Receiving the news that you have a breast abnormality can be frightening and confusing - what do you do next?
Nurse Navigation at Summit Medical Group's Breast Care Center is a process designed to help a woman through and around barriers to getting breast health care services.
Clinical Program Manager and a certified breast nurse patient navigator for the Summit Medical Group Breast Nurse Navigation Program, Carol Boyer, RN, MSN, APN, CBPN-IC, AOCNS, explains the navigation process and what a woman can expect upon entering the nurse navigation program.
Selected Podcast
Nurse Navigation at the Breast Care Center
Featured Speaker:
Carol Boyer, RN, MSN
Founder of the Summit Medical Group Breast Nurse Navigation Program, Carol G. Boyer, RN, MSN, APN, CBPN-IC, AOCNS, is also Clinical Program Manager and a certified breast nurse patient navigator for the Summit Medical Group Breast Nurse Navigation Program. An oncology and board-certified gerontology clinical nurse specialist, Ms. Boyer has more than 25 years' experience in clinical nursing practice. Transcription:
Nurse Navigation at the Breast Care Center
Melanie Cole (Host): With the majority of services located under one roof, the Summit Medical Group Breast Care Center offers comprehensive support and care of benign breast health conditions and all stages of breast cancer. My guest is Carol Boyer. She is a Clinical Program Manager and a Certified Breast Nurse Patient Navigator for the SMG Breast Care Center. Welcome to the show, Carol. Tell us about nurse navigation at the Breast Care Center. What does that mean for patients coming in there?
Carol Boyer (Guest): Okay. Nurse navigation is a process by which a nurse provides one-to-one support for a patient who has some type of breast abnormality. The nurse navigator guides the patient with the suspicious abnormality through and around barriers to care. Now, what are those barriers, you might ask? So, one of the biggest barriers is fear. Fear is something that is paralyzing, and many of our patients, the minute they hear they have an abnormal mammogram, they are in a panic state and they hear nothing else after “abnormal mammogram.” So the nurse navigator is there when they get news of an abnormal mammogram to guide them through the system and to give them a plan so that they know exactly what they do when they're leaving our room. Another common barrier is communication. They just don’t understand the words, or they're too fearful to understand the words, and we’ll explain things in language that they can understand. Also just dealing with the overwhelming healthcare system, you're talking about a medical radiologist, a surgeon, you’re talking about breast imagers – all of these things are brand new to somebody who has an abnormality, and we have to explain that. Some of our patients have economic and financial issues that they need to deal with. They're worried about taking time off from work. We’re always cognizant of trying to work around somebody’s work schedule so they don’t need to leave work in order to make an appointment. And then there are language and cultural barriers that we also have to work around. But the bottom line is that the patients and navigation get one-to-one attention. We ensure that every suspicious finding has some type of resolution, whether that’s having a biopsy, whether that’s seeing a breast surgeon, whether that’s getting more imaging. We also work very closely with the patient’s family. If they have questions, we try to respond to all of their questions and their concerns, because sometimes the patient will hear some news, they’ll leave, and we get a call from their husband or their family member that the patient really didn’t understand anything that went on just because of fear.
Melanie: Well, that’s great. So, you are really being the patient’s best advocate. You're guiding them through the whole process, which, as you say, can be very scary even for the most educated of us patients. What about insurance? Because people freak out about that, Carol, and they don’t know what’s going to be covered, and, “Oh, is the diagnostic not covered?” Do you help people sort of navigate the waters or refer them for financial assistance or explain to them how things work a little bit?
Boyer: Yes. We actually do have financial counselors onsite. In the Berkeley Heights campus, they are onsite. If patients are concerned about their insurance, we can refer them to a financial counselor. We do that very often, especially when they're concerned about changes in insurance. Their insurance is changing from one to another type and they want to make sure that they can continue with the care, we make sure that there's some continuity there, and we will provide a referral or call the financial counselors ourselves to get in touch with the patient. Absolutely. That’s an important part of our job.
Melanie: And since everything is kind of located, in a sense, under one roof, tell us about the Breast Care Center itself. What is your team that goes on there that you have everybody there for patients that makes them feel they don’t have to go running around to a million places?
Boyer: Right. Well, our breast care center offers comprehensive support and care for patients, anything from a benign breast tissue, like a cyst or a non-cancerous growth, right through all stages of breast cancer. So our actual sensor, we hold two national accreditations, meaning that we’ve met a certain set of quality standards and benchmarks. So these are National Quality Measures for Breast Center Programs. We are a center of excellence. Secondly, we are accredited by the National Accreditation Program for Breast Centers. These are two of the highest accreditations you can get as a breast center. So we’re very proud of that. We actually have two campuses. We have the Berkeley Heights campus, where we have four dedicated breast surgeons, Dr. John Cunningham, our Medical Director, Dr. Lozner, Dr. Addis, and Dr. Polen. Also, we have three surgeons at our Morristown offices, Dr. Diehl, Dr. Dolgin, and Dr. Carter, who also perform breast surgery. In the larger picture, we also have medical oncologists here, Dr. Wax, Dr. Mills, and Dr. Reeder, in addition to plastic surgeons, Dr. Hyans, Dr. Momeni, and Dr. Schmidt. We can quickly refer patients from one service to another, and with our electronic medical records, it’s very easy to communicate with one another. Plus, it’s a very personal type of relationship we have among the doctors. Everybody is always picking up the phone and talking to one another. So the patient really can feel that they're getting comprehensive care, and quickly. We try to see a patient within a day or two, if not the same day. If they call us up and they tell us they have a lump and they need to come in, we bring them in as soon as possible to see somebody.
Melanie: Now, as I understand, you also have cognitive therapists.
Boyer: Right.
Melanie: Women, as we spoke once before about anxiety and stress, surrounding all sorts of illnesses, breast cancer, or even just getting our mammograms. So how are they involved?
Boyer: Right. We have a wonderful cognitive therapy department that will meet with breast patients in a very timely fashion. We will refer them. Some patients, the anxiety of a new diagnosis of breast cancer is just overwhelming. They're not eating. They're not sleeping. We offer this service. The other thing that we have are support groups that I co-lead with a behavioral therapist, Liz Nikol. These groups are geared towards newly diagnosed patients as well as patients in survivorship. So both of those modalities, together, really are very helpful for the patients. Because some patients in the beginning, when they're first diagnosed, it’s a very, very difficult time. They're trying to navigate the waters. Even with the navigator holding their hand, they need an extra support. We are very, very quick to make that referral and really encourage our patients to see our cognitive behavioral therapist.
Melanie: Now, what about nutrition? What part does that play in our breast health?
Boyer: Well, as with any condition, we really promote a healthy lifestyle, weight management, exercise. All of those things help with general breast health. We do have a nutritional therapist here, Susan Canonico, who will see our patients even when they are in chemotherapy. In the chemotherapy unit, she’ll see them there and she’ll do private consults with them as well, just to get them looking at their diet and trying to eat better for a healthy lifestyle.
Melanie: Now, one of the most important things I hear from the Breast Center is the education part of it all, educating women and their spouses and their families. When a woman comes in, maybe she has to have the diagnostic or she’s gotten the diagnosis none of us wants to hear, how do you work with the family, the spouses? Is nurse navigation involved in that process?
Boyer: Absolutely. We have five certified breast nurse navigators here, two working directly in navigation and three others that work with the surgeons. We provide the patient with some general material initially on just breast cancer. Then when we meet with the family, we meet with the husbands, we meet sometimes with the children, we will provide the resources that they need at that time. Sometimes it’s just knowing that they have somebody that they can call. That is a comfort in and of itself. We always say to patients, “If you have a question, don’t lose sleep over it. Call us. We’ll get back to you. We get back to patients immediately.” Sometimes they have a question that they forgot the doctor, and we explain to them that we have very quick access to the physicians and we’ll get back to them. Just the comfort of knowing that there's somebody on the other end of the phone that can help them really makes a big difference, especially to the families too.
Melanie: Okay. So guiding through the healthcare system, education and support, after an abnormal mammogram, and then coordinating the healthcare services for additional testing, that would seem to be one of the most important jobs I can see that you would do, because that’s where it gets jumbled up, whether they have to have the diagnostic and then possibly surgery afterwards.
Boyer: Right.
Melanie: How do you work with them to coordinate all these different appointments they're going to have to have?
Boyer: Right. So navigation really begins at the time of abnormal mammogram. So a patient has an abnormal mammogram, she meets with the radiologist and the nurse navigator. From that point on, the nurse navigator goes on to make an appointment, offers the patient a timely appointment with one of our breast specialists. We’ll follow that patient along. As they get to that appointment at the time of that appointment, the next step is the patient will meet with one of the navigators that work with the breast surgeons. At that point, the patient will be given their options for whatever is next, whether it’s biopsy, moving on to surgery. Every step of the way, the navigator follows the patient to resolution of the problem. So there really isn’t a time when the patient feels that they're on their own. We give them a road map at the beginning and we explain to them, the first step is having a biopsy. Biopsy results will be back in three to five days. The surgeon who does your biopsy will call you as soon as those results are in. The next step will be coming in and having a discussion with the surgeon on what to do next. Every step of the way, they walk out of here and they have an exact plan on what they need to do, and that, I think, gives them a lot of comfort.
Melanie: It does, and what a wonderful program. Thank you so much, Carol Boyer. You're listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. You can go to summitmedicalgroup.com/service/Breast-Health-Center for more information on their Breast Health Center. This is Melanie Cole for SMG Radio. Thank you so much for listening.
Nurse Navigation at the Breast Care Center
Melanie Cole (Host): With the majority of services located under one roof, the Summit Medical Group Breast Care Center offers comprehensive support and care of benign breast health conditions and all stages of breast cancer. My guest is Carol Boyer. She is a Clinical Program Manager and a Certified Breast Nurse Patient Navigator for the SMG Breast Care Center. Welcome to the show, Carol. Tell us about nurse navigation at the Breast Care Center. What does that mean for patients coming in there?
Carol Boyer (Guest): Okay. Nurse navigation is a process by which a nurse provides one-to-one support for a patient who has some type of breast abnormality. The nurse navigator guides the patient with the suspicious abnormality through and around barriers to care. Now, what are those barriers, you might ask? So, one of the biggest barriers is fear. Fear is something that is paralyzing, and many of our patients, the minute they hear they have an abnormal mammogram, they are in a panic state and they hear nothing else after “abnormal mammogram.” So the nurse navigator is there when they get news of an abnormal mammogram to guide them through the system and to give them a plan so that they know exactly what they do when they're leaving our room. Another common barrier is communication. They just don’t understand the words, or they're too fearful to understand the words, and we’ll explain things in language that they can understand. Also just dealing with the overwhelming healthcare system, you're talking about a medical radiologist, a surgeon, you’re talking about breast imagers – all of these things are brand new to somebody who has an abnormality, and we have to explain that. Some of our patients have economic and financial issues that they need to deal with. They're worried about taking time off from work. We’re always cognizant of trying to work around somebody’s work schedule so they don’t need to leave work in order to make an appointment. And then there are language and cultural barriers that we also have to work around. But the bottom line is that the patients and navigation get one-to-one attention. We ensure that every suspicious finding has some type of resolution, whether that’s having a biopsy, whether that’s seeing a breast surgeon, whether that’s getting more imaging. We also work very closely with the patient’s family. If they have questions, we try to respond to all of their questions and their concerns, because sometimes the patient will hear some news, they’ll leave, and we get a call from their husband or their family member that the patient really didn’t understand anything that went on just because of fear.
Melanie: Well, that’s great. So, you are really being the patient’s best advocate. You're guiding them through the whole process, which, as you say, can be very scary even for the most educated of us patients. What about insurance? Because people freak out about that, Carol, and they don’t know what’s going to be covered, and, “Oh, is the diagnostic not covered?” Do you help people sort of navigate the waters or refer them for financial assistance or explain to them how things work a little bit?
Boyer: Yes. We actually do have financial counselors onsite. In the Berkeley Heights campus, they are onsite. If patients are concerned about their insurance, we can refer them to a financial counselor. We do that very often, especially when they're concerned about changes in insurance. Their insurance is changing from one to another type and they want to make sure that they can continue with the care, we make sure that there's some continuity there, and we will provide a referral or call the financial counselors ourselves to get in touch with the patient. Absolutely. That’s an important part of our job.
Melanie: And since everything is kind of located, in a sense, under one roof, tell us about the Breast Care Center itself. What is your team that goes on there that you have everybody there for patients that makes them feel they don’t have to go running around to a million places?
Boyer: Right. Well, our breast care center offers comprehensive support and care for patients, anything from a benign breast tissue, like a cyst or a non-cancerous growth, right through all stages of breast cancer. So our actual sensor, we hold two national accreditations, meaning that we’ve met a certain set of quality standards and benchmarks. So these are National Quality Measures for Breast Center Programs. We are a center of excellence. Secondly, we are accredited by the National Accreditation Program for Breast Centers. These are two of the highest accreditations you can get as a breast center. So we’re very proud of that. We actually have two campuses. We have the Berkeley Heights campus, where we have four dedicated breast surgeons, Dr. John Cunningham, our Medical Director, Dr. Lozner, Dr. Addis, and Dr. Polen. Also, we have three surgeons at our Morristown offices, Dr. Diehl, Dr. Dolgin, and Dr. Carter, who also perform breast surgery. In the larger picture, we also have medical oncologists here, Dr. Wax, Dr. Mills, and Dr. Reeder, in addition to plastic surgeons, Dr. Hyans, Dr. Momeni, and Dr. Schmidt. We can quickly refer patients from one service to another, and with our electronic medical records, it’s very easy to communicate with one another. Plus, it’s a very personal type of relationship we have among the doctors. Everybody is always picking up the phone and talking to one another. So the patient really can feel that they're getting comprehensive care, and quickly. We try to see a patient within a day or two, if not the same day. If they call us up and they tell us they have a lump and they need to come in, we bring them in as soon as possible to see somebody.
Melanie: Now, as I understand, you also have cognitive therapists.
Boyer: Right.
Melanie: Women, as we spoke once before about anxiety and stress, surrounding all sorts of illnesses, breast cancer, or even just getting our mammograms. So how are they involved?
Boyer: Right. We have a wonderful cognitive therapy department that will meet with breast patients in a very timely fashion. We will refer them. Some patients, the anxiety of a new diagnosis of breast cancer is just overwhelming. They're not eating. They're not sleeping. We offer this service. The other thing that we have are support groups that I co-lead with a behavioral therapist, Liz Nikol. These groups are geared towards newly diagnosed patients as well as patients in survivorship. So both of those modalities, together, really are very helpful for the patients. Because some patients in the beginning, when they're first diagnosed, it’s a very, very difficult time. They're trying to navigate the waters. Even with the navigator holding their hand, they need an extra support. We are very, very quick to make that referral and really encourage our patients to see our cognitive behavioral therapist.
Melanie: Now, what about nutrition? What part does that play in our breast health?
Boyer: Well, as with any condition, we really promote a healthy lifestyle, weight management, exercise. All of those things help with general breast health. We do have a nutritional therapist here, Susan Canonico, who will see our patients even when they are in chemotherapy. In the chemotherapy unit, she’ll see them there and she’ll do private consults with them as well, just to get them looking at their diet and trying to eat better for a healthy lifestyle.
Melanie: Now, one of the most important things I hear from the Breast Center is the education part of it all, educating women and their spouses and their families. When a woman comes in, maybe she has to have the diagnostic or she’s gotten the diagnosis none of us wants to hear, how do you work with the family, the spouses? Is nurse navigation involved in that process?
Boyer: Absolutely. We have five certified breast nurse navigators here, two working directly in navigation and three others that work with the surgeons. We provide the patient with some general material initially on just breast cancer. Then when we meet with the family, we meet with the husbands, we meet sometimes with the children, we will provide the resources that they need at that time. Sometimes it’s just knowing that they have somebody that they can call. That is a comfort in and of itself. We always say to patients, “If you have a question, don’t lose sleep over it. Call us. We’ll get back to you. We get back to patients immediately.” Sometimes they have a question that they forgot the doctor, and we explain to them that we have very quick access to the physicians and we’ll get back to them. Just the comfort of knowing that there's somebody on the other end of the phone that can help them really makes a big difference, especially to the families too.
Melanie: Okay. So guiding through the healthcare system, education and support, after an abnormal mammogram, and then coordinating the healthcare services for additional testing, that would seem to be one of the most important jobs I can see that you would do, because that’s where it gets jumbled up, whether they have to have the diagnostic and then possibly surgery afterwards.
Boyer: Right.
Melanie: How do you work with them to coordinate all these different appointments they're going to have to have?
Boyer: Right. So navigation really begins at the time of abnormal mammogram. So a patient has an abnormal mammogram, she meets with the radiologist and the nurse navigator. From that point on, the nurse navigator goes on to make an appointment, offers the patient a timely appointment with one of our breast specialists. We’ll follow that patient along. As they get to that appointment at the time of that appointment, the next step is the patient will meet with one of the navigators that work with the breast surgeons. At that point, the patient will be given their options for whatever is next, whether it’s biopsy, moving on to surgery. Every step of the way, the navigator follows the patient to resolution of the problem. So there really isn’t a time when the patient feels that they're on their own. We give them a road map at the beginning and we explain to them, the first step is having a biopsy. Biopsy results will be back in three to five days. The surgeon who does your biopsy will call you as soon as those results are in. The next step will be coming in and having a discussion with the surgeon on what to do next. Every step of the way, they walk out of here and they have an exact plan on what they need to do, and that, I think, gives them a lot of comfort.
Melanie: It does, and what a wonderful program. Thank you so much, Carol Boyer. You're listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. You can go to summitmedicalgroup.com/service/Breast-Health-Center for more information on their Breast Health Center. This is Melanie Cole for SMG Radio. Thank you so much for listening.