Oncology Case Management: Optimizing Care Pathways

March 26, 2018
Melissa Mills, RN, BSN, CCM, MHA

Oncology Nursing News, March 2018, Volume 12, Issue 2

Applying 4 philosophies to the nurse case manager role can assist with patient decision making.

Cancer care starts at prediagnosis. The initial conversa­tion between a patient and the healthcare team helps establish trust. However, many patients and their loved ones report receiv­ing inadequate information about diagnosis, treatment, and prognosis from the beginning.

In a study by Figg et al, 44% of the 437 patients who completed a survey reported that the initial conversation about their cancer diagnosis lasted 10 minutes or less. That can leave a patient feeling confused, angry, and unsupported. However, oncology nurse case man­agers can help bridge the gap between fear of the unknown and confidence in the healthcare team.

THE MAKING OF AN ONCOLOGY NURSE CASE MANAGER

Oncology nurse case managers optimize quality and cost-ef­fective care in both hospital and community settings. These highly skilled nurses possess specialized training and certifi­cation in case management and/or oncology. Case managers may work face-to-face or via telephone with patients.

Nurse case management has been recognized as a success­ful method for optimizing cancer care pathways, increasing quality of care and achieving cost-effectiveness. These health­care professionals possess not only an extensive clinical back­ground but also a vast understanding of the healthcare indus­try, payer sources, and psychosocial care.

Many nurse case managers become certified. The Commission for Case Manager Certification (CCMC) is the larg­est accrediting body and considered the gold standard in the field. An estimated 50% of employers require the certifica­tion for nurse case managers, and 63% of employers offer reimbursement for the exam, according to CCMC. Experience coupled with certification prepares nurse case managers to deliver care in a patient-centric model.

WHAT’S IN A NAME?

Nurse case managers and nurse navigators are often confused and the terms interchanged. Although they may have com­mon responsibilities, such as timely access to care and mini­mizing healthcare barriers, they are not the same.

Navigation is defined as individualized assistance that helps patients, families, and caregivers overcome healthcare system barriers and facilitates timely access to quality health and psychosocial care, from prediagnosis through all phases of the cancer experience.

Case management involves a collaborative process of assess­ment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet the individ­ual needs of the patient, according to the Case Management Society of America. Through communication, resource man­agement, education, and patient advocacy, the case manager coordinates a patient-centered plan of care.

PHILOSOPHIES OF ONCOLOGY CASE MANAGEMENT

1. Advocacy

The case manager is tasked with finding the delicate balance between treatment, resource use, evi­denced-based medicine, and the patient’s ability to make informed decisions. Through education, resource allocation, and support, the case manager advocates for the patient. Further, a case manager advocates for multidisci­plinary team members, the hospital, and the payer source. This role of advocacy for the common good and for the patient requires careful balance.

2. Communication

Case managers are highly skilled in inter­viewing, reflection, critical thinking, and collaboration. They use techniques such as motivational interviewing to help empower the patient to make individualized decisions and accomplish goals. This approach helps the case man­ager ensure that all oncology treatment is patient-centered.

3. Resource Management

Case managers are familiar with available local, state, and national resources. They work with the patient to find the support they need in their own community. For instance, a patient may require transportation, meals, or financial assistance.A case manager is in a unique role that involves both assist­ing with the patient’s clinical needs and examining inter­personal and psychosocial needs. One of the most challeng­ing aspects of this position involves considering the cost of treatment. Some patients have a realistic outlook on their prognosis; others do not. It is the case manager’s job to help the patient find the right resources and treatment that are not only clinically focused but financially sound. This may be the difference between another round of chemotherapy or pursuing palliative or hospice care. These conversations take a great amount of skill, empathy, and compassion.

4. Education

Nurses educate, and oncology nurse case man­agers use education as a pillar of their practice. By educat­ing the patient in an open, honest manner, case managers increase adherence to treatment pathways. The case man­ager ensures that the patient understands the treatment plan, diagnosis, and prognosis. It is the case manager’s job to provide the patient with the information needed to make informed self-care decisions.

Case managers are committed to helping patients navigate the highly specialized and fragmented healthcare system. Using the 4 case management philosophies, they ensure that the patient experiences a coherent and individually focused care pathway that is delivered at the right time using the right resources.

Melissa Mills is a freelance healthcare writer and owner of MakingSpace.company. She has been a Registered Nurse for 20 years and is passionate about case management, nursing leadership, and finding the right care for patients in every setting.