Impact of a Nurse Navigator on Genomic Testing and Timely Treatment Decision Making in Patients With Breast Cancer

Kelly A. McAllister, RN, BSN, OCN, CBCN; Mary L. Schmitt, MS, APRN, FNP-BC, AOCNP


Clin J Oncol Nurs. 2015;19(5):510-512. 

In This Article

Abstract and Introduction


The purpose of this quality improvement project was to define best practices for identifying appropriate patients for genomic testing and improve timeliness for ordering tests and reporting results. An interdisciplinary team of surgeons, radiologists, medical oncologists, and nurses agreed that the RN navigator would be the key person to facilitate timely access to genomic profiling.

At a Glance

• Genomic profiling has become the standard of care for patients with early-stage breast cancer to assist in developing individualized treatment plans.

• Nurse navigators can play a key role in improving timeliness of care.

• The APN-RN model led to improvements in turnaround time and complicance with the National Comprehensive Cancer Network's recommendations for genomic testing.


Along with the diagnosis of breast cancer comes many decisions regarding treatment options. At Saint Joseph Hospital in Nashua, New Hampshire, a genomic/gene expression assay, Oncotype DX®, is used to further refine risk stratification and assist with decision making regarding chemotherapy as a treatment option for breast cancer (Paik et al., 2004). Genomic profiling is performed on early-stage, estrogen receptor-positive (ER+), HER2/neu-negative breast cancer to assist in developing individualized treatment plans.

Barriers were found in identifying eligible patients, timely ordering of tests, and distributing test results to the appropriate discipline. Oncotype DX testing was being ordered at the initial medical oncology consultation, about two weeks after surgery. This resulted in delays in initiating treatment, requiring patients to have additional appointments to discuss results and participate in joint decision making regarding treatment (see Figure 1).

Figure 1.

Comparison of the Genomic Testing Ordering Process

The oncology nurse navigator has knowledge of the healthcare system, is a skilled communicator, and provides holistic care. The navigator empowers patients and families with education and knowledge, and facilitates timely access to appropriate healthcare resources (Desimini et al., 2011). Within the interdisciplinary team, the nurse navigator works as an advocate, care provider, educator, counselor, and facilitator to ensure that every patient receives comprehensive, timely, and quality healthcare services (Case, 2011; Swanson & Koh, 2010). The role of the navigator can be that of an RN or an APN.