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Ver Hoeve ES, Calhoun E, Hernandez M, High E, Armin JS, Ali-Akbarian L, Frithsen M, Andrews W, Hamann HA. Evaluating implementation of a community-focused patient navigation intervention at an NCI-designated cancer center using RE-AIM. BMC Health Serv Res 2024; 24:550. [PMID: 38685006 PMCID: PMC11059763 DOI: 10.1186/s12913-024-10919-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patient navigation is an evidence-based intervention that reduces cancer health disparities by directly addressing the barriers to care for underserved patients with cancer. Variability in design and integration of patient navigation programs within cancer care settings has limited this intervention's utility. The implementation science evaluation framework, RE-AIM, allows quantitative and qualitative examination of effective implementation of patient navigation programs into cancer care settings. METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation of a community-focused patient navigation intervention at an NCI-designated cancer center between June 2018 and October 2021. Using a 3-month longitudinal, non-comparative measurement period, univariate and bivariate analyses were conducted to examine associations between participant-level demographics and primary (i.e., barrier reduction) and secondary (i.e., patient-reported outcomes) effectiveness outcomes. Mixed methods analyses were used to examine adoption and delivery of the intervention into the cancer center setting. Process-level analyses were used to evaluate maintenance of the intervention. RESULTS Participants (n = 311) represented a largely underserved population, as defined by the National Cancer Institute, with the majority identifying as Hispanic/Latino, having a household income of $35,000 or less, and being enrolled in Medicaid. Participants were diagnosed with a variety of cancer types and most had advanced staged cancers. Pre-post-intervention analyses indicated significant reduction from pre-intervention assessments in the average number of reported barriers, F(1, 207) = 117.62, p < .001, as well as significant increases in patient-reported physical health, t(205) = - 6.004, p < .001, mental health, t(205) = - 3.810, p < .001, self-efficacy, t(205) = - 5.321, p < .001, and satisfaction with medical team communication, t(206) = - 2.03, p = .029. Referral patterns and qualitative data supported increased adoption and integration of the intervention into the target setting, and consistent intervention delivery metrics suggested high fidelity to intervention delivery over time. Process-level data outlined a successful transition from a grant-funded community-focused patient navigation intervention to an institution-funded program. CONCLUSIONS This study utilized the implementation science evaluation framework, RE-AIM, to evaluate implementation of a community-focused patient navigation program. Our analyses indicate successful implementation within a cancer care setting and provide a potential guide for other oncology settings who may be interested in implementing community-focused patient navigation programs.
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Affiliation(s)
| | | | | | | | | | | | - Michael Frithsen
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Wendy Andrews
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
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Scruton S, Warner G, Kendell C, Pfaff K, Stajduhar K, Patrick L, Dujela C, Fauteux F, Urquhart R. Navigation programs to support community-dwelling individuals with life-limiting illness: determinants of implementation. BMC Health Serv Res 2024; 24:39. [PMID: 38184522 PMCID: PMC10770879 DOI: 10.1186/s12913-024-10541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND As the Canadian population ages and the prevalence of chronic illnesses increases, delivering high-quality care to individuals with advanced life limiting illnesses becomes more challenging. Community-based navigation programs are a promising approach to address these challenges, but little is known about how these programs are successfully implemented to meet the needs of this population. This study sought to identify the key determinants that contribute to the successful implementation of these programs within Canada. METHODS A qualitative study was undertaken to understand the implementation of eleven innovative, community-based navigation programs that aim to address the needs of individuals with life-limiting illnesses as they approach the end of life. The Consolidated Framework for Implementation Research (CFIR) guided the study design. Key informants (n = 23) within these programs took part in semi-structured interviews where they were asked to discuss how these programs are implemented. Data were analyzed using techniques employed in qualitative description. RESULTS We identified key determinants of successful implementation within each CFIR domain. In the outer setting domain, participants emphasized the importance of filling gaps in care to meet client needs, developing strong relationships with clients and community-based organizations, and navigating relationships with healthcare providers. At the inner setting level, leadership support, staff compatibility, and available resources were identified as important factors. In terms of intervention characteristics, the ability to adapt was cited as a facilitator, whereas costs were identified as a barrier. For the characteristics of individuals, participants described the importance of having staff whose values align with the program, and who have the experience and skills necessary to work with complex clients. Finally, having strong champions and evaluation processes were highlighted as important process-oriented determinants of successful implementation. CONCLUSION This study provides valuable insights into the determinants of successful implementation of community-based navigation programs in Canada. Understanding these determinants can guide the future development and integration of navigation programs to successfully meet the needs of those with life-limiting illnesses.
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Affiliation(s)
- Sarah Scruton
- Department of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Room 413, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
| | - Cynthia Kendell
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kathryn Pfaff
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Linda Patrick
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Carren Dujela
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Faith Fauteux
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Room 413, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada.
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Ruderman RS, Dahl EC, Williams BR, Feinglass JM, Kominiarek MA, Grobman WA, Yee LM. Obstetric Provider Perspectives on Postpartum Patient Navigation for Low-Income Patients. HEALTH EDUCATION & BEHAVIOR 2023; 50:260-267. [PMID: 34636273 PMCID: PMC9086643 DOI: 10.1177/10901981211043117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient navigation programs have shown promise for improving health but are not widely used in obstetric care. Our objective was to understand obstetric provider perspectives on how to implement patient navigation to optimize care during the postpartum period for low-income patients. METHOD Focus groups were conducted with obstetric physicians, nurses, and social workers who care for low-income pregnant and postpartum patients in an academic medical center. Semistructured interview guides were developed to elicit conversations about the potential value of patient navigators, recommendations for navigator training, and how navigators could be most effective in improving postpartum care. Analysis of themes was based on the constant comparative method. RESULTS Twenty-six obstetric providers (six focus groups) discussed elements for a successful obstetric navigation program. Successful implementation themes included selecting navigators with appropriate interpersonal attributes, arranging navigator training, and identifying the most valuable services navigators could render. Desirable navigator attributes included persistence in patient advocacy, consistency, relatability, and a supportive manner. Training recommendations included learning the health care system, identifying where to obtain health system and community resources, and learning how be effective health educators. Suggested services were broad, ranging from traditional care coordination to specific educational and resource-driven tasks. CONCLUSIONS Obstetric providers perceive patient navigation to be a potentially beneficial resource to support low-income patients and offered recommendations for navigation implementation. These included suggestions for patient-centered navigators, with specific training and services focused on promoting care continuity and coordination.
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Affiliation(s)
- Rachel S. Ruderman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emma C. Dahl
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brittney R. Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joe M. Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine, and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michelle A. Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Michallet A, Malartre S, Vignaud E, Bocquet A, Sontag P, Galvez C, Blay J, Heudel P, Vimont A, Blachier M, Ferrua M, Minvielle E, Mir O. The Ambulatory Medical Assistance (AMA) programme during active-phase treatment in patients with haematological malignancies: A cost-effectiveness analysis. Eur J Cancer Care (Engl) 2022; 31:e13709. [PMID: 36168105 PMCID: PMC9786720 DOI: 10.1111/ecc.13709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 08/11/2022] [Accepted: 08/31/2022] [Indexed: 12/30/2022]
Abstract
CONTEXT The need for patient navigator is growing, and there is a lack of cost evaluation, especially during survivorship. OBJECTIVE The objective of this study is to evaluate the cost-effectiveness of an Ambulatory Medical Assistance (AMA) programme in patients with haematological malignancies (HM). DESIGN A cost-effectiveness analysis of the AMA programme was performed compared to a simulated control arm. SETTING An interventional, single-arm and prospective study was conducted in a French reference haematology-oncology centre between 2016 and 2020. PARTICIPANTS Adult patients were enrolled with histologically documented malignant haematology, during their active therapy phase, and treated either by intravenous chemotherapy or oral therapy. METHODS An extrapolation of the effectiveness was derived from a similar nurse monitoring programme (CAPRI study). Cost effectiveness of the programme was evaluated through adverse events of Grade 3 or 4 avoided in different populations. RESULTS Included patient (n = 797) from the AMA programme were followed during 125 days (IQR: 0-181), and adverse events (Grade 3/4) were observed in 10.1% of patients versus 13.4% in the simulated control arm. The overall cost of AE avoided was estimated to €81,113, leading to an ICER of €864. CONCLUSION The AMA programme was shown to be cost-effective compared to a simulated control arm with no intervention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Marie Ferrua
- Division of Interdisciplinary Patient Care Pathways (DIOPP)Gustave RoussyVillejuifFrance
| | - Etienne Minvielle
- Division of Interdisciplinary Patient Care Pathways (DIOPP)Gustave RoussyVillejuifFrance,I3‐CRG, Ecole polytechnique‐CNRSPalaiseauFrance
| | - Olivier Mir
- Department of Ambulatory Cancer CareGustave RoussyVillejuifFrance
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Rajabiun S, Xiao V, Bak S, Robbins C, Casanova N, Cabral HJ, Lemon SC, Haas JS, Freund KM, Battaglia T. Using community-engaged methods to develop a study protocol for a cost analysis of a multi-site patient navigation intervention for breast cancer care. BMC Health Serv Res 2022; 22:881. [PMID: 35804359 PMCID: PMC9264587 DOI: 10.1186/s12913-022-08192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient navigation is an evidence-based intervention for reducing delays in oncology care among underserved populations. In order to address the financial sustainability of this intervention, information is needed on the cost of implementing patient navigation in diverse healthcare settings. Because patient navigation programs and care settings are highly variable, this paucity of cost data creates difficulties in identifying best practices and decisions about the feasibility of implementing navigation programs within a health care system. One barrier to collecting these cost data is the lack of assessment tools available to support patient navigation programs. These tools must be relevant to the wide variety of navigation activities that exist in health care settings, and be flexible enough to collect cost data important to stakeholders in fee-for-service and value-based care environments. METHODS AND RESULTS We present a novel approach and methods for assessing the cost of a patient navigation program implemented across six hospital systems to enhance timely entry and uptake of breast cancer care and treatment. These methods and tools were developed in partnership with breast oncology patient navigators and supervisors using principles of stakeholder engagement, with the goal of increasing usability and feasibility in the field. CONCLUSIONS This methodology can be used to strengthen cost analysis and assessment tools for other navigation programs for improving care and treatment for patients with chronic conditions. TRIAL REGISTRATION NCT03514433.
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Affiliation(s)
- Serena Rajabiun
- Department of Public Health, University of Massachusetts, Lowell, MA, USA.
| | | | | | | | | | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | | | | | | | - Tracy Battaglia
- Boston University School of Medicine, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA
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White AA, Ba A, Faith TD, Ramakrishnan V, Dismuke-Greer CL, Oates JC, Williams EM. The Care-coordination Approach to Learning Lupus Self-Management: a patient navigator intervention for systemic lupus inpatients. Lupus Sci Med 2021; 8:e000482. [PMID: 33975925 PMCID: PMC8118035 DOI: 10.1136/lupus-2021-000482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The Care-coordination Approach to Learning Lupus Self-Management (CALLS) study was designed to improve SLE disease self-management. This study aims to assess the benefits of the intervention compared with existing lupus care. METHODS Participants were randomly assigned to participate in 12-weekly phone sessions with the patient navigator that included structured educational content, care coordination and patient-centred support services, or a usual care control condition. Validated measures of health literacy, self-efficacy, patient activation and disease activity were collected. We used least squares means and linear mixed-effects regression models for each outcome variable to assess the changes in outcome, from baseline to postintervention and to estimate the difference in these changes between the intervention and control group. RESULTS Thirty participants were enrolled and 14 were randomised to the treatment group. For perceived lupus self-efficacy, there was a significant increase in mean score for the intervention group, but not for the control group. With regard to disease activity, the experimental group experienced a slight decrease in mean flare score in the previous 3 months, whereas the control group experienced a slight increase, but this finding did not reach statistical significance. Trends were similar in self-reported global disease activity, but none of the findings were significant. Health literacy and patient activation measure scores remained largely unchanged throughout the study for the two groups. CONCLUSION These findings suggest that the CALLS intervention may work to improve aspects of SLE disease self-management. Future research will be needed to validate these findings long-term. TRIAL REGISTRATION NUMBER NCT04400240.
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Affiliation(s)
- Ashley A White
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Aissatou Ba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Trevor Daniel Faith
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Jim C Oates
- Medicine, Medical University of South Carolina, Charleston, SC, USA
- Medical Service, Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Edith Marie Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Phillips S, Raskin S, Zhang Y, Pratt-Chapman M. Perspectives from oncology patient navigation programs on information management practices and needs: a descriptive study. Support Care Cancer 2020; 28:515-524. [PMID: 31073852 PMCID: PMC6954125 DOI: 10.1007/s00520-019-04837-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/23/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The purposes of this study are to describe oncology patient navigation (PN) program perspectives on: (1) use of information systems and processes, (2) uses of program data, and (3) desired information system characteristics. METHODS We conducted multi-phase data collection to inform development of the Patient Navigation Barriers and Outcomes Tool™ (PN-BOT™), a new information management and reporting tool for oncology PN programs. Phase I was a national online survey of PN staff (n = 343) about data practices. Phase II was a pilot test of a PN-BOT™ prototype with nine PN programs. Survey results were tabulated. Qualitative analysis identified emergent themes from open-response fields from the Phase I survey and open-response survey and interview data from Phase II pilot testers. RESULTS PN program information management practices and systems were diverse and often leveraged a patchwork of untailored platforms. Navigators used data to inform navigation tasks, service improvement, research, and reporting. Respondents desired a streamlined, integrated, affordable data system able to minimize data entry burden, meet needs of diverse stakeholders, facilitate navigation work, readily generate reports, and share information among healthcare team members. CONCLUSIONS Although oncology navigation programs explore diverse solutions, programs struggle to find health information technologies that sufficiently meet their needs. Information systems designed for oncology PN programs should perform a wide range of functions: be customizable, affordable, interoperable, and have low data entry burden. Organizations exploring solutions should invite PN input in decisions. PN-BOT™ was developed as a free Excel-based tool for PN programs responsive to reported needs.
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Affiliation(s)
- Serena Phillips
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC, 20037, USA
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, 923 W. Franklin Street, Richmond, VA, 23284, USA
| | - Yuqing Zhang
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC, 20037, USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC, 20037, USA.
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Molina Y, Khanna A, Watson KS, Villines D, Bergeron N, Strayhorn S, Strahan D, Skwara A, Cronin M, Mohan P, Walton S, Wang T, Schneider JA, Calhoun EA. Leveraging system sciences methods in clinical trial evaluation: An example concerning African American women diagnosed with breast cancer via the Patient Navigation in Medically Underserved Areas study. Contemp Clin Trials Commun 2019; 15:100411. [PMID: 31406947 PMCID: PMC6682374 DOI: 10.1016/j.conctc.2019.100411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Systems science methodologies offer a promising assessment approach for clinical trials by: 1) providing an in-silico laboratory to conduct investigations where purely empirical research may be infeasible or unethical; and, 2) offering a more precise measurement of intervention benefits across individual, network, and population levels. We propose to assess the potential of systems sciences methodologies by quantifying the spillover effects of randomized controlled trial via empirical social network analysis and agent-based models (ABM). DESIGN/METHODS We will evaluate the effects of the Patient Navigation in Medically Underserved Areas (PNMUA) study on adult African American participants diagnosed with breast cancer and their networks through social network analysis and agent-based modeling. First, we will survey 100 original trial participants (50 navigated, 50 non-navigated) and 150 of members of their social networks (75 from navigated, 75 non-navigated) to assess if navigation results in: 1) greater dissemination of breast health information and breast healthcare utilization throughout the trial participants' networks; and, 2) lower incremental costs, when incorporating navigation effects on trial participants and network members. Second, we will compare cost-effectiveness models, using a provider perspective, incorporating effects on trial participants versus trial participants and network members. Third, we will develop an ABM platform, parameterized using published data sources and PNMUA data, to examine if navigation increases the proportion of early stage breast cancer diagnoses. DISCUSSION Our study results will provide promising venues for leveraging systems science methodologies in clinical trial evaluation.
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Affiliation(s)
- Yamilé Molina
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA
| | - Aditya Khanna
- The University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Karriem S. Watson
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA
- University of Illinois Cancer Center, 1801 W Taylor St #1E, Chicago, IL, 60612, USA
| | - Dana Villines
- Advocate Health Care Research Institute, Chicago, IL, USA
| | - Nyahne Bergeron
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA
| | - Shaila Strayhorn
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA
| | - Desmona Strahan
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA
| | - Abigail Skwara
- The University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Michael Cronin
- The University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Prashanthinie Mohan
- College of Medicine, University of Arizona, 550 East Van Buren Street, Phoenix, AZ, 85004, USA
| | - Surrey Walton
- College of Pharmacy, University of Illinois at Chicago, 833 West Wood, Chicago, IL, 60612, USA
| | - Tianxiu Wang
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA
| | - John A. Schneider
- The University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Elizabeth A. Calhoun
- College of Medicine, University of Arizona, 550 East Van Buren Street, Phoenix, AZ, 85004, USA
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Williams EM, Dismuke CL, Faith TD, Smalls BL, Brown E, Oates JC, Egede LE. Cost-effectiveness of a peer mentoring intervention to improve disease self-management practices and self-efficacy among African American women with systemic lupus erythematosus: analysis of the Peer Approaches to Lupus Self-management (PALS) pilot study. Lupus 2019; 28:937-944. [PMID: 31166867 PMCID: PMC6597273 DOI: 10.1177/0961203319851559] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Peer Approaches to Lupus Self-management (PALS) program was developed as a peer mentoring tool to improve health behaviors, beliefs, and outcomes in African American women with systemic lupus erythematosus (SLE). This study aims to assess the cost of the PALS intervention and determine its effectiveness when compared to existing treatments. METHODS Peer mentors and mentees were paired on shared criteria such as life stage, marital status, or whether they were mothers. This 12-week program consisted of a weekly peer mentoring session by telephone. Cost of healthcare utilization was evaluated by assessing the healthcare costs pre- and post-intervention. Validated measures of quality of life, self-management, disease activity, depression, and anxiety were collected. Total direct program costs per participant were totaled and used to determine average per unit improvement in outcome measures. The benefit-cost ratio and pre- versus post-intervention hospital charges were examined. RESULTS A total of 20 mentees and 7 mentors were enrolled in the PALS program. All PALS pairs completed 12 sessions lasting an average of 54 minutes. Mentees reported statistically significant decreases in patient-reported disease activity, depression, and anxiety, with improved trends in patient activation or patient engagement in their disease and management. The total cost per patient was $1291.50, which was $107.62 per patient per week. There was a savings of $23,417 per individual receiving the intervention with a benefit-cost ratio of 18.13 per patient. CONCLUSION These findings suggest that the PALS intervention was effective in improving patient-level factors and was cost-effective. Future research will need to validate these findings in a larger sample.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Clara L. Dismuke
- Veterans Health Administration, Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC 29401, USA
- College of Medicine, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Ave, Suite 280, Charleston, SC 29425, USA
| | - Trevor D. Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Brittany L. Smalls
- Center for Health Services Research, College of Medicine, University of Kentucky, 740 S. Limestone Street, Suite J530, Lexington, KY 40536, USA
| | - Elizabeth Brown
- Division of Healthcare Studies, Department of Health Professions, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave, Charleston, SC 29425, USA
| | - James C. Oates
- Division of Rheumatology and Immunology, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Leonard E. Egede
- Division of General Internal Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Gervès-Pinquié C, Girault A, Phillips S, Raskin S, Pratt-Chapman M. Economic evaluation of patient navigation programs in colorectal cancer care, a systematic review. HEALTH ECONOMICS REVIEW 2018; 8:12. [PMID: 29904805 PMCID: PMC6002330 DOI: 10.1186/s13561-018-0196-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/07/2018] [Indexed: 05/03/2023]
Abstract
Patient navigation has expanded as a promising approach to improve cancer care coordination and patient adherence. This paper addresses the need to identify the evidence on the economic impact of patient navigation in colorectal cancer, following the Health Economic Evaluation Publication Guidelines. Articles indexed in Medline, Cochrane, CINAHL, and Web of Science between January 2000 and March 2017 were analyzed. We conducted a systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality assessment of the included studies was based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Inclusion criteria indicated that the paper's subject had to explicitly address patient navigation in colorectal cancer and the study had to be an economic evaluation. The search yielded 243 papers, 9 of which were finally included within this review. Seven out of the nine studies included met standards for high-quality based on CHEERS criteria. Eight concluded that patient navigation programs were unequivocally cost-effective for the health outcomes of interest. Six studies were cost-effectiveness analyses. All studies computed the direct costs of the program, which were defined a minima as the program costs. Eight of the reviewed studies adopted the healthcare system perspective. Direct medical costs were usually divided into outpatient and inpatient visits, tests, and diagnostics. Effectiveness outcomes were mainly assessed through screening adherence, quality of life and time to diagnostic resolution. Given these outcomes, more economic research is needed for patient navigation during cancer treatment and survivorship as well as for patient navigation for other cancer types so that decision makers better understand costs and benefits for heterogeneous patient navigation programs.
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Affiliation(s)
- Chloé Gervès-Pinquié
- Research Institute for Environmental and Occupational Health (Irset-Inserm UMR1085), Ester Team – UFR Santé – Département de Médecine, Rue Haute de Reculée, 49045 ANGERS Cedex01, France
| | - Anne Girault
- EA MOS 7348 - French School of Public Health, 20 avenue George Sand, 93200 Saint Denis, France
| | - Serena Phillips
- Institute for Patient-Centered Initiatives and Health Equity at the George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC 20037 USA
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Scherer Hall, #313923 W. Franklin Street, Richmond, VA 23284 USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives and Health Equity at the George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC 20037 USA
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Allary C, Bourmaud A, Tinquaut F, Oriol M, Kalecinski J, Dutertre V, Lechopier N, Pommier M, Benoist Y, Rousseau S, Regnier V, Buthion V, Chauvin F. ColoNav: patient navigation for colorectal cancer screening in deprived areas - Study protocol. BMC Cancer 2016; 16:416. [PMID: 27388807 PMCID: PMC4936239 DOI: 10.1186/s12885-016-2469-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/29/2016] [Indexed: 01/22/2023] Open
Abstract
Background The mass colorectal cancer screening program was implemented in 2008 in France, targeting 16 million French people aged between 50 and 74. The current adhesion is insufficient and the participation rate is even lower among the underserved population, increasing health inequalities within our health care system. Patient Navigation programs have proved their efficiency to promote the access to cancer screening and diagnosis. Methods/Design The purpose of the study is to assess the implementation of a patient navigation intervention that has been described in another cultural environment and another health care system. The main objective of the program is to increase the colorectal cancer screening participation rate among the deprived population through the intervention of a navigator to promote the Fecal Occult Blood Test (FOBT) and complementary exams. We performed a multisite cluster randomized controlled trial, with three groups (one experimental group and two control groups) for 18 months. Discussion The study attempts to give a better understanding of the adhesion barriers to colorectal cancer screening among underserved populations. If this project is cost-effective, it could create a dynamic based on peer approaches that could be developed for other cancer screening programs and other chronic diseases. Trial registration NCT02369757
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Affiliation(s)
- C Allary
- Hygée Centre, Lucien Neuwirth Cancer Institut- ICLN, CIC 1408 INSERM, 108bis avenue A. Raimond, 42270, Saint-Priest-en-Jarez, France
| | - A Bourmaud
- Hygée Centre, Lucien Neuwirth Cancer Institut- ICLN, CIC 1408 INSERM, 108bis avenue A. Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - F Tinquaut
- Hygée Centre, Lucien Neuwirth Cancer Institut- ICLN, CIC 1408 INSERM, 108bis avenue A. Raimond, 42270, Saint-Priest-en-Jarez, France
| | - M Oriol
- Hygée Centre, Lucien Neuwirth Cancer Institut- ICLN, CIC 1408 INSERM, 108bis avenue A. Raimond, 42270, Saint-Priest-en-Jarez, France
| | - J Kalecinski
- Hygée Centre, Lucien Neuwirth Cancer Institut- ICLN, CIC 1408 INSERM, 108bis avenue A. Raimond, 42270, Saint-Priest-en-Jarez, France
| | - V Dutertre
- Hygée Centre, Lucien Neuwirth Cancer Institut- ICLN, CIC 1408 INSERM, 108bis avenue A. Raimond, 42270, Saint-Priest-en-Jarez, France
| | - N Lechopier
- EA 4148 - S2HEP, University Lyon 1/Ecole Normale Supérieure de Lyon, 43, Boulevard du 11 novembre 1918, 69622, Villeurbanne cedex, France
| | - M Pommier
- EA 4148 - S2HEP, University Lyon 1/Ecole Normale Supérieure de Lyon, 43, Boulevard du 11 novembre 1918, 69622, Villeurbanne cedex, France
| | - Y Benoist
- Gustave Roussy Institut, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - S Rousseau
- Gustave Roussy Institut, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - V Regnier
- Hygée Centre, Lucien Neuwirth Cancer Institut- ICLN, CIC 1408 INSERM, 108bis avenue A. Raimond, 42270, Saint-Priest-en-Jarez, France
| | - V Buthion
- COACTIS, Lumière University Lyon 2, 16 avenue Berthelot, 69007, Lyon, France
| | - F Chauvin
- Hygée Centre, Lucien Neuwirth Cancer Institut- ICLN, CIC 1408 INSERM, 108bis avenue A. Raimond, 42270, Saint-Priest-en-Jarez, France
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Fouad MN, Acemgil A, Bae S, Forero A, Lisovicz N, Martin MY, Oates GR, Partridge EE, Vickers SM. Patient Navigation As a Model to Increase Participation of African Americans in Cancer Clinical Trials. J Oncol Pract 2016; 12:556-63. [PMID: 27189356 PMCID: PMC4957258 DOI: 10.1200/jop.2015.008946] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Less than 10% of patients enrolled in clinical trials are minorities. The patient navigation model has been used to improve access to medical care but has not been evaluated as a tool to increase the participation of minorities in clinical trials. The Increasing Minority Participation in Clinical Trials project used patient navigators (PNs) to enhance the recruitment of African Americans for and their retention in therapeutic cancer clinical trials in a National Cancer Institute-designated comprehensive cancer center. METHODS Lay individuals were hired and trained to serve as PNs for clinical trials. African American patients potentially eligible for clinical trials were identified through chart review or referrals by clinic nurses, physicians, and social workers. PNs provided two levels of services: education about clinical trials and tailored support for patients who enrolled in clinical trials. RESULTS Between 2007 and 2014, 424 African American patients with cancer were referred to the Increasing Minority Participation in Clinical Trials project. Of those eligible for a clinical trial (N = 378), 304 (80.4%) enrolled in a trial and 272 (72%) consented to receive patient navigation support. Of those receiving patient navigation support, 74.5% completed the trial, compared with 37.5% of those not receiving patient navigation support. The difference in retention rates between the two groups was statistically significant (P < .001). Participation of African Americans in therapeutic cancer clinical trials increased from 9% to 16%. CONCLUSION Patient navigation for clinical trials successfully retained African Americans in therapeutic trials compared with non-patient navigation trial participation. The model holds promise as a strategy to reduce disparities in cancer clinical trial participation. Future studies should evaluate it with racial/ethnic minorities across cancer centers.
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Affiliation(s)
- Mona N Fouad
- University of Alabama at Birmingham, Birmingham, AL
| | - Aras Acemgil
- University of Alabama at Birmingham, Birmingham, AL
| | - Sejong Bae
- University of Alabama at Birmingham, Birmingham, AL
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Ghebre RG, Jones LA, Wenzel J, Martin MY, Durant R, Ford JG. State-of-the-science of patient navigation as a strategy for enhancing minority clinical trial accrual. Cancer 2014; 120 Suppl 7:1122-30. [PMID: 24643650 PMCID: PMC4039342 DOI: 10.1002/cncr.28570] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patient navigation programs are emerging that aim to address disparities in clinical trial participation among medically underserved populations, including racial/ethnic minorities. However, there is a lack of consensus on the role of patient navigators within the clinical trial process as well as outcome measures to evaluate program effectiveness. METHODS A review of the literature was conducted of PubMed, Medline, CINHAL, and other sources to identify qualitative and quantitative studies on patient navigation in clinical trials. The search yielded 212 studies, of which only 12 were eligible for this review. RESULTS The eligible studies reported on the development of programs for patient navigation in cancer clinical trials, including training and implementation among African Americans, American Indians, and Native Hawaiians. A low rate of clinical trial refusal (range, 4%-6%) was reported among patients enrolled in patient navigation programs. However, few studies reported on the efficacy of patient navigation in increasing clinical treatment trial enrollment. CONCLUSIONS Outcome measures are proposed to assist in developing and evaluating the efficacy and/or effectiveness of patient navigation programs that aim to increase participation in cancer clinical trials. Future research is needed to evaluate the efficacy of patient navigators in addressing barriers to clinical trial participation and increasing enrollment among medically underserved cancer patients.
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Affiliation(s)
- Rahel G. Ghebre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | - Lovell A. Jones
- Dorothy I. Height Center for Health Equity and Evaluation Research, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle Y. Martin
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raegan Durant
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jean G. Ford
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
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Bensink ME, Ramsey SD, Battaglia T, Fiscella K, Hurd TC, McKoy JM, Patierno SR, Raich PC, Seiber EE, Mears VW, Whitley E, Paskett ED, Mandelblatt JS. Costs and outcomes evaluation of patient navigation after abnormal cancer screening: evidence from the Patient Navigation Research Program. Cancer 2014; 120:570-8. [PMID: 24166217 PMCID: PMC3946403 DOI: 10.1002/cncr.28438] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/01/2013] [Accepted: 08/21/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Navigators can facilitate timely access to cancer services, but to the authors' knowledge there are little data available regarding their economic impact. METHODS The authors conducted a cost-consequence analysis of navigation versus usual care among 10,521 individuals with abnormal breast, cervical, colorectal, or prostate cancer screening results who enrolled in the Patient Navigation Research Program study from January 1, 2006 to March 31, 2010. Navigation costs included diagnostic evaluation, patient and staff time, materials, and overhead. Consequences or outcomes were time to diagnostic resolution and probability of resolution. Differences in costs and outcomes were evaluated using multilevel, mixed-effects regression modeling adjusting for age, race/ethnicity, language, marital status, insurance status, cancer, and site clustering. RESULTS The majority of individuals were members of a minority (70.7%) and uninsured or publically insured (72.7%). Diagnostic resolution was higher for navigation versus usual care at 180 days (56.2% vs 53.8%; P = .008) and 270 days (70.0% vs 68.2%; P < .001). Although there were no differences in the average number of days to resolution between the 2 groups (110 days vs 109 days; P = .63), the probability of ever having diagnostic resolution was higher for the navigation group versus the usual-care group (84.5% vs 79.6%; P < .001). The added cost of navigation versus usual care was $275 per patient (95% confidence interval, $260-$290; P < .001). There was no significant difference in stage distribution among the 12.4% of patients in the navigation group vs 11% of the usual-care patients diagnosed with cancer. CONCLUSIONS Navigation adds costs and modestly increases the probability of diagnostic resolution among patients with abnormal screening test results. Navigation is only likely to be cost-effective if improved resolution translates into an earlier cancer stage at the time of diagnosis.
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Affiliation(s)
- Mark E. Bensink
- Research and Economic Assessment in Cancer and Healthcare Group, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Scott D. Ramsey
- Research and Economic Assessment in Cancer and Healthcare Group, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tracy Battaglia
- Women’s Health Unit, Department of Medicine and Women’s Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Thelma C. Hurd
- School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - June M. McKoy
- Departments of Medicine and Preventative Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Steven R. Patierno
- George Washington University Cancer Institute, Washington, District of Columbia
| | | | - Eric E. Seiber
- College of Public Health, Ohio State University, Columbus, Ohio
| | - Victoria Warren Mears
- Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, Oregon
| | | | | | - Jeanne S. Mandelblatt
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
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Abstract
OBJECTIVES To address the value of patient navigation (PN) to a community cancer center and suggest ways to measure PN outcomes to justify it as a critical component of cancer care. DATA SOURCES Literature review and unpublished data from the DC Citywide Patient Navigation Network. CONCLUSION Economic challenges in health care necessitate justification and appropriate utilization of all specialties and roles in cancer care. Demonstrating the value of PN programs is critical for sustaining these programs in community cancer centers. Having a clear business plan helps to define appropriate return-on-investment measures and an evaluation plan is important to assess program impact. IMPLICATIONS FOR NURSING PRACTICE Nurses play a key role in working with administrators to define value metrics, track these measures, and report the results. Nurses should also seek out training and resources to enhance knowledge and skills for navigating patients.
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DeGroff A, Coa K, Morrissey KG, Rohan E, Slotman B. Key considerations in designing a patient navigation program for colorectal cancer screening. Health Promot Pract 2013; 15:483-95. [PMID: 24357862 DOI: 10.1177/1524839913513587] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Colorectal cancer is the second leading cause of cancer mortality among those cancers affecting both men and women. Screening is known to reduce mortality by detecting cancer early and through colonoscopy, removing precancerous polyps. Only 58.6% of adults are currently up-to-date with colorectal cancer screening by any method. Patient navigation shows promise in increasing adherence to colorectal cancer screening and reducing health disparities; however, it is a complex intervention that is operationalized differently across institutions. This article describes 10 key considerations in designing a patient navigation intervention for colorectal cancer screening based on a literature review and environmental scan. Factors include (1) identifying a theoretical framework and setting program goals, (2) specifying community characteristics, (3) establishing the point(s) of intervention within the cancer continuum, (4) determining the setting in which navigation services are provided, (5) identifying the range of services offered and patient navigator responsibilities, (6) determining the background and qualifications of navigators, (7) selecting the method of communications between patients and navigators, (8) designing the navigator training, (9) defining oversight and supervision for the navigators, and (10) evaluating patient navigation. Public health practitioners can benefit from the practical perspective offered here for designing patient navigation programs.
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Affiliation(s)
- Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kisha Coa
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Elizabeth Rohan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
OBJECTIVE A survey of hospital-based nurse executives was conducted to determine the extent, approaches, and outcomes of nurse navigator (NN) programs. BACKGROUND Nurse navigators are distinct from other recognized healthcare roles. Navigators most commonly focus on a single health condition with the goal of improving the provision of specified health services for an individual patient. METHODS An 11-question Internet-based survey was e-mailed to 580 nurse executives in Texas. RESULTS Of the respondents, only 24% implemented any type of NN program. Most of the respondents with navigators rated these programs as successful. Most of the NN programs served cancer patients. Sixty percent implemented noncancer NN programs, with most reporting quality improvement as the main outcome measure for patients with conditions such as diabetes, cardiovascular disease, and high-risk obstetrics. CONCLUSIONS Opportunities exist in demonstrating the value of NN roles. To increase support for the role, nurse executives should develop the programs to meet the clinical, marketing, and financial objectives of the organization and targeted patient populations.
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:543-52. [DOI: 10.1097/spc.0b013e32835ad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Taplin SH, Yabroff KR, Zapka J. A multilevel research perspective on cancer care delivery: the example of follow-up to an abnormal mammogram. Cancer Epidemiol Biomarkers Prev 2012; 21:1709-15. [PMID: 22911332 PMCID: PMC3467321 DOI: 10.1158/1055-9965.epi-12-0265] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 1999, researchers and policy makers recognized the challenge of creating an integrated patient-centered cancer care process across the many types of care from risk assessment through end of life. More than a decade later, there has been limited progress toward that goal even though the standard reductionist approach to health services and medical research has resulted in major advances in tests, procedures, and individualized patient approaches to care. In this commentary, we propose that considering an entire care process within its multilevel context may increase progress toward an integrated experience and improvements in the quality of care. As an illustrative case, we describe the multilevel context of care delivery for the process of follow-up to an abnormal screening mammogram. By taking a multilevel perspective on this process, we identify a rich set of options for intervening and improving follow-up to abnormalities and, therefore, outcomes of screening. We propose that taking this multilevel perspective when designing interventions may improve the quality of cancer care in an effective and sustainable way.
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Affiliation(s)
- Stephen H Taplin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
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Abstract
BACKGROUND Although end-stage kidney disease in African Americans (AAs) is four times greater than in whites, AAs are less than one half as likely to undergo kidney transplantation (KT). This racial disparity has been found even after controlling for clinical factors such as comorbid conditions, dialysis vintage and type, and availability of potential living donors. Therefore, studying nonmedical factors is critical to understanding disparities in KT. METHODS We conducted a longitudinal cohort study with 127 AA and white patients with end-stage kidney disease undergoing evaluation for KT (December 2006 to July 2007) to determine whether, after controlling for medical factors, differences in time to acceptance for transplant is explained by patients' cultural factors (e.g., perceived racism and discrimination, medical mistrust, religious objections to living donor KT), psychosocial characteristics (e.g., social support, anxiety, depression), or transplant knowledge. Participants completed two telephone interviews (shortly after initiation of transplant evaluation and after being accepted or found ineligible for transplant). RESULTS Results indicated that AA patients reported higher levels of the cultural factors than did whites. We found no differences in comorbidity or availability of potential living donors. AAs took significantly longer to get accepted for transplant than did whites (hazard ratio=1.49, P=0.005). After adjustment for demographic, psychosocial, and cultural factors, the association of race with longer time for listing was no longer significant. CONCLUSIONS We suggest that interventions to address racial disparities in KT incorporate key nonmedical risk factors in patients.
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Abstract
Despite substantial evidence that patients with cancer commonly have significant psychosocial problems, for which we have evidence-based treatments, many patients still do not receive adequate psychosocial care. This means that we risk prolonging life without adequately addressing the quality of that life. There are many challenges to improving the current situation, the major one of which is organizational. Many cancer centers lack a system of psychosocial care that is integrated with the cancer care of the patient. Psychosocial care encompasses a range of problems (emotional, social, palliative, and logistical). The integration must occur with the cancer care of the patient at all stages (from screening to palliative care) and across all clinical sites of care (inpatient and outpatient cancer services as well as primary care). In this article, we consider the challenges we face if we are to provide such integrated psychosocial services. We focus on the collaborative care service model. This model comprises systematic identification of need, integrated delivery of care by care managers, appropriate specialist supervision, and the stepping of care based on systematic measurement of outcomes. Several trials of this approach to the management of depression in patients with cancer have found it to be both feasible to deliver and effective. It provides a model for services to meet other psychosocial needs. We conclude by proposing the key components of an integrated psychosocial service that could be implemented now and by considering what we need to do next if we are to succeed in providing better and more comprehensive care to our patients.
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Affiliation(s)
- Jesse R Fann
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA.
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