Navigation Program Proves a Win-Win for Patients and Medical Center

Oncology Nursing News, June 2013, Volume 7, Issue 4

A grant from a pharmaceutical company is translating into a win for both the University Medical Center of Princeton at Plainsboro and its patients with cancer.

University Medical Center of Princeton

at Plainsboro

A grant from a pharmaceutical company is translating into a win for both the University Medical Center of Princeton at Plainsboro (UMCPP) and its patients with cancer.

Under the grant from Bristol-Myers Squibb, the medical center in New Jersey has hired a full-time oncology nurse navigator to guide patients through the complexities of their experience with cancer, and is working collaboratively on that effort with another grant winner, the American Cancer Society (ACS) Eastern Division.

Ultimately, leaders of the hospital’s navigation program expect the effort will not only help patients cope with their disease and its ramifications, but encourage them to receive all of their treatments at UMCPP, boosting the size of the patient population at the medical center’s new facility, which opened a year ago.

Judy Neuman, CTR

“It’s part of having patients at the center of the care, and that is how the healthcare system and reimbursement are moving,” said Judy Neuman, CTR, director of Cancer Services at UMCPP’s Edward & Marie Matthews Center for Cancer Care. “Supportive services have proven to bring better outcomes, so my vision is that it’s important to provide as many as we can.”

At the same time, Neuman said, the pilot program is designed to prove that there’s a fiscal argument for keeping a navigator on staff. “Once we can quantify that” for hospital administrators, she said, “they’ll be able to say that it’s worth putting our funds into that area.”

Building the Program

Launched in January and partially funded by the one-time $50,000 grant, the oncology nurse navigation program at the cancer center consists of a single, full-time senior oncology nurse navigator, Lori McMullen, RN, MSN, OCN. The establishment of her position represents an expansion of the navigation program run by the hospital’s parent company, Princeton HealthCare System, which previously consisted of one breast health navigator at its Plainsboro Breast Health Center in East Windsor.

Lori McMullen, RN, MSN, OCN

Since coming on board, McMullen has been seeing a growing number of patients—the number has risen to 60—and is available to help them, at no extra charge, to deal with anxiety and fear about their cancer; arrange for transportation to chemotherapy appointments, home meal delivery, home cleaning, or other supportive resources; find financial assistance or arrange payment plans; learn about their conditions or side effects of treatments; or even locate inexpensive funeral services.

“I see patients through the whole cancer trajectory, although the most opportune time is when they’re first told they have cancer or a positive biopsy,” McMullen said. “I can help keep them moving forward and get them through the system without getting stalled, shepherd them into treatment, and empower them to make decisions, such as getting a second opinion.”

Under the grant, McMullen is also designing an orientation program for patients who are set to undergo radiation or chemotherapy, which will consist of a meeting, tour, talk, and binder full of printed materials about the cancer center’s services.

To supplement her work, McMullen is being assisted two mornings each week by a lay navigator from the ACS Eastern Division—funded through a related $125,000 Bristol-Myers Squibb grant—who visits UMCPP to check in with patients and either help them resolve problems or refer them for nurse navigation. ACS is also providing that service to other area hospitals via the grant.

Together, UMCPP and ACS also collaborate to offer the “Look Good Feel Better” program, through which cosmetics companies donate products, and training in their application, to patients undergoing chemotherapy, who are often upset not only by the loss of their hair, but of their eyebrows and eyelashes.

Both the Princeton HealthCare System Foundation (on behalf of UMCPP) and ACS received their grants after submitting unsolicited requests for the projects, which Bristol-Myers Squibb considered complementary. The pharmaceutical company, whose US operations are based in Plainsboro, is one of the medical center’s neighbors.

“Bringing together organizations with common goals, similar programs, and potentially complementary services can lead to efficiencies in immediately tangible ways,” said Murdo Gordon, senior vice president of US Pharmaceuticals at Bristol- Myers Squibb. “With the coming changes of the Affordable Care Act, the financial impact on organizations and individuals will likely be profound, and the entire cancer community will need to work together to address these concerns. Collaborative approaches, such as those being taken by UMCPP and the American Cancer Society, which bring together meaningful services from various providers to support a given community, is a refreshing solution.”

So far, Neuman said, the program is working well.

“The feedback from the entire hospital has been nothing short of wonderful,” she said. “The nurses feel it has helped their patients, and the chief nursing officer has commented on the value it brings to our facility and patients.”

The infusion room at the University Medical Center of Princeton at Plainsboro.

Navigation at UMCPP: Today and Tomorrow

Since arriving at UMCPP, McMullen has been working to ensure that staff members are aware of the services she can provide.

“It’s a new position in an established hospital, so getting the rest of the facility to understand what I do and how I can help will take time,” she said.

While staff members within the cancer center know about McMullen, doctors in other parts of the UMCPP building—who also might diagnose cancers— are less aware.

“I’ve been going to staff and section meetings and physicians’ offices to tell them I’m here, as well as working with the nurses,” McMullen said.

Ultimately, Neuman would like to expand the program to include enough navigators to handle the hospital’s entire caseload of about 900 patients per year who are diagnosed with cancer and about 200 per year who return to the facility to have their cancers treated.

“It’s important to have some kind of touch with all of them, although they don’t all need it,” McMullen agreed. “Some patients come out of the womb empowered, and some need help every little step of the way.”

To make that vision a reality, Neuman said, she hopes to use the pilot program with McMullen to prove to the hospital’s leaders that navigation more than pays for itself.

McMullen has begun the process by starting to assess patient satisfaction with her services, and has found the early results promising.

In a survey, McMullen asked patients diagnosed with cancer at UMCPP whether the facility’s navigation services had affected their decision about whether to stay on to receive their cancer treatments. She sent out 22 surveys in a 6-week period, and received five back; among them were two from patients who said they’d stayed at UMCPP because of its oncology navigation program.

“Eventually, we’ll be able to look at the downstream revenue from having navigation services,” McMullen said.

“Even just the two patients we know of who stayed due to the navigation program can represent a substantial amount of money to the system,” Neuman added.

The Bottom Line: Helping Patients

For McMullen, navigating at UMCPP’s cancer center has already been very rewarding.

McMullen has helped to transition a couple of patients into end-of-life care, and is glad she was able to aid them and their families in having difficult but necessary conversations at a time when they didn’t know where else to turn.

In many other cases, McMullen’s efforts are focused on helping patients to live as well as possible. She has been able to help resolve problems with symptom management and disease process, sometimes answering questions patients were too shy to bring to their doctors.

Lori McMullen, RN, MSN, OCN, seated, and Judy Neuman, CTR, of the University Medical Center of Princeton at Plainsboro.

“Cancer is complicated,” the navigator said. “A doctor might tell a patient he has colon cancer, but there are different stages and treatments. I can help patients understand their treatment plans, and that what they find on the Internet might not apply.”

McMullen is also focused on letting patients know there is support for them outside the hospital, as well as within the facility.

Jeff Descoteau, whose mother undergoes treatment for cancer at UMCPP, said McMullen relieved their stress by helping them understand treatment options and available resources.

She also explained which expenses were covered by insurance or secondary insurance, and informed the family about national programs that offer financial aid, as well as potential assistance with the cost of prescriptions. She made them aware of in-home services, including medical care and help with household tasks, and connected them with transportation services for medical visits or treatments.

“Lori McMullen is an angel in our eyes,” Descoteau said. “She took the time to learn of our personal situation, and she not only shared her knowledge about the resources available to us, but also did the legwork to get the results we needed for any situation. With her assistance, my mom was able to focus on what she needed to do to get back to a normal life. And I was able to focus on what is most important to me: my mom.”