Navigators steer patients through the shoals

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Maureen Rubright says her nurse navigator at Forbes Regional Hospital in Monroeville is "like a guardian angel in a human body."

That's because Karen Schwaderer has been available to guide Mrs. Rubright every step of the way, from diagnosis through chemotherapy and scheduling of surgery since she was diagnosed with breast cancer in mid-October.

Ms. Schwaderer was the first of four registered nurses assigned by the West Penn Allegheny Health System to work as navigators -- nurses who have been trained to steer breast cancer patients through the maze of doctors and procedures they face after diagnosis.

The nurse navigators provide emotional support, educate their patients about their disease and treatment options, answer questions and even make surgical appointments for them. They remain available to their patients post-treatment.

"She said, 'I have to make sure you're comfortable. I am your friend. I am really here to guide you,' " Mrs. Rubright, 64, a retired nanny from Export, recalled of her nurse navigator.

"I said, 'It's your job.' She said, 'It's my job, but I love what I do. I enjoy helping my people.' "

The other three nurse navigators began their new jobs at Allegheny General Hospital in March. Ms. Schwaderer, who did a similar kind of navigating at WPAHS and UPMC under a multiyear grant from the National Institutes of Health, started her assignment at Forbes more than 18 months ago. She already has navigated more than 200 patients with abnormal findings, between 100 and 125 of them who eventually were determined to have breast cancer.

"My job here is much more of a care coordinator job, to help the patients get from point A to point B," Ms. Schwaderer said. The NIH grant-funded program was about resource navigation, helping patients overcome barriers to care.

"I meet with patients the minute they have an abnormal finding. I get them through the abnormal finding, the diagnosing of it and on to treatment," she added.

Next comes the appointment with a surgeon and education. "Once they get to the surgeon, I just check on them. I make sure they see the surgeon, the medical oncologist, radiation oncologist. I make sure they have hit all the stops," she said.

David Parda, chair of radiation oncology for WPAHS, noted that breast cancer patients have to see a lot of different physicians and auxiliary programs like nutrition and social services. He chairs the clinical and operational umbrella organization, known as a service line, of the WPAHS Cancer Institute.

"When the cancer patient has to traverse so many divisions and services, part of the job is navigation, and [nurse navigation] is formalizing the process," said Dr. Parda, who pushed for the program.

"A diagnosis of cancer is a tough diagnosis to reconcile, and it's just as daunting to go through all the entities you need to traverse."

Dr. Parda wants eventually to expand the program to all cancer patients treated at WPAHS's 22 locations throughout southwestern Pennsylvania.

"What we want to do in the first year is get up to about 20 [nurse navigators] and get that diffused out through the region and then build on that," he said. "We think we're going to need a lot more than 20."

Currently, he said, the program is seeking nurses with a lot of oncology experience, so R.N.s with additional oncology certification are preferred to work directly with patients on their treatment and educational needs.

Later, as the program is expanded, WPAHS hopes to hire what it calls patient navigators who can help with other support, including financial counseling, social services and spiritual needs. "These people who can extend navigation beyond doctors and nurses will be friends, family members, church and community members and others," Dr. Parda said.

Ms. Schwaderer said the nurse navigator concept was developed by breast surgeon Harold Freeman at Harlem Hospital in New York City in the mid-1990s.

"Dr. Freeman found young black women were coming to his clinic with stage 4 disease and didn't have resources for screening mammograms," she said. "So his program was community-based to promote screenings and then clinic-navigating to help if they were diagnosed.

"Through that it spread through the country with pilot programs funded by the NIH."

So far, feedback from Forbes has been positive, Dr. Parda said.

"The patients really do appreciate this navigational help," he said. "We really think of it as a lifeline for care."

People who are interested in becoming nurse navigators should contact Crystal Ross, coordinator of the nurse navigator program, at 412-359-6339.

Pohla Smith: or 412-263-1228.


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