On behalf of Respiratory Futures, Natalie Smith recently caught up with lung navigators Claire Spettu and John Vickers (all from the Royal United Hospitals Bath NHS Trust), alongside Dr Vidan Masani, respiratory consultant and lead clinician for the Somerset Wiltshire Avon and Gloucestershire (SWAG) Targeted Lung Health Check programme (TLHC). The article below summarises the conversation around lung navigators and their potential role in the TLHC.
Special thanks also go to Anna Bibby, from Bristol Academic Respiratory Unit, University of Bristol, for helping to facilitate this Feature.
Photo (left to right): Dr Vidan Masani, Claire Spettu and Jon Vickers
What is a lung navigator and how do they support current lung cancer pathways?
Lung navigators (also known as pathway coordinators or cancer navigators) coordinate and track every stage of the lung cancer diagnostic pathway, and sometimes treatment pathways too. There is no unified job description of the role and it can vary between trusts. In Bath, navigators support with the daily triage of patients referred in to the lung cancer service, book patients into two week-wait clinics, expedite relevant investigations and help prepare the MDT. By tracking patients from the point of referral to treatment, across multiple sites and specialities, they help coordinate care and oversee the majority of clerical and administrative duties. This work, as well as providing an additional point of contact for patients, helps free up lung cancer nurses for patient-facing work. In Bath, the lung navigators are Band 4 and are embedded within the cancer MDT, with strong working relationships with clinicians, specialist nurses, primary care, and colleagues in other departments such as radiology and endoscopy.Â
This work, as well as providing an additional point of contact for patients, helps free up lung cancer nurses for patient-facing work.
How has the navigator role evolved with the arrival of TLHC?
Building on their existing lung cancer work, the lung navigators have become the first point of contact for new patients referred from the TLHC. When a suspected lung cancer is discussed at Screening Review Meeting (SRM), the TLHC nurse calls the participant to inform them of the finding and need for referral into local two week wait (2WW) services. At the same time, they provide the participant with the contact details of the lung navigator as a contact point for any future queries or questions. This provides the participant with a named contact within secondary care whilst they await their initial appointment, relieving anxiety.
The navigators attend the SRM, so they are aware of people being referred into the service. They also help facilitate initial investigations such as PET-CTs and lung function testing, which are often performed prior to the initial 2WW appointment, to accelerate patient care.
The navigators also facilitate communication between the TLHC programme and the trust. As TLHC participants sometimes exist outside of traditional primary/secondary care referral pathways, tracking and maintaining oversight of their care is crucial to streamline and safeguard the pathway.
How do you think the navigator role could be developed further in the context of TLHC?
The TLHC programme can involve coordinating care across several specialities, for example for non-lung cancer incidental findings. This can require multiple referrals and complex discussions with patients, outside of traditional care structures and referral pathways. As the TLHC expands, the number of patients on the pathway will increase, and it would be advantageous to have oversight of this cohort, coordinating their care and ensuring they return for investigations and appointments. It is likely that dedicated TLHC navigators will be required to undertake this work, and improve patient experience of the programme. We expect that each hospital may need 2 or 3 lung navigators for existing lung cancer work, with additional dedicated TLHC navigators exclusively focussed on patients in the TLHC programme.
In our service, the lung navigator plays an essential role in the lung cancer MDT, without which the service could not perform at the level that it does.
What top tips would you give to other services who want to expand the navigator role or grow their workforce?
By linking the navigator role to measurable outcomes, such as RTT targets, lung cancer managers and leads can prove the impact and therefore value of navigators’ work. This can help retain positions or expand roles. For example, auditing cancer timelines against the NOLCP, or the clerical workload of lung cancer nurses, can identify areas within a service where lung navigators could improve performance. Repeat audit after navigator input can prove to Trusts the cost-effectiveness and clinical utility of lung navigators. For example, since developing the role in Bath, we have seen improvements in several parts of the lung cancer timeline that are all under the oversight and control of the lung navigators. In our service, the lung navigator plays an essential role in the lung cancer MDT, without which the service could not perform at the level that it does.