first annual navigation & survivoship conference

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Prostate Cancer Navigation:Coast-to-Coast

Presented to thePresented to theAcademy of Oncology Academy of Oncology

Nurse NavigatorsNurse NavigatorsAnnual ConferenceAnnual ConferenceSeptember 19, 2010September 19, 2010

Baltimore, MDBaltimore, MD

Jennifer R. Powers, MS, BSN, CCRC, OCNMaine Medical Center Cancer Institute

Frank delaRama, RN, MS, AOCNSPalo Alto Medical Foundation

AONN First Annual National MeetingAONN First Annual National Meeting

PROSTATE CANCER NAVIGATIONPROSTATE CANCER NAVIGATION

Jennifer R. Powers, MS, BSN, CCRC, OCNJennifer R. Powers, MS, BSN, CCRC, OCNSeptember 19, 2010September 19, 2010

AONN First Annual National MeetingAONN First Annual National Meeting

PROSTATE CANCER NAVIGATIONPROSTATE CANCER NAVIGATION

Jennifer R. Powers, MS, BSN, CCRC, OCNJennifer R. Powers, MS, BSN, CCRC, OCNSeptember 19, 2010September 19, 2010

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Optimizing Cancer Care Optimizing Cancer Care DeliveryDelivery

The Role of the Nurse NavigatorThe Role of the Nurse Navigator

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HistoryHistory

•• 1990 1990 –– Dr. Harold Freeman conceived and initiated the first Dr. Harold Freeman conceived and initiated the first patient navigation program funded by a grant from the American patient navigation program funded by a grant from the American Cancer SocietyCancer Society

•• 20012001 –– President’s Cancer Panel issued a report that indicatedPresident’s Cancer Panel issued a report that indicated

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•• 2001 2001 President s Cancer Panel issued a report that indicated President s Cancer Panel issued a report that indicated barriers to obtaining cancer care exist for persons of all barriers to obtaining cancer care exist for persons of all socioeconomic levelssocioeconomic levels

•• 2003 2003 –– H.R. 918 and S. 453 introduced to create Patient H.R. 918 and S. 453 introduced to create Patient Navigation programsNavigation programs

•• 2005 2005 –– Patient Navigator Outreach and Chronic Disease Patient Navigator Outreach and Chronic Disease Prevention Act was signed into lawPrevention Act was signed into law

What is a Patient Navigator?What is a Patient Navigator?

•• Currently, there is no consensus definitionCurrently, there is no consensus definition

•• NCI Definition NCI Definition

–– “Patient navigation in cancer care refers to the assistance “Patient navigation in cancer care refers to the assistance

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offered to healthcare consumers to help them access and offered to healthcare consumers to help them access and then chart a course through the healthcare system and then chart a course through the healthcare system and overcome any barriers to quality care”overcome any barriers to quality care”

•• Each institution should evaluate current services and gaps Each institution should evaluate current services and gaps in their program to determine their individual program in their program to determine their individual program needsneeds

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MMC GU Navigator ProgramMMC GU Navigator Program

•• Virtual Clinic Virtual Clinic –– ProstateProstate–– BladderBladder

KidneyKidney–– KidneyKidney–– TestesTestes–– PenilePenile

•• Urology Tumor Conference (2 x/month)Urology Tumor Conference (2 x/month)•• Prostate Work Group (Quarterly MTG)Prostate Work Group (Quarterly MTG)•• Renal Cryo ConferenceRenal Cryo Conference

My role with the Prostate My role with the Prostate Cancer PopulationCancer Population

☺☺ All newly diagnosed prostate cancer All newly diagnosed prostate cancer patients going through MMC should patients going through MMC should be referred (approx. 300/year)be referred (approx. 300/year)

☺☺ Make sure patient understands his Make sure patient understands his

☺☺Make appropriate referrals Make appropriate referrals (Urology, Radiation Oncology, (Urology, Radiation Oncology, Medical Oncology, Second Medical Oncology, Second Opinions, Oncology Support Opinions, Oncology Support Services)Services)

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diagnosisdiagnosis

☺☺ Make sure patient has fair balance Make sure patient has fair balance regarding his treatment optionsregarding his treatment options

☺☺ Utilizes NCCN GuidelinesUtilizes NCCN Guidelines

☺☺ Assess barriers to care (no insurance, Assess barriers to care (no insurance, no transportation, cultural, language, no transportation, cultural, language, etc.)etc.)

☺☺ Work with patients in making Work with patients in making timely treatment decisionstimely treatment decisions

☺☺ Be available as a resource and Be available as a resource and advocate for patients and advocate for patients and familiesfamilies

☺☺ Collaborate with multiCollaborate with multi--disciplinary teamdisciplinary team

Prostate Navigator Pathway

UrologyMedOnc

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Navigator(Triage)

Other

RadOncEntry Point

SOC

Referring MD

…Patient

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Prostate Navigator Pathway cont…

Support Services (Barriers to Care)• Cultural/Language• Education• Health Insurance/Financial Concerns• Transportation

Follow UpPost Treatment/Survivorship

Navigator(Triage)

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• Transportation• Physical/Psychosocial Needs• Disease Management

GU Tumor Conference

Clinical Diagnosis/Treatment• Diagnostic Radiology• Surgery• Medical Oncology

• Radiation Oncology• Palliative Care• Cancer Risk & Prevention

Clinic (CRPC)

MedOnc RT Urology

GU Navigator Referral Process

Newly Diagnosed Prostate Cancer Newly Diagnosed Prostate Cancer

Patient should be referred upon diagnosis Patient should be referred upon diagnosis and/or initial consultation and completed and/or initial consultation and completed

Referrals must include:Referrals must include:•• H&PH&P•• Pt. DemographicsPt. Demographics

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ppdictationdictation •• F/U Notes documenting + DXF/U Notes documenting + DX

•• Outside pathology & imaging reportsOutside pathology & imaging reports

MMCCI Staff InvolvementMMCCI Staff Involvement

Referrals TeamReferrals Team•• UrologyUrology•• Rad OncRad Onc

Medical RecordsMedical Records Clinical TeamClinical Team•• MDMD•• PA & NPPA & NP•• RNRN

Oncology Support Services at Oncology Support Services at MMCMMC

•• Breast NavigatorsBreast Navigators•• Lung NavigatorLung Navigator•• Gynecologic NavigatorGynecologic Navigator

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Gynecologic NavigatorGynecologic Navigator•• Upper GI NavigatorUpper GI Navigator•• Lower GI NavigatorLower GI Navigator•• ACS Patient NavigatorACS Patient Navigator•• Clinical Social WorkerClinical Social Worker•• Oncology DietitianOncology Dietitian

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Skills that help the navigatorSkills that help the navigator

•• Clinical expertiseClinical expertise•• CompassionCompassion•• Good Communication SkillsGood Communication Skills

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•• Good assessment skills (over Good assessment skills (over the phone)the phone)

•• HumorHumor•• Mind ReadingMind Reading•• JugglingJuggling•• Fortune TellingFortune Telling

Prostate Cancer StatisticsProstate Cancer Statistics

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Prostate Cancer Prostate Cancer

United States / 2009United States / 2009

•• 192, 280 new prostate cancer diagnoses (ME 192, 280 new prostate cancer diagnoses (ME 1,130)1,130)

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))

•• 27, 360 deaths from prostate cancer (ME 160)27, 360 deaths from prostate cancer (ME 160)

•• Most common malignancy in menMost common malignancy in men

•• 22ndnd leading cause of cancer death in menleading cause of cancer death in men

•• Lifetime incidence 16%Lifetime incidence 16%

•• Lifetime risk of death 3.4%Lifetime risk of death 3.4%ACS 2009; CA Cancer J Clin 56: 106, 2006

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MMC ExperienceMMC Experience

Year Prostate Other GU Total

2005 272 148 420

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2006 361 163 524

2007 313 170 483

2008 320 183 503

2009 234 165 381

* Analytic cases, by year first seen at MMC

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4

Maine Cancer Centers by MMC Service Areas

NCI

2002-2006

1 yr. avg

MMC 2009

MMC %

PSA 382 114 29 8%

17

22

2

2

2

3

5

3

1

1

3

1

1

37 hospitals (11 COC accredited)37 hospitals (11 COC accredited)

Total382 114 29.8%

SSA Total

426 92 21.6%

Other Total

343 20 5.8%

Prostate Cancer Stage at Diagnosis in Maine: Changes over Time

70%

80%

90%

1995-1997

Stage at Diagnosis in MaineStage at Diagnosis in Maine

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0%

10%

20%

30%

40%

50%

60%

70%

Local: Confined tothe prostate

Regional: Spread tonearby locations

Distant: Spread todistant locations

Per

cen

t 1998-2000

2001-2003

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Incidence and MortalityIncidence and Mortality

Prostate Cancer Incidence and Mortality in Maine: Changes over Time

175200

025

5075

100

125150

175

Incidence Mortality

Rat

e (p

er 1

00,0

00)

199520002005

MMC Prostate Cancer ProgramMMC Prostate Cancer Program

MMC selected as 1 of 5 model prostate cancer programs in the U.S. MMC selected as 1 of 5 model prostate cancer programs in the U.S. by the Association of Community Cancer Centers / 2009by the Association of Community Cancer Centers / 2009

acccaccc cancer orgcancer org

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•• www.acccwww.accc--cancer.orgcancer.org

•• Oncology IssuesOncology Issues Sept/Oct 2009Sept/Oct 2009

•• “Clinical navigator” model assists patients in Shared Decision “Clinical navigator” model assists patients in Shared Decision Making processMaking process

Prostate CancerProstate Cancer

Essence of the ConundrumEssence of the Conundrum

•• NotNot all patients are alikeall patients are alike

•• NotNot all prostate cancers are alikeall prostate cancers are alike

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•• NotNot all prostate cancers are alikeall prostate cancers are alike

•• SDM should SDM should linklink available evidence to patient available evidence to patient values and preferencesvalues and preferences

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SDM and Cancer CareSDM and Cancer Care

•• SDM in cancer care cannot be focused on a SDM in cancer care cannot be focused on a singlesingle decision point.decision point.

•• Patients change the cancer changes and thePatients change the cancer changes and the

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Patients change, the cancer changes, and the Patients change, the cancer changes, and the resources necessary to make a “shared decision” resources necessary to make a “shared decision” change.change.

•• SDM in cancer care requires a SDM in cancer care requires a multitudemultitude of of approaches to manage the approaches to manage the cascade of decisionscascade of decisionsthat cancer patients will encounter.that cancer patients will encounter.

SDM and Active Surveillance SDM and Active Surveillance ProtocolProtocol

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What is it?What is it?

•• Active Surveillance is closely monitoring a Active Surveillance is closely monitoring a prostate cancer patient’s condition without prostate cancer patient’s condition without giving active treatment until cancer progression giving active treatment until cancer progression

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g g p gg g p gis demonstrated.is demonstrated.

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It is estimated that 45 % of patients with It is estimated that 45 % of patients with newly diagnosed prostate cancer meet the newly diagnosed prostate cancer meet the

early stage lowearly stage low--risk definition andrisk definition and

Active SurveillanceActive Surveillance

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early stage, lowearly stage, low risk definition and risk definition and therefore are candidates therefore are candidates for Active Surveillance.for Active Surveillance.

Laurence Klotz, MD 11/19/2007Laurence Klotz, MD 11/19/2007

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Active Surveillance may represent an Active Surveillance may represent an appropriate strategy for men with early stage, appropriate strategy for men with early stage,

lowlow--risk disease.risk disease.


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lowlow risk disease. risk disease.

A selective approach to treatment of early A selective approach to treatment of early stage, lowstage, low--risk prostate cancer is critical. It can risk prostate cancer is critical. It can provide an alternative to the problem of over provide an alternative to the problem of over

diagnosis and over treatment. diagnosis and over treatment.

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Who is appropriate for it?Who is appropriate for it?

•• PSA PSA << 10 ng/ml10 ng/ml

•• Gleason Score Gleason Score << 6 (Tumor Grade)6 (Tumor Grade)

•• T1cT1c T2a (Clinical Tumor Stage)T2a (Clinical Tumor Stage)

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•• T1cT1c--T2a (Clinical Tumor Stage)T2a (Clinical Tumor Stage)

•• < 3 core biopsies involved, < 50 % of any core < 3 core biopsies involved, < 50 % of any core biopsybiopsy

•• For men with > 15For men with > 15--year life expectancyyear life expectancy

FollowFollow--up Scheduleup Schedule

•• PSA, Digital Rectal Exam (DRE) every 3 PSA, Digital Rectal Exam (DRE) every 3 months x 2 years,months x 2 years,

•• Then every 6 months (as long as PSA is stable)Then every 6 months (as long as PSA is stable)

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Then every 6 months (as long as PSA is stable)Then every 6 months (as long as PSA is stable)

•• 1010--12 cores biopsies at 1 year (following 12 cores biopsies at 1 year (following diagnosis),diagnosis),

•• Then every 3 years until age 80 yearsThen every 3 years until age 80 years

InterventionIntervention

•• For PSA doubling time < 3 yearsFor PSA doubling time < 3 years

•• For tumor grade progression to Gleason For tumor grade progression to Gleason scorescore >> 77

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score score >> 77

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PSA based prostate cancer screening results in the PSA based prostate cancer screening results in the diagnosis of prostate cancer in many men who will not diagnosis of prostate cancer in many men who will not have disease progression during their lifetime. have disease progression during their lifetime.


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Early stage, lowEarly stage, low--risk prostate cancer is defined as the risk prostate cancer is defined as the following, PSA following, PSA << 10, Gleason score 10, Gleason score << 6, and Tumor 6, and Tumor staging T1c to T2astaging T1c to T2a

In most cases of early stage, lowIn most cases of early stage, low--risk prostate cancer is risk prostate cancer is slow growing.slow growing.

Prostate Cancer Treatment Prostate Cancer Treatment OptionsOptions

•• Open Radical ProstatectomyOpen Radical Prostatectomy•• Laparoscopic Robotic daVinci® Radical ProstatectomyLaparoscopic Robotic daVinci® Radical Prostatectomy•• CryosurgeryCryosurgery•• Prostate Seed Implantation (PSI)Prostate Seed Implantation (PSI)

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•• Prostate Seed Implantation (PSI)Prostate Seed Implantation (PSI)•• External Beam Radiation TherapyExternal Beam Radiation Therapy•• Intensity Modulated Radiation Therapy (IMRT)Intensity Modulated Radiation Therapy (IMRT)•• Cyberknife® Robotic Radiation Therapy SystemCyberknife® Robotic Radiation Therapy System•• Proton Beam Radiation TherapyProton Beam Radiation Therapy

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www.mmc.org/CancerInstituteOutcomeswww.mmc.org/CancerInstituteOutcomes

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SDM and Prostate Cancer CareSDM and Prostate Cancer Care

•• PSA screeningPSA screening•• Active surveillanceActive surveillance•• Active treatment of localized diseaseActive treatment of localized disease••NeoNeo--adjuvant treatmentadjuvant treatment

Adj t t t tAdj t t t t

A “Portfolio Approach” A “Portfolio Approach”

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•• Active treatment of metastatic diseaseActive treatment of metastatic disease••Adjuvant treatmentsAdjuvant treatments••Hormonal therapyHormonal therapy••ChemotherapyChemotherapy••Clinical trialsClinical trials••Palliative and endPalliative and end--ofof--life carelife care


“Informed” (pt alone)“Informed” (pt alone)

–– Print brochuresPrint brochures

•• “Individualized”“Individualized”

–– Informed or sharedInformed or shared

Different ModelsDifferent Models

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–– VideoVideo

•• “Shared” (pt & doc together)“Shared” (pt & doc together)

–– Patient Patient –– Physician / NPPhysician / NP

–– Patient Patient –– NavigatorNavigator

–– Cards or game boardsCards or game boards

–– WebWeb--basedbased•• Michigan Cancer Michigan Cancer

CosortiumCosortium

•• ProsdexProsdex

•• NCINCI

•• AHRQAHRQ

•• HealthwiseHealthwise

•• HealthDialoguesHealthDialogues


A proposed “hybrid approach” includes both “shared” and A proposed “hybrid approach” includes both “shared” and “individualized” elements.“individualized” elements.

•• Mayo Clinic SDM cards Mayo Clinic SDM cards –– Victor MontoriVictor Montori•• Interactive matrix websites Interactive matrix websites –– Nananda ColNananda Col

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•• Develop webDevelop web--based personalized prostate cancer decision tool based personalized prostate cancer decision tool ––Drs Haskins, Hansen, ColDrs Haskins, Hansen, Col–– Maine Cancer Foundation (MCF) Grant "Predicting Quality Maine Cancer Foundation (MCF) Grant "Predicting Quality

of Life Outcomes after Prostate Cancer Treatment”of Life Outcomes after Prostate Cancer Treatment”

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CORE AbstractCORE Abstract

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Prostate Cancer Case #1Prostate Cancer Case #1

•• 66 yo male66 yo male

•• T1cT1c

•• Gleason grade 3+3=6Gleason grade 3+3=6

•• Review Dx & Tx Options Review Dx & Tx Options (90 minute consultation)(90 minute consultation)

•• Rad Onc referralRad Onc referral

FolloFollo p / Urologp / Urolog

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•• PSA 4.7PSA 4.7

•• No barriers to careNo barriers to care

•• No further staging studies per No further staging studies per NCCN guidelinesNCCN guidelines

•• Urology refers to NavigatorUrology refers to Navigator

•• FollowFollow--up w/ Urologyup w/ Urology

•• s/p LRAP s/p LRAP

Prostate Cancer Case #2Prostate Cancer Case #2

•• 49 yo male49 yo male•• Clinical T3Clinical T3•• Gleason grade 5+4=9Gleason grade 5+4=9•• PSA 336PSA 336

M l if l b iM l if l b i

•• PostPost--dx staging studies (CT dx staging studies (CT abd/pel, bone scan)abd/pel, bone scan)

•• Med Onc consultMed Onc consult•• Rad Onc consultRad Onc consult•• Interpreter ServicesInterpreter Services

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•• Multifocal bone metastasisMultifocal bone metastasis•• Russian speaking onlyRussian speaking only•• No transportationNo transportation•• MaineCare (Medicaid)MaineCare (Medicaid)•• Financial concernsFinancial concerns

•• Interpreter ServicesInterpreter Services•• Oncology Social WorkerOncology Social Worker•• ACS PT NavigatorACS PT Navigator•• ONS Network for Russian Written ONS Network for Russian Written

MaterialsMaterials•• PT Counseled on Tx options (~6 PT Counseled on Tx options (~6

hours facehours face--toto--face w/ interpreter)face w/ interpreter)

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Prostate Cancer Case #2

•• Patient agreed to hormone ablation therapy and Patient agreed to hormone ablation therapy and observation under the direction of Med Onc observation under the direction of Med Onc (after much contemplation and concern (after much contemplation and concern

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( p( pregarding sexual side effects and cultural regarding sexual side effects and cultural concerns)concerns)

•• Baseline bone density testing pendingBaseline bone density testing pending

•• Consider Zoledronic Acid therapyConsider Zoledronic Acid therapy

Lost in the sea of health care Lost in the sea of health care information?information?

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MaineHealth Prostate CancerMaineHealth Prostate Cancer

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Screening GuidelinesScreening Guidelines

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MaineHealth MaineHealth Prostate Prostate CancerCancer

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CancerCancerScreening Screening GuidelinesGuidelines

Growing a Prostate Cancer Program:A Navigator’s Perspective

Frank delaRama RN MS AOCNS

Growing a Prostate Cancer Program:A Navigator’s Perspective

Frank delaRama RN MS AOCNSFrank delaRama, RN, MS, AOCNSPalo Alto Medical Foundation

Frank delaRama, RN, MS, AOCNSPalo Alto Medical Foundation

Presented to theAcademy of Oncology Nurse Navigators

First Annual ConferenceSeptember 19, 2010

Baltimore, MD

Palo Alto Medical FoundationProstate Cancer Care


The program today…

How did we get here?

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Program Development & the Navigator Role


1990’s: Urology-Oncology Rounds– Mainly physician representation

– Urology, Radiation Oncology, Pathology

– Retrospective cases

Early 2000’s: Developing a Navigator– RN Radiation Oncology

• Coordinating rounds

• Arranging consults & tests



2004: Prostate Cancer Nurse Navigator– Hired additional Rad Onc RN’s, so PCNN

could dedicate majority of time to PC pts

I l t i li i id QI itt– Involvement in clinic-wide QI committees: Patient-Focused Cancer Care Committee

• Site visits

• Focus groups

• Staff education– *Prostate Cancer Survivor Panels

– Similar Community Education event

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2004: Shared Decision Making in Prostate Cancer– Multi-site study

Prostate Cancer Resource Notebook– Prostate Cancer Resource Notebook

– Grant writing

– Study aim to explore the value of the PCNN/SDM Intervention & patient satisfaction with treatment decision vs. usual care



2006: Cancer Care Clinic– Physical space @ PAMF

– Plan to host Multi-specialty ClinicsPlan to host Multi specialty Clinics

– Navigator offices there (Breast & Prostate)



2006 to present: Prostate Cancer Care Program blossoms…– Prostate Cancer Survivor Video– PCNN Study funded– PAMF Outcomes Measures Project

• EMR/Info Tech• QOL surveys• Retrospective data collection

– Buddy Program– ACCC Article– Hosting Multi-Spec Clinics for non-PAMF

patients– Cancer Patient Advisory Council

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Shared Decision MakingNurse Navigator Intervention Study

Shared Decision MakingNurse Navigator Intervention Study

Prostate Cancer Resource Binder

Shared Decision Making WorksheetBoth available online at:– Both available online at:http://www.pamf.org/prostate/

SDM Study GoalsSDM Study Goals

reducing decisional conflict decreasing the time between Dx and a Tx

decision improving adjustment to Tx outcomes improving adjustment to Tx outcomes increasing satisfaction with overall care

and with the Tx decision process reducing health care resource utilization

during the decision period improving quality of life.

TOCTOC

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SDM WorksheetPrioritizing Goals for Treament & Outcomes

SDM WorksheetPrioritizing Goals for Treament & Outcomes

SDM: STEP 1SDM: STEP 1

Where do I start?Level of RiskMSKCC NomogramgRecommended treatment options(NCCN)


Identifying my goals– Avoiding side effects

– Maintaining QOLMaintaining QOL

– Getting the cancer out/gone

– Making treatment as convenient as possible

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Setting priorities– Avoiding immediate side effects

– Avoiding long-term side effects

– Control cancer / life expectancy– Control cancer / life expectancy

– Quality of Life

– Convenience

– Operative risk

– Other …


My realistic options are:

Written plan

PCNN SDM Study: PearlsPCNN SDM Study: Pearls

Qualitative differences, men vs. women, in how they handle a new cancer diagnosis– Men: internalize, research, analytical– Women: externalize, search support, pp

psychosocial Value of the navigator, as expressed by

survivors (more time with PCNN, the better)

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PCNN SDM Study: PearlsPCNN SDM Study: Pearls

Value of the shared experience, once the men opened up (surprised to find out who also had PC, and how willing to share stories)

Early feedback – satisfaction with txEarly feedback satisfaction with tx decision + PCNN Intervention (vs. ‘woulda/coulda/shoulda’!)

Consider potential downstream financial benefits of PCNN– Minimize outmigration– More encounters in the PAMF system

(Primary Care, Specialty Care, Lab/Imaging)

Multi-specialty Clinic: PearlsMulti-specialty Clinic: Pearls

Initial consult time in MSC similar to traditional consults, but less MD visits prior to treatment decision making

3 providers MAX, before info & time overloadoverload

Rapid succession of one-on-one visits vs. panel-type visit

Traditional visits (over several days) work better for some

Fundamental Themes for PCNN Development & Maintenance


Helping physicians/HCP’s

Helping patients in tx decisions

Helping population: Prostate CA Helping population: Prostate CA

Outcome Measurement

Patients giving back…

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What’s the Problem?

How can the PCNN bring value?How can the PCNN bring value?

Physicians/Healthcare ProvidersPhysicians/Healthcare Providers

Problems:– MD tracking of pos bx’s

– Arranging appts, potentially over severalArranging appts, potentially over several depts or even facilities

Navigator – solutions / value added servicesNavigator – solutions / value added services

One point of contact

Arrange appts (consults / tests)

Focus during early program dev’t– Opportunities to

demonstrate simple value added services / gain confidence

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Patients & tx decisionsPatients & tx decisions

Problems:– Mutliple “equal tx options”

– The “Male Patient”The Male Patient• Subthemes: Engineers, Stewers, Couple

Dynamics


Identifying vetted resources (internet, paper, nomograms*)

Shared Decision Making Shared Decision Making Interventions

“One person to call”

Unbiased 3rd party

Prostate Cancer PopulationProstate Cancer Population

Problems:– Screening controversies

– Many options / treatment technologiesMany options / treatment technologies

– Outcome measures, or lack thereof…

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Outcome measures Chart reviews / Aggregated reports /

Outmigration / $$$ reports Community Education Events / Speaking

O t itiOpportunities PCNN Perspective on Technology, plus

QOL Research Grants Philanthropic Opportunities

Giving BackGiving Back

Survivors helping the Navigator!– PC Survivor video / panel presentations

– Recruiting Buddies / Shared ExperienceRecruiting Buddies / Shared Experience

– Patient Advisory Boards / Committee Representation

– Philanthropy

Prostate Cancer NavigatorProstate Cancer Navigator

MissionThe mission of AONN is to advance the role of patient navigation in cancer care and survivorship planning by providing a network for collaboration and development of best practices for the improvement of patient access to carefor the improvement of patient access to care and quality of life.

VisionThe vision of AONN is to increase the role of and access to oncology nurse and patient navigators, so that all cancer patients may benefit from their guidance, insight, and personal advocacy.

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In prostate cancer, the nurse navigator plays an important role throughout the cancer care continuum, from screening/diagnosis, through treatment, and into survivorship

Serves as a valuable resource to patients, providers, and prostate cancer population in general


Advocate

Teacher

C l Counselor

Nurse

Linchpin: Are You Indispensible?Linchpin: Are You Indispensible?

www.sethgodin.com

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BONUS MATERIALBONUS MATERIAL

Oncology Nurse Navigator as a “LINCHPIN”

Becoming a LinchpinBecoming a Linchpin

“the linchpin is an individual who can walk into chaos and create order, someone who can invent, connect, , ,create, and make things happen. Every worthwhile institution has indispensable people who make differences like these”

There is no mapThere is no map

“Indispensible linchpins are not waiting for instructions, but instead, figuring out what to do next. If you g g yhave a job where someone tells you what to do next, you’ve just given up the chance to create value”

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The Culture of ConnectionThe Culture of Connection

“Linchpins don’t work in a vacuum. Your personality and attitude are more important than the actual work pproduct you create, because indispensable work is work that is connected to others.”

The Seven Abilities of the LinchpinThe Seven Abilities of the Linchpin

what does it take to be this person they can’t live without?

Providing a unique interface between members of the organization

Delivering unique creativity Managing a situation or organization of great

complexity Leading customers Inspiring staff Providing deep domain knowledge Processing a unique talent

A Turning PointA Turning Point

“Instead of focusing up complying with management as a long-term strategy for getting more stuff and being more secure,

h h t d ib f lwe have a chance to describe a powerful vision for our future and to actually make it happen. The new dream isn’t about obedience, it’s about vision and engagement.”

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Thank You!Thank You!

Questions?

Comments?

Selected ResourcesSelected Resources

PAMF Prostate Cancer Resource Notebook / SDM Worksheethttp://www.pamf.org/prostate/resources/binder.html

ACCC Oncology Issues, Sept/Oct 2009Developing a Multispecialty Prostate Cancer Clinic

ACCC Guide to Best Practices in a Comprehensive Prostate Cancer Programhttp://www.accc-cancer.org/publications/

first annual navigation & survivoship conference

Documents

optimizing cancer care

prostate cancer populat

president s cancer panel

assistance patient navigation

quality care

annual national meetingaonn

healthcare system

healthcare consumers