1. MMC Cancer Institute Navigation Program Donna Green BSN, RN,BA,OCN greenda@mmc.org

2. MMC model Utilizes an Oncology Nurse Navigator (ONN) –Experienced RN –Oncology certified –BSN minimum preparation (or matriculated)

3. Key Elements of the ONN Role Screening for barriers to care; psychosocial, financial, transportation, lodging, cultural, information & educational Coordinating diagnostic, staging & treatment appointments Providing information, education & access to support services for patients & families Facilitating timely accurate communication among providers Screening for appropriate clinical trials/ genetic risk assessment Coordinating multidisciplinary tumor conferences Acting as patient advocate

4. Time line for the MMC/ONN Program 2006-2007 Cancer Committee considers concept 2008 GU Nav Hired 2008 Convert 2 clinical BCC / 1 coordinator TOC positions to Nav 2009 Budgeted Funding for UGI, LGI, GYN, 2010 NCCCP 3.5 million 2yr contract 2010 NCCCP 1.5 SW Cross cultural Navigator 2011 NCCCP Survivor Nav 2011 NCCCP SW 2011 48K NBCF Grant SW Nav dedication to Breast Survivorship ALLCANCERSALLCANCERS SURVIVORSHIPSURVIVORSHIP 2008 Shared funding of ACS navigation

5. Similar roles different needs Breast Thoracic GU Upper GI Lower GI GYN Health System Survivorship Cross Cultural

6. Program Goals Increase number of referrals to support services and palliative care Support Informed decision making Increased accruals to clinical trials Retention of patients within the health care system Adherence to referencing NCCN guidelines and TNM staging in multidisciplinary tumor conferences Outreach, screening events, support groups

7. NCI Community Cancer Centers Program (NCCCP) Overview NCCCP started in 2007 with initial funding of 16 sites primarily in rural, small town and underserved urban areas in 14 states In April 2010, MMCCI became one of 14 newly- funded sites MMCCI second site in New England 2-Year, $3.7 million contract Joint effort between CORE/MMCRI/MMCCI

8. Overall goal To improve access to quality cancer care -- including high-priority clinical trials -- with a focus on rural, poor, and immigrant/refugee populations in Maine

9. NCCCP Regional Rural Navigation concept The creation of a Maine Health regional rural Patient Navigator role serving cancer patients in a pilot community will increase access to high quality cancer care for those patients.

10. Methodology A Patient Navigator designated to support the primarily rural geographic area currently serviced by Penobscot Bay Medical Center, Waldo County General Hospital and Lincoln County Healthcare. Individual will based out of those communities, but has a reporting relationship with NCCCP staff at MMCCI to ensure that contract deliverables are being addressed.

11. Contract Objectives addressed Targeted access to underserved populations (rural, poor, primarily white, population) Increasing accruals to clinical trials and biospecimens initiatives Advancing the quality of cancer care provided in the community (with a particular focus on improving the care of breast cancer patients in a pilot region) Improving access to high quality cancer services (i.e. palliative care, screening, reconstructive services, radiation oncology, etc.)

12. Cross Cultural Navigators focus –Immigrant and/or refugee patients –Rural patients –Underserved patients (underinsured, uninsured)

13. Cross Cultural Navigator Roles Outreach –Community needs assessments –Establish and foster community relationships Navigation –System-wide navigation Hospital, community, state, regional –Staff support Cultural competence and awareness

14. Cross Cultural Navigator Roles Some patient populations we have served: –African cultures, particularly Somali, Burundi, Rwandan –Serbian –Vietnamese, Chinese –Underinsured and uninsured –Rural

15. Survivorship Navigator Focused on assessment of Survivorship needs Co Facilates Bridges program Participates in program development

16. Future of Patient Navigation “In my opinion, the creation of the navigator role is one of those advances which I can no longer imagine functioning without.” ~ Thomas Vander Kloot, MD