Navigation/Care Coordination

To evaluate how nurse navigation affected care satisfaction and distress among women who were undergoing breast biopsy. Specifically, were there significant differences in women undergoing breast biopsy with and without nurse navigators?

• N = 137  
• AGE: Range = 18-89 years. Thirty-two percent were aged 50 years or younger; 68% older than age 50
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Non-pregnant women aged 18 years or older undergoing core needle breast biopsy procedure

• SITE: Multi-site    
• SETTING TYPE: Outpatient    
• LOCATION: Northern Appalachia

• PHASE OF CARE: Diagnostic

• Descriptive, cross-sectional survey

• Demographics were collected via a questionnaire.
• Distress was measured with the Hospital Anxiety and Depression Scale (HADS-A, HADS-D) and the State Trait Anxiety Inventory, State (STAI-S) scale.
• Satisfaction was recorded with the Patient Satisfaction Questionnaire (PSQ-18).

No significant between-group differences were noted in depression. Lower scores were shown for anxiety (significance p < 0.05) among patients who had navigation. There was no difference in overall satisfaction with care though there was an association between satisfaction and distress: that is, women with more satisfaction reported less distress. The population with nurse navigators shows stronger relationship-based characteristics. Significant differences were shown in five categories (accessibility, communication, finances, interpersonal manner, and time) for the navigated population and in two categories (accessibility, general satisfaction) for the non-navigated or usual care population.

Nurse navigation increased satisfaction with care. General satisfaction measured significantly higher in the non-navigated sample when compared to the navigated group. Distress screening followed by interventions of emotional support, education, and facilitating communication between and among providers are roles nurses can fulfill to improve satisfaction outcomes and lower distress levels.

Train nurse navigators in addressing key areas of patient-center interface: accessibility to care, communication among providers, financial support, interpersonal manner, time with care provider, and technical quality. Nurse navigators have knowledge and skill to manage care of women undergoing needle biopsy and, thereby, improve general satisfaction in specific areas.

To evaluate effects of nurse navigation on depression among patients newly diagnosed with cancer

The nurse navigation intervention was designed to address care delays, care coordination, information needs, and help in patient decision-making and lack of emotional and social supports for patients. Patients randomized to receive the intervention had weekly nurse navigator contacts for 16 weeks. Nurses used a distress thermometer to identify problems and monitor progress. Those with high distress scores and suspected to have depression were referred for further assessment and treatment. Outcomes were evaluated in a four month follow-up telephone interview.

• N = 248  
• MEAN AGE: 61.3 years
• MALES: 11.3%, FEMALES: 88.7%
• KEY DISEASE CHARACTERISTICS: Breast, colorectal, and lung cancers, mostly stage I and II
• OTHER KEY SAMPLE CHARACTERISTICS: Most had at least some college education, they were predominantly Caucasian, and the majority were married.

• SITE: Multi-site  
• SETTING TYPE: Not specified    
• LOCATION: Seattle, WA

PHASE OF CARE: Active antitumor treatment

• Randomized cohort controlled study
• Secondary analysis

• Patient Health Questionnaire-9 (PHQ-9)
• Distress Thermometer (DT)
• Patient Assessment of Chronic Illness Care (PACIC)

Most patients did not have depression at baseline. For those with higher baseline PHQ-9 scores, nurse navigation patients had higher PACIC scores; however, differences were not statistically significant.

Findings did not show that nurse navigation was of greater benefit for patients with depressive symptoms or had an impact on depression scores.

• Risk of bias (no appropriate attentional control condition)

Findings of this study did not show that nurse navigation affected depressive symptoms or was of greater benefit to patients with depression among those newly diagnosed with cancer.