Navigating the Breast Cancer Journey

Nurse navigators guide breast cancer patients to the care and support they need

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

When a woman learns she has breast cancer, she may go into something of a twilight zone. She might be in shock for a while, stunned to learn she has a disease every woman fears.

And she’s often not sure what to do next.

There are so many paths in this journey and so many questions — questions she may not even know to ask — about the disease itself, its treatment and how cancer will affect her life and those she loves.

It’s a confusing and overwhelming time, not to mention emotionally distressing.

That’s why so many breast cancer centers around the country have established programs in which nurses guide patients through the breast cancer journey.

These professionals are called breast cancer nurse navigators, and they serve many roles as educators and translators, helping patients understand the disease, its treatment and how to live with and beyond it with grace.

Navigators are liaisons within the health team, keen listeners and referral sources to community support resources.

They are individuals who genuinely care about and focus on the overall well-being of their patients.

dailyRx spoke with a nurse navigator about the myriad roles and services she provides to her breast cancer patients.

Jessica Garris, BSN, RN, is a Breast Clinical Nurse Navigator with the Cancer Care Collaborative, a program of the Seton Medical Center in Austin, Texas. She’s a trained oncology nurse who has been helping breast cancer patients for 16 years.

When asked to describe her role, Garris said she provides “individualized support to breast cancer patients.”

She told dailyRx, “Nurse navigators can serve as a single point of contact during the woman’s cancer journey with the goal of smooth and timely execution of her treatment plan.”

Getting to know her patients

Garris meets her patients either face-to-face in the hospital or through a phone call.

She introduces herself and lets her patient know who referred her, which might be the patient’s physician, nurse, a case manager, social worker or other healthcare professional.

Once she has explained how she can help, Garris gets the patient’s permission to “dig deeper and establish a relationship.”

At that point, Garris asks her patient to tell her story, where she is in the breast cancer journey and what her concerns may be at that point.

Understanding barriers to care

During this discussion, Garris often comes to know what she calls “barriers to care” — anything that might prevent the patient from receiving the care she needs in a timely and efficient manner.

“Some examples of barriers to care can include lack of understanding about her diagnosis or treatment plan, lack of reliable transportation to appointments, lack of information about resources in her community, physical fragmentation of the healthcare services in her community, financial or employment stressors, caregiver responsibilities for children or aging parents, emotional distress, mental illness, homelessness...there are many,” Garris said.

“Any one of these might negatively affect the efficiency and timeliness of the delivery of her care," she said. "And getting timely treatment is so important, whether it be surgery or chemotherapy or radiation, including the transition periods from one treatment modality to the next, if applicable.”

Understanding the goals

Garris explained that her primary goal is to facilitate the entire journey, work with the patient to overcome whatever barriers are standing in the way and make sure that the treatment plan is executed as smoothly as possible.

During the initial conversation, Garris asks her patient to talk about her goals.

“Some of my patient’s goals include getting answers about financial concerns surrounding treatment, focusing on healing, addressing concerns about telling their children about their diagnosis, feeling good about their bodies, changing jobs to reduce stress, getting through chemotherapy, getting genetic counseling, connecting with another woman who has had the same treatment they will have, addressing end-of-life issues, finding a way to share what they’ve learned with others...and the list goes on,” Garris explained.

Sometimes a woman's goals change, and Garris is there to “help facilitate her transitions as well as provide ongoing support and education as it pertains to her physical, emotional and practical concerns.”

From this point forward, Garris stays in touch with her patients through email, phone calls and/or in-person visits.

Being a single point of contact

Breast cancer isn’t treated by a single professional but by an entire health team, including a surgeon, radiologist, oncologists (medical oncologists and/or radiation oncologists), sometimes a plastic surgeon and other professionals.

Being introduced to and becoming acquainted with all these professionals “ often overwhelming to a newly diagnosed woman and her support system, in addition to the emotional distress a new diagnosis of cancer can cause,” according to Garris.

Again, her role as a nurse navigator is to unburden the patient.

“A big part of my role is to help coordinate patient care by facilitating ongoing communication among members of the patient’s care team as well,” Garris said.

“I collaborate with physicians, nurses, social workers, case managers, dieticians, physical therapists and other healthcare professionals. The goal of this collaborative approach is to help ensure smooth, timely, excellent patient care.”

Garris added, “I educate patients and their families/support systems to reinforce what their physicians have explained to them about their diagnosis and treatment plan."

Sharing the emotions

Breast cancer is often a highly charged emotional journey.

And Garris appreciates this. She’s there to listen, calm, counsel, coach and even inspire.

Garris said, “I find that my patients also highly value the emotional support that I am able to provide as well. Sometimes that is in the form of encouragement to make hard decisions, listening to their fears with sensitivity and compassion, or even helping them to remember the goals that they set for themselves."

Dealing with financial concerns

Breast cancer can interrupt an individual’s work life, and there are a number of financial and insurance issues that need to be addressed.

“I am able to connect patients to resources that help answer specific insurance, work-related and financial/insurance questions,” Garris said.

“There are laws to protect patients with cancer, and I am able to help patients look into what is applicable to their specific situation through some excellent resources we have,” she said.

She added, “Sometimes patients want to know if they are going to be able to continue to work, and I encourage them to have a conversation with their physicians to help them make those decisions and provide the necessary information to their employer as early as possible.”

Connecting patients to support resources

Nurse navigators are connectors. They connect patients to organizations that offer a variety of different types of support.

“I collaborate with and make referrals to a variety of organizations that help connect patients to other survivors online or in person, organizations that have lay navigators who are sometimes also breast cancer survivors, organizations that help with transportation and financial needs, ones that provide support groups and/or counseling services for patients and even for their children,” Garris said.

“I also help educate patients about how to obtain wigs and/or breast prostheses here in our community. We are fortunate to have a wealth of resources here in Austin,” she said.

“My patients are appreciative of my ability to educate them about and connect them with valuable resources to address their physical, emotional, practical and/or spiritual concerns,” Garris explained.

Understanding the uniqueness

Just as every breast cancer is unique, so is every breast cancer patient.

“Some women access my knowledge and skills as an experienced oncology nurse frequently and others get connected to the resources I provide and do not rely on me regularly," Garris told dailyRx.

“I recognize every woman is different and therefore the one-on-one guidance and assistance I provide looks different for each person I navigate.”

Learning more

If you, a friend or a loved one is facing a breast cancer diagnosis, find out if the treating facility has a nurse navigator program.

This nurse, this individual, this care provider will help navigate, calm the sometimes stormy waters and help make the breast cancer adventure a smooth sailing journey.

Review Date: 
October 17, 2013