Making room at the table.

A s an oncology nurse practitioner with a busy breast cancer practice, I would spend more than my share of time coordinating patient care. You know the drill: referrals to specialists, insurance pre-authorizations for diagnostic tests, assisting patients in completing applications for indigent care or pharmaceutical benefit programs, and a host of other services to provide high-quality cancer care. The patients represented a wide spectrum of ethnocultural, social, financial, and educational backgrounds, yet all had the same basic goal: healthcare choices that would ensure the best possible outcome. Often, after spending hours on the phone each week, I wondered why my hospital system didn't designate or hire someone to help patients move through the trajectory of cancer care. The original goal of patient navigation programs was to decrease or remove financial and social barriers to cancer screening and follow-up in underserved populations (Freeman, Muth, & Kerner, 1995). The patient navigator model included social workers and trained patient counselors rather than nurses or trained medical providers. Interest in patient navigation is growing , but what constitutes patient navigation or to whom we should assign the title " patient navigator " is unclear. Dohan and Schrag (2005) defined a patient navigator as one who helps patients overcome barriers to care. Oncology nurse navigators (ONNs) are an evolving group of RNs with a specialization in oncology who perform the tasks of patient navigation. The Academy of Oncology Nurse Navigators and the National Coalition of Oncology Nurse Navigators are still in the early stages of organization, with goals to promote the role of nurse navigators, establish navigator-specific certification examinations, and share resources among members. Several ONN-related educational sessions and symposia were presented at the Oncology Nursing Society (ONS) Annual Congress in April 2009 and the Institutes of Learning in November 2009. A search of ONS conference abstracts from 2004–2009 yielded 11 abstracts related to the search term " navigator. " The American Cancer Society and the Commission on Cancer of the Ameri-can College of Surgeons have identified care coordination and patient navigation as focus items for 2009. ONS and the Association of Oncology Social Work held a joint patient navigation think tank in June 2009 to address the specific needs of oncology nurses and social workers in support of the patient navigation role. It looks to me like everyone is trying to gather at the same table and, believe me, there are plenty of …