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Country/JA: Malta flag Malta
Action type: Program

Problem: The Directorate of Cancer Care Pathways conducted retrospective qualitative research in 2019 with Maltese cancer patients who had gone through the whole continuum of the cancer care pathway prior to the establishment of the Nurse Navigator services. This study clearly identified that patients experienced an absence of a key person to coordinate or facilitate their care, as well as to reduce gaps to timely care.

Objective: (1) Facilitate access to timely, coordinated cancer care by a key person/ case manager for patients with all types of cancer; (2) Provide care and support throughout a patient’s cancer journey (from screening/first diagnosis to survivorship/end-of-life care) and address individualized needs of patients; (3) Address gaps and overcome any hurdles that may arise during the cancer care pathway with the relevant multi-disciplinary team (MDT); (4) Help to meet established timeframes and provide coordination and continuity of care across all the treatment trajectories.

Implementation status: Implementation complet, the programme continuing to expand incrementally.

Key Contextual Factors

  • Programme is led by the Cancer Care Pathways Directorate (DCCP) within the Department for Health Services of the Ministry for Health.
  • DCCP is housed within the Sir Anthony Mamo Oncology Center and Mater Dei Hospital.
  • The related policy framework is the National Cancer Plan 2017-2021.

Key Components/Steps

  • Meetings were held with stakeholders to obtain support to the idea for this new role
  • Parameters for the role were established with the Nursing Directorate. These included the establishment of a Core Competency Framework to direct the skills required to practice effectively.
  • First call for a colorectal Nurse Navigator was issued in 2016 and the successful candidate became the first Cancer Nurse Navigator in Malta in early 2017.
  • To date (2017-2021), a total of eight Nurse Navigators have been recruited and include two for patients with colorectal cancers; two for patients with urological cancers (one for prostate cancers and another for bladder, penile and testicular cancers); one for patients with gynecological cancers;  one for patients with lung cancers; one for patients with upper gastro-intestinal and hepato-pancreato-biliary (HPB) cancer; one for patients with cancers of the head and neck.  Initial recruitment for Nurse Navigators for breast cancers was challenged by some resistance to the role by the Breast Cancer Team, but their concerns have been resolved and a new call for breast cancer Nurse Navigators has been issued.
  • A Patient Reported Experience Measures (PREM) survey was conducted in 2020 to evaluate patients’ perceptions of the Nurse Navigator service.
  • To enrich their learning, the first cadre of Nurse Navigators shadowed nurse navigators at a UK hospital in an Oncology Specialist area. 
  • New recruits participate in an orientation program and now shadow established Maltese Nurse Navigators for experiential learning to develop standard competencies and skills.

Main Impacts / Added Value

  • This initiative effectively addresses the need for coordinated and timely services and support to cancer patients and their relatives during the whole spectrum of their cancer journey.
  • Individual patients and their significant others have a single point of reference to help them overcome barriers to care whilst providing access to the required multi-disciplinary and person-centered care.
  • Nurse Navigation services can assist in meeting timeframes that need be adhered to base on international and national services standards.
  • Equity is ensured as patients have access to timely cancer care regardless of social or financial status.

Lessons Learned

Success factors include:

  • Obtaining senior level officials’ support and buy-in from stakeholders.
  • Coordinating with human resources and Nursing Directors before and during the issue of calls for Navigator Nurses and the subsequent release of the successful applicants from other nursing duties (the latter is a significant issue due to the general lack of nursing professionals in Malta)
  • Ensuring resources required are procured and connections accessible (workspace, laptops, invites for multidisciplinary team (MDT) meetings etc.). 
  • It is essential to have an established core competency framework (set of required competencies and skills) and a robust orientation program including a period of at least three months shadowing an experienced Navigator and other MDT stakeholders.

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