In 2008, the NCBC recognized the need for a standardization of the Breast Patient Navigator’s role. Just as the breast care/cancer diagnosis and treatment process may differ from facility to facility, so do the definitions, activities, knowledge and job descriptions of a breast patient navigator. These disparities can adversely affect the breast care/cancer treatment provided to women across the nation and around the world. In an effort to minimize and eventually eliminate the variances in a breast patient’s continuum of care and the definition/function of a breast patient navigator providing care within that continuum, the NCBC created this program.
A peer committee was formed to develop a certification program designed to validate the skill sets of breast patient navigators. The first certification program was offered at the NCBC’s 21st Annual National Interdisciplinary Breast Center Conference in Las Vegas, NV. More than 900 breast healthcare professionals received their designations as certified Breast Patient Navigators.
Purpose of Certification:
The Breast Patient Navigator Certification Program is a certification that has been developed by a peer review team of the National Consortium of Breast Centers (NCBC). The Navigator program identifies the purpose of certification as a means to:  set standards of achievement and the navigator’s role;  enhance patient safety, quality of care and delivery of services through recognition and resolution of barriers to care; and  recognize professionals who advance beyond basic knowledge in a specialty field.
Reviewing and assessing a candidate for certification in Navigation is dependent on, but not the same as, individual professional licensure. We are testing for Navigational knowledge and skills, and while combined with individual professional practices we are not testing for their licensure. Example: Registered Nurses are tested for working as a Navigator under a RN scope of practice versus testing for RN knowledge and skill sets which is an already recognized status.
In 2012 (for enactment in 2015) the Commission on Cancer report (CoC) identified some core requirements for breast centers of excellence to include community outreach, prevention program, screening program, and a patient navigation process. The professional Navigator often serve in all of these capacities, but at minimum needs to have a knowledge of all four requirements. Subsets of navigational duties include:
- Outreach (entering communities/neighborhoods, health fair, community needs assessments)
- Screening (education and promotion of mammographic standards of care)
- Diagnostics (imaging, tissue sampling, MRI)
- Treatment (oncologic: surgical, medical, radiation, adjuvant, supportive, complementary, alternative)
- Survivorship (care plans)
- End of Life care
Navigators renegotiate the flow of patient care to continually assess for barriers to care and effective ways to reduce or eliminate the impact.
Barriers are defined as anything that stops or delays decisions for diagnosis or treatment for breast cancer. Barriers include (not an exclusive list):
- Financial (cost of living, working, insurance, treatment costs)
- Emotional (lack of emotional resources to effectively cope with a cancer diagnosis, effects of treatment, lack of trust in medical professionals, prospect of disability or death from disease)
- Cultural/language disparities
- Educational (lack of or misunderstanding of diagnosis, treatment, prognosis)
- Transportation (getting to/from numerous and complex appointments)
- Physical (co-morbid conditions prior to or developing from treatment)
- Spiritual (reflection of crossing spiritual with physical illness, loss or lack of)
- Sexual (complexity of physical changes due to cancer and treatment effect on partners)
Role of the Registered Nurse Breast Navigator (CN-BN) Defined:
Registered Nurses who work full-time or in cooperation with a Navigation program carry over from a more job-limiting position of a care or case manager. The origins of the job generally were seen on discharge from a hospital or care facility to be sure of appropriate resources in the home setting before the patient is released from care.
A Nurse Navigator, or CN-BN, may be a full-time Navigator working anywhere among the spectrum of navigation subsets, or a full time RN who adds additional Navigational work to support patients before, during, and after breast related care. The CN-BN is unique in the role of Navigation due to the large spectrum of care nurses currently provide. Nurses are often integral in completing work and applications for breast center accreditation recognition, patient outreach into communities, ongoing program development, statistical analysis, communication between departments and other facilities or community resources. Please see attached MLQ and MLT document provided.
Each accredited breast center must plan for a Navigational presence to include the aforementioned Commission on Cancer requirements for the highest standard of care. Two standards include:
NAPBC Standard 3.1 Patient Navigation Process
A patient navigation process, driven by a community needs assessment is established to address health care disparities and barriers to care for patients.
The report (at least one within a 3 year period) to the cancer committee should evaluate and report:
Description of the navigation process
Population and barriers identified
Documentation of activities and metrics (outcomes/outputs)
Areas of Quality Initiatives, enhancement and future directions
NAPBC Standard 3.2 Psychosocial Distress Screening
The cancer committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care.
The Navigator’s vital role in the CoC standards of care for breast cancer patients is pivotal in data collection, standardizing routine care, and keeping patient care on a smooth and steady track.
Most importantly, on a Navigator to patient role, the Navigator is in a unique position to support a patient with personalized care. With the myriad of shifting treatments, oncology providers, appointment dates/times, and general patient confusion of variances in oncology focus the care becomes fragmented and frightening. A professional Navigator spends time understanding the patient, the support, viewpoints on personal healthcare philosophies, and basis of barriers to care.
- Engage continued care and transition to additional care providers or navigators
- Offer resources to minimize or eliminate known barriers to care.