Analysis of nurse navigators’ activities for hospital discharge coordination: a mixed method study for the case of cancer patients

Background Modern cancer care requires the development of clinical pathways to enhance coordination, but there are few descriptive studies about the content of coordination activities. More specifically, little is known about hospital discharge co- ordination, although this is seen as a sensitive phase of clinical pathway. Purpose The purpose of this study was to identify and quan- tify the categories of activities performed by nurse navigators for hospital discharge coordination. Methods Patients supported within the Coordinating Outpatient Care department (COC) at Gustave Roussy (Villejuif, France). Study conducted over two consecutive phases (Feb-September 2014): (1) a qualitative phase to iden- tify the categories of coordination activities (interviews with patients plus, focus groups with nurse navigators—NNs); (2) a quantitative phase to quantify the relative share of each category. The calls received through the telephone platform of COC (made by both patients and primary care providers) were systematically reported (caller; reason for the call; pro- cedure performed) and then analyzed. Results Qualitative phase: 17 interviews with patients, plus 2 focus groups with NNs. Quantitative phase: 543 calls ana- lyzed. The callers were patients or their relatives (38 %), pri- vate nurses (35 %), medical device providers (20 %), and other primary care providers (e.g., pharmacists, family physi- cians) (7 %). Five categories of coordination activities identified: (F1) Patient monitoring (29 %); (F2) Helping to navigate (24 %); (F3) Managing technical problems (17 %); (F4) Explaining care protocols (16 %); (F5) Collecting and transmitting the patient medical record information (14 %). Conclusions The majority of requirements are related to or- ganizational issues (e.g., navigation, lack of information, ap- pointments). Nurse navigators’ training and qualification must therefore combine both clinical and managerial skills.