When Dee Collins began her job eight years ago, there were few, if any, other breast care navigators in the state.

 

Collins, a registered nurse practitioner who is the breast health care navigator for St. Bernard's Medical Center in Jonesboro, said the Care Navigator program at her hospital was two years old when she replaced the former navigator. A grant from the Susan G. Komen Foundation helped get the program started, and Collins said it was possibly the first of its kind in Arkansas.

 

Today, more and more Arkansas hospitals and clinics are finding ways to include breast care navigators on the treatment teams.

 

Navigators, in general, are becoming more widely used in all sorts of medical disciplines and patient subgroups, but breast cancer is a particularly good area for navigator services, Collins said.

 

"Patients hear more about breast cancer now and talk about that more openly, which is great. But they will sometimes work themselves up getting nervous about coming in, reading things online or hearing horror stories," she said. "Sometimes increased awareness is beneficial, and sometimes it makes them more apprehensive. That's where we come in."

 

Breast care navigators are nurses whose role is to be a constant for the patient through the disparate elements of their treatment plan and an informed and willing ear to help the patient with anything from answering questions about their care to supporting them through the roller coaster of emotions they may experience. Nurse navigators act as a sort of nurse, social worker, counselor and cheerleader all rolled into one very coordinated function.

 

Laurie Lloyd, RN, has been the breast health nurse navigator for the Baptist Breast Center in Little Rock since the program started in 2006 through a Runway for the Cause grant from AY Magazine.

 

"It's becoming more common (to have breast nurse navigators) because of the fragmented care that the patients get seeing one doctor for this and another doctor for this, various doctors who don't have a chance to see the patient as a whole," she explained. "What the women have told me is that it's been very nice to have one central person to be able to talk to through this. You see your surgeon, and they deal with surgical issues. You see your oncologist, and they deal with oncology issues, same with the radiation. But there's a lot of other stuff that goes on with the treatment of a woman, be it physiological or psychological that I can help sometimes by just listening or connecting them to the information they need. Sometimes they can't even vent to their families because their families want them to be upbeat all the time so they aren't scaring the family. They can ventilate to me and cry and get mad and it's okay. I'm a safe zone for them."

 

"When women are first diagnosed with breast cancer, they don't have any idea what to expect," said Susan Earnest, RN, the breast health navigator at Washington Regional Cancer Support House in Fayetteville. "It can be completely overwhelming, so I have a really nice package of educational materials, information I give at the very beginning to the new patients I see. The doctors and nurses are of course wonderful about giving patients good information, but there's a lot going on, a lot of new language to absorb, so I go over it all with the patient. I try to give them the whole scenario of what to expect, all the little details that get left out."

 

Collin said the program is extremely beneficial for patients and physicians. "People are more compliant to do what you need them to do, and feel more compelled to come back if they understand what's wrong, why is it important, how easy is this procedure, or how hard," she opined. "Everybody expects this to be a horrible process. They dread mammography because of the compression, or they've heard horror stories about a procedure, so when you have the opportunity to sit across the table and then expound on their questions of 'Specifically, what's wrong with ME? What does this mean? What do I need to do next? Who's going to help me?'"

 

The structure of care navigators' work is varied. Lloyd works in the Breast Care Center, but does the bulk of her interaction with breast cancer patients on the phone, calling to check on them after each doctor's visit and in between just to see how they are doing. Collins has several roles at St. Bernard's and provides face-to-face care coordination with women having all manner of breast health concerns, not just cancer, but also relies heavily on phone interaction for cancer patients who may not be in the clinic but still require her help. She works closely with the physicians' offices to schedule appointments and notify them when test results, pathology reports or films are coming their way.

 

Earnest, on the other hand, works in an entirely non-clinical function in the Cancer Support House, and will travel to meet with new patients at their homes or physician's office if it is not convenient for them to come to her. Because her job is completely funded by a grant from the Susan G. Komen Foundation, Ozark Affiliate, she is able to work with patients who come from anywhere in the region, not only from Washington Regional Medical Center in Fayetteville.

 

The longer the woman's course of therapy, the more their relationship grows as the patient often learns to rely on this single, constant point of contact and information throughout all the varied elements of their care. Collins said the women who have chemotherapy for several months to a year tend to become closest to her. Earnest said she has some patients who have had recurrences over the course of several years and who thus develop a longstanding trust and camaraderie with her.

 

Besides providing nursing information and a listening ear, navigators often help connect the patient to resources ranging from local vendors for durable medical equipment to American Cancer Society programs to financial assistance or help with insurance concerns.

 

Earnest said the clinical staff seems to appreciate her help.

 

"I've worked in big clinics and I know how busy it gets. The staff just doesn't have the time to give some of these patients who need a lot of hand-holding," she said. "But I've got the time to sit and visit with them, on the phone or while they're waiting for the doctor or in their doctor's office if they want a third-party to listen. I can be that unbiased person who helps these ladies understand, and I feel like if I can make it easier for them to understand what's going on, then it makes it easier for the doctors."

 

Lloyd said it is important that physicians understand her role is focused on supporting them as well as the patients.

 

"My job is to help the doctor, not to infringe upon them or to contradict anything the doctors say," she explained. "I'm here to back them up, help the patients if they have questions about the decision they've made or are making, answering honestly, but not inserting my opinion."

 

Although a number of health systems in the state have invested in nurse navigators, Collins said it is far from enough.

 

"I wish there were more of us. Not just for my facility, and not just for breast health, but for everybody," she said. "I know every facility may not be able to provide this standard of care, but I think it's great when they can. I have so many patients tell me, 'Oh, I feel so much better knowing what this is about and not walking out only knowing that I have to come back in four days for a biopsy.' It makes such a difference to them, and it feels so good to be able to help."