Background: The VA Puget Sound Health Care System (VAPSHCS) is a referral center for cancer care of veterans in Washington, Idaho, Oregon, and Alaska. Travel burden poses a significant barrier, putting veterans at high risk for delays in care. Nearly 50% of veterans seen in oncology at the VAPSHCS in 2012 and 2013 traveled 50 miles or more, and 25% came from out of state. A VISN 20 pilot program was established, consisting of multidisciplinary Cancer Care Navigation Teams (CCNTs) at 8 sites across the VISN to address and reduce barriers for these veterans. At VAPSHCS, a nurse practitioner, registered nurse, social worker, and program assistant comprise the CCNT. A clear transition process was developed to ensure timely cancer care and prevent veterans from getting lost in the cancer continuum.
Purpose: Identify and implement processes for patient navigation for veterans traveling for cancer care.
Methods: Navigation processes were identified based on a local needs assessment and review of cancer navigation literature. Veteran identification, assessment, education, and care team coordination processes were established and modified over time according to veteran and provider feedback.
Results: Veterans are identified through pathology results, tumor board, or consult from medical providers or referring facilities. During the veteran’s initial visit, an intake evaluation is completed to identify barriers to care. A distress screening and functional assessment are also documented at this time, and a plan is put into place to address identified concerns. Veterans are educated about their diagnosis and treatment and receive an orientation to the facility. During treatment, weekly chart reviews and patient call rounds are conducted with CCNTs at referring facilities. At the conclusion of treatment, a written treatment summary with follow-up recommendations is given to the veteran and documented in the medical record. Since October 2014, the VAPSHCS CCNT has provided navigation services to 345 veterans with the tracking of > 1,300 appointments, 360 trips, and has made over 350 referrals to other services.
Implications: We present a multidisciplinary navigation team model that may be adopted to address barriers of veterans who must travel for cancer care.
