Final considerations: