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Gallups SF, Demirci J, Nilsen ML, Burke J, Bender C, Rosenzweig MQ. Stakeholder perspectives on six identified interpersonal communication components of patient navigation in breast cancer care. Support Care Cancer 2023; 31:688. [PMID: 37947858 DOI: 10.1007/s00520-023-08121-7] [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: 06/30/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Although identified as a key competency domain and a needed area of professional development, interpersonal communication in breast cancer care patient navigation is understudied. Moreover, the patient-navigator relationship may be influenced by the interpersonal communication skills and behaviors of the patient navigator. This paper reports on the interpretation step of a concept mapping study, where key stakeholders shared their perspectives on six identified interpersonal communication components of breast cancer care patient navigation. METHODS This study utilized concept mapping, a community-engaged mixed method approach. After conducting brainstorming, sorting, and concept mapping analysis, a six-cluster concept map of interpersonal communication in breast cancer care patient navigation was identified. Interpretation sessions with each participant group (patients, patient navigators, administrators) allowed both naming and more in-depth exploration of the six clusters. The sessions were led by a facilitator, the PI, and were audio recorded and transcribed. RESULTS Six 2-h interpretation sessions were conducted with 21 participants, including patients with breast cancer, breast cancer patient navigators (lay or medically trained), and patient navigation administrators from Western Pennsylvania. Through a group consensus process, the six clusters were named. Participants identified that all six identified components were essential to patient navigation, but the ability to build patient-centered trust and relationships and maintain professional communication were the most impactful components of the patient-navigator relationship. CONCLUSION These findings validate the importance of interpersonal skills and behaviors of patient navigators in breast cancer care. These findings can inform the patient navigation role description, competencies, and the development of curriculum for training and metrics for evaluation.
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Affiliation(s)
- Sarah F Gallups
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA.
| | - Jill Demirci
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | - Jessica Burke
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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2
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Gallups SF, Demirci J, Nilsen M, Burke J, Bender C, Rosenzweig MQ. Using Concept Mapping to Explore Interpersonal Communication Components of Patient Navigation in Breast Cancer Care. Cancer Nurs 2023; 46:321-330. [PMID: 35439221 PMCID: PMC11182702 DOI: 10.1097/ncc.0000000000001118] [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: 11/25/2022]
Abstract
BACKGROUND Research exploring the relational dimensions of patient navigation identifies interpersonal communication as fundamental to the patient navigator's (PN's) ability to reduce barriers to care and improve cancer care outcomes. Although interpersonal communication is a core competency for PNs, its key components are commonly understudied and overlooked. OBJECTIVE The purpose of this study was to identify the key interpersonal communication components of patient navigation in breast cancer care that patients, PNs, and PN administrators perceived to impact the patient-navigator relationship. METHODS This study used concept mapping, a community-engaged research method. Participants completed 3 concept mapping activities: brainstorming, sorting and rating, and interpretation. RESULTS A total of 31 persons participated in the study: 13 patients, 14 PNs, and 4 PN administrators. The concept mapping analysis produced a 6-cluster concept map, and each concept was named through a group consensus process. Among the 6 concepts, both patients and PNs emphasized the importance of "Empathetic, Comprehensive, and Compassionate Support," "Bridge to Clinical Education and Supportive Resources," and "Ongoing Individualized Coordination of Care" as the most important components for facilitating the patient-navigator relationship. CONCLUSION Patients, PNs, and PN administrators all emphasized the essential role of interpersonal communication in the PN-patient relationship and how it is woven into every aspect of the PN role. IMPLICATIONS FOR PRACTICE As a core competency, we need to work toward the development and testing of evidence-based training to support their professional development and ultimately promote positive cancer care outcomes.
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Affiliation(s)
- Sarah F Gallups
- Author Affiliations: School of Nursing, University of Alabama at Birmingham (Dr Gallups); School of Nursing, University of Pittsburgh (Drs Demirci, Nilsen, Bender, and Rosenzweig), Pennsylvania; and Graduate School of Public Health, University of Pittsburgh (Dr Burke), Pennsylvania
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Mistry SK, Harris E, Li X, Harris MF. Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia. BMC Health Serv Res 2023; 23:476. [PMID: 37170092 PMCID: PMC10174608 DOI: 10.1186/s12913-023-09514-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/08/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Patients from culturally and linguistically diverse (CALD) backgrounds often face difficulties in accessing health and social care services. This study explored the feasibility and acceptability of involving community health workers (CHWs) as bilingual community navigators (BCNs) in general practice setting, to help patients from CALD backgrounds access health and social care services in Australia. METHODS This research was conducted in two general practices in Sydney where most patients are from specific CALD backgrounds (Chinese in one practice and Samoan in other). Three CHWs trained as BCNs were placed in these practices to help patients access health and social care service. A mixed-method design was followed to explore the feasibility and acceptability of this intervention including analysis of a record of services provided by BCNs and post-intervention qualitative interviews with patients, practice staff and BCNs exploring the feasibility and acceptability of the BCNs' role. The record was analyzed using descriptive statistics and interviews were audio-recorded, transcribed, and thematically analyzed. RESULTS BCNs served a total of 95 patients, providing help with referral to other services (52.6%), information about appointments (46.3%), local resources (12.6%) or available social benefits (23.2%). Most patients received one service from BCNs with the average duration of appointments being half an hour. Overall, BCNs fitted in well within the practices and patients as well as staff of participating practices accepted them well. Their role was facilitated by patients' felt need for and acceptance of BCNs' services, recruitment of BCNs from the patient community, as well as BCNs' training and motivation for their role. Major barriers for patients to access BCNs' services included lack of awareness of the BCNs' roles among some patients and practice staff, unavailability of information about local culture specific services, and inadequate time and health system knowledge by BCNs. Limited funding support and the short timeframe of the project were major limitations of the project. CONCLUSION BCNs' placement in general practice was feasible and acceptable to patients and staff in these practices. This first step needs to be followed by accredited training, development of the workforce and establishing systems for supervision in order to sustain the program. Future research is needed on the extension of the intrevention to other practices and culture groups.
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Affiliation(s)
- Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Xue Li
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Mazor M, David D, Moorehead D, Merriman JD, Lin JJ. Community Navigation and Supportive Care Experiences of Low-Income Black and Latina Cancer Survivors: Patient and Navigator Perspectives. JOURNAL OF ONCOLOGY NAVIGATION & SURVIVORSHIP 2023; 14:https://www.jons-online.com/jons-categories?view=article&artid=4883:low-income-black-and-latina-cancer-survivors&catid=128. [PMID: 37293184 PMCID: PMC10249905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Little is known about the role of community-based navigation in supportive care delivery for historically marginalized cancer survivors. The purposes of this study were to evaluate supportive care experiences of low-income, Black and Latina cancer survivors and examine the care role of their community navigator. Methods Qualitative evaluation of semi-structured interviews with Black and Latina cancer survivors (n=10) and navigators (n=4) from a community-based organization for low-income women were conducted and analyzed using content analysis. Results Content analysis yielded six themes that described the supportive care experience over time and before and after navigator support. Navigating supportive care alone: a) internal and external influencers; b) alone and just surviving; c) feeling overwhelmed and distressed. Community Navigator delivered supportive care: a) establishing trust and safety; b) accepting multi-dimensional, navigator assisted supportive care management; c) distress alleviation. Conclusions Low-income Black and Latina women with cancer reported internal strength yet endured cancer care alone leading to a feeling of distress. Subsequently, community navigators provided patient-centric, supportive care and alleviate physical and emotional distress. These findings highlight the importance of increasing awareness of and linkage to community navigators who may be able to meet the supportive care needs of diverse patient populations.
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Affiliation(s)
- Melissa Mazor
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
| | - Daniel David
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
| | - Dolores Moorehead
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
| | - John D Merriman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
| | - Jenny J Lin
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
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5
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The integration of accompanying patients into clinical teams in oncology: Perceptions of accompanying patients and nurses. Eur J Oncol Nurs 2023; 62:102256. [PMID: 36634593 DOI: 10.1016/j.ejon.2022.102256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/30/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES In Canada, two out of five people will be diagnosed with cancer which will affect their lives on a physical, psychological, and social levels. To help people affected by cancer (PAC) cope with the disease, support is provided by oncology nurses (ONs), including oncology pivot nurses (OPNs), as well as by accompanying patients (APs), i.e. people who have already had to deal with a cancer problem. APs are still a recent addition to the services offered in oncology, and as of yet no study has explored how the support provided by APs is being integrated into usual care, especially ONs care. This study explores the perceptions of APs and ONs on APs' integration into clinical teams. METHOD An exploratory qualitative study was carried out with six ONs and six APs through semi-structured interviews conducted from 2020 to 2021. Data were analyzed using a qualitative content analysis. RESULTS Participants perceived the AP's integration into the teams and during care as variable and in flux. They also identified factors that influence APs' integration into clinical teams (e.g.:the clinical teams' dynamics, the understanding of the AP's role, APs and patients' characteristics). Lastly, participants made recommendations to improve APs integration into clinical teams. CONCLUSION This study highlights how integrating APs into clinical teams has not yet become part of ONs' routines. ONs can play a key role in their integration through their collaborative and teamwork skills. Furthermore, there is a recognition that these two approaches can play complementary roles in supporting PACs.
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Mistry SK, Harris E, Harris MF. Learning from a codesign exercise aimed at developing a navigation intervention in the general practice setting. Fam Pract 2022; 39:1070-1079. [PMID: 35365997 DOI: 10.1093/fampra/cmac020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In this study, we aimed to describe and evaluate the codesign of an intervention in general practice setting to help address navigation problems faced by the patients from the culturally and linguistically diverse (CALD) community in Australia. METHODS An experience-based codesign (EBCD) methodology was adopted using the Double Diamond design process. Two codesign workshops were conducted online with 13 participants including patients, their caregivers, health service providers, researchers, and other stakeholders. Workshops were audio-recorded, transcribed, and thematically analyzed. RESULTS The codesign participants identified several navigation problems among CALD patients such as inadequate health literacy, cultural and language barriers, and difficulties with navigating health and social services. They believed that bilingual community navigators (BCNs; lay health workers from the same language or cultural background) could help them address these problems. However, this depended on BCNs being trained and supervised, with a clear role definition and manageable workloads, and not used as an interpreter. In undertaking the codesign process, we found that pre-workshop consultations were useful to ensure engagement, especially for consumers who participated more actively in group activities with service providers after these and their own separate small group discussions during the workshop. CONCLUSION Overall, participants identified that BCNs could offer help in addressing the problems faced by the CALD patients in accessing care in general practice setting. The codesign process provided new insights into the navigation problems faced by CALD patients in accessing care and collaboratively developed a strategy for further testing and evaluation.
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Affiliation(s)
- Sabuj K Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Botany Street, Kensington, NSW 2052, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Botany Street, Kensington, NSW 2052, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Botany Street, Kensington, NSW 2052, Australia
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Nadal IP, Cliffton C, Tolani E, Achilleos S, Winkley K, Chamley M, Gaughran F, Kottegoda R, Gallo F, Ismail K. Eliciting the mechanisms of action of care navigators in the management of type 2 diabetes in people with severe mental illness: A qualitative study. Diabet Med 2022; 39:e14894. [PMID: 35635552 PMCID: PMC9543493 DOI: 10.1111/dme.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with severe mental illness and type 2 diabetes have a reduced life expectancy compared to the general population. One factor that contributes to this is the inability to provide optimal management, as the two conditions are typically managed by separate physical and mental health systems. The role of care navigators in coordinating diabetes care in people with severe mental illness may provide a solution to better management. AIM To explore the views of clinicians and people with severe mental illness and type 2 diabetes on an integrated health service model with a focus on the care navigator to identify potential mechanisms of action. DESIGN Qualitative one-to-one semi-structured interviews and part of a wider pilot intervention study. SETTING Community Mental Health Unit in South London. METHOD Topic guides explored the perspectives and experiences of both clinicians and people with severe mental illness and diabetes. Data analysis was conducted using Thematic Analysis. RESULTS From the analysis of 19 participants, five main themes emerged regarding the care navigator role: administrative service; signposting to local services; adhering to lifestyle changes and medication; engaging in social activities; further skills and training needed. The key findings from this study emphasise the benefits that the role of a care navigator has in helping people with severe mental illness to better manage their diabetes i.e. through diet, exercise medication and attending essential health check-ups. CONCLUSION This study illustrates that having a care navigator in place empowers those with severe mental illness to improve the management of their diabetes. Future research should focus on the extent to which care navigators are effective in improving specific outcomes.
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Affiliation(s)
- Iliatha Papachristou Nadal
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Department of Non‐Communicable Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Catherine Cliffton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Esther Tolani
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Stavria Achilleos
- Lewisham and Greenwich NHS TrustUniversity Lewisham HospitalLondonUK
| | - Kirsty Winkley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Mark Chamley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Fiona Gaughran
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Ruvan Kottegoda
- Lewisham and Greenwich NHS TrustUniversity Lewisham HospitalLondonUK
| | - Fidel Gallo
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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Gallups SF, Ejem D, Rosenzweig MQ. Power and Privilege: A Critical Analysis of Interpersonal Communication in Health Care as a Guide for Oncology Patient Navigation in Breast Cancer Care. ANS Adv Nurs Sci 2022; 45:227-239. [PMID: 34387214 DOI: 10.1097/ans.0000000000000397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite advances in cancer care, inequalities in race, ethnicity, and social class in breast cancer outcomes still exist. Interpersonal communication is a critical piece to addressing health disparities and it is a core component of the oncology patient navigator role. While widely used, the concept of interpersonal communication is vague, understudied, and requires better clarification to promote equity in health communication. The aim of this article is to investigate the concept of interpersonal communication through a critical lens. Findings from this critical analysis identified a gap in the current literature addressing the intersections of race, gender, and social class.
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Affiliation(s)
- Sarah F Gallups
- Family, Community, and Health Systems, The University of Alabama at Birmingham, School of Nursing (Drs Gallups and Ejem); and Acute and Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania (Dr Rosenzweig)
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Thevathasan N, Luck KE, Luke A, Doucet S. Perceptions and experiences of care providers as clients of NaviCare/SoinsNavi: a patient navigation centre for children and youth with complex care needs. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2020-000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectiveNaviCare/SoinsNavi is a bilingual patient navigation centre for children and youth 25 years of age or younger with complex care needs in New Brunswick. This research-based centre employs two bilingual patient navigators, one a registered nurse and the other a lay navigator, who assist children/youth, family members and the care team by facilitating more convenient and integrated care using a personalised family-centred approach. The purpose of this study was to explore the perceptions and experiences of care providers who use NaviCare/SoinsNavi. This study builds on ongoing research exploring the experiences of children/youth and their families who are clients of NaviCare/SoinsNavi.MethodsInterviews were conducted with 10 care providers (n=10) from various sectors including social support services (n=6), primary care (n=2), mental health services (n=1) and acute care (n=1).ResultsQualitative interviews were conducted and five themes related to the participants’ perceptions and experiences with NaviCare/SoinsNavi emerged, including : (1) trusted source, (2) connector, (3) capacity builder, (4) partner and (5) time saver. The overall impression of NaviCare/SoinsNavi was positive in the service’s ability to help support care providers and streamline the care they provide to their clients.ConclusionsIt is within every healthcare provider’s scope of practice to provide navigational support to essential programmes and services; however, due to limitations in time, resources and capacity, services such as NaviCare/SoinsNavi can be used to help close gaps in care that exists for children/youth with complex care needs and their families.
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Roland KB, Higa DH, Leighton CA, Mizuno Y, DeLuca JB, Koenig LJ. HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis of Navigators' Experiences. Health Promot Pract 2020; 23:74-85. [PMID: 33356623 DOI: 10.1177/1524839920982603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient navigation is increasingly used to link and (re)engage persons with human immunodeficiency virus (HIV) to care. A more holistic understanding of patient navigation can be achieved by exploring the experiences of navigators, the persons who comprise half of the navigation process. We conducted a meta-synthesis of navigator experiences with HIV patient navigation using a phenomenological approach. We identified nine relevant studies. Data were analyzed using thematic synthesis. Analysis identified two overarching themes relating to (1) the breadth and depth of bidirectional relationships and functional activities that navigators undertake to connect their clients to care and (2) the inherently personal experience of delivering navigation services. From these thematic findings, we recommend that HIV patient navigators exhibit capacity and expertise in developing and maintaining interpersonal relationships with clients and health care systems/providers and develop self-care practices and emotional boundaries with clients. Our review seeks to advance public health research and practice by articulating key experiences and perspectives of HIV patient navigators, drawing findings and recommendations applicable to the development, implementation, and evaluation of HIV patient navigation.
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Affiliation(s)
| | - Darrel H Higa
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yuko Mizuno
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia B DeLuca
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda J Koenig
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Pardhan A, Vu K, Gallo-Hershberg D, Forbes L, Gavura S, Kukreti V. Evolving Best Practice for Take-Home Cancer Drugs. JCO Oncol Pract 2020; 17:e526-e536. [PMID: 33079644 DOI: 10.1200/op.20.00448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Take-home cancer drugs (THCDs) have become a standard treatment of many cancers. Robust guidelines have been developed for intravenous chemotherapy drugs, but few exist for THCDs with a focus on decentralized models. Hence, Ontario Health (Cancer Care Ontario) established the Oncology Pharmacy Task Force (OPTF) to develop consensus-based recommendations on best practices for THCDs to ensure that patients receive safe, consistent, high-quality care in the community once they leave the cancer center/practice with a prescription. METHODS The OPTF included 34 members with comprehensive representation. Guidance from leading authorities was extracted through literature review, thematically analyzed, and synthesized to develop 29 recommendations. The consensus process (> 70% agreement) included a three-step modified Delphi method followed by an extensive review process. RESULTS Sixteen recommendations were developed: training and education for providers (2), drug access (1), prescribing (4), patient and family/caregiver education (3), communication (1), dispensing (3), monitoring for patient adherence and adverse effects (1), and incident reporting (1). CONCLUSION Through a rigorous methodology, the OPTF derived a robust set of recommendations similar to the ASCO/Oncology Nursing Society and ASCO/National Community Oncology Dispensing Association guidelines, further validating and strengthening the applicability across multiple jurisdictions, including those with decentralized models. Unique aspects in a decentralized model include the need for two pharmacy professionals, with one doing cognitive verification of the script and the other dispensing the medication; moreover, they optimize interprofessional communication between community providers and the cancer center/practice health care team.
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Affiliation(s)
- Aliya Pardhan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Kathy Vu
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Daniela Gallo-Hershberg
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Leta Forbes
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Lakeridge Health, Oshawa, Ontario, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Vishal Kukreti
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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12
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Bernstein A, Harrison KL, Dulaney S, Merrilees J, Bowhay A, Heunis J, Choi J, Feuer JE, Clark AM, Chiong W, Lee K, Braley TL, Bonasera SJ, Ritchie CS, Dohan D, Miller BL, Possin KL. The Role of Care Navigators Working with People with Dementia and Their Caregivers. J Alzheimers Dis 2020; 71:45-55. [PMID: 31322558 DOI: 10.3233/jad-180957] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Care navigation is an approach to personalized care management and care coordination that can help overcome barriers to care. Care navigation has not been extensively studied in dementia, where health care workforce innovations are needed as a result of increasing disease prevalence and resulting costs to the health care system. OBJECTIVE To identify facilitators and barriers to care navigation in dementia and to assess dementia caregiver satisfaction with care navigation. METHODS Methods include qualitative research (interviews, focus groups, observations) with "Care Team Navigators" (CTNs) who were part of a dementia care navigation program, the Care Ecosystem, and a quantitative survey with caregivers about their experiences with CTNs. Transcripts were analyzed to identify themes within the data. RESULTS CTNs identified the following facilitators to care navigation in dementia: working closely with caregivers; providing emotional support; tailoring education and resources; and coordinating with a clinical team around issues ranging from clinical questions to financial and legal decision-making. The barriers CTNS identified included burn-out, the progressive nature of the disease; coordinating with primary care providers; and identifying resources for dyads who are low-income, do not speak English, or live in rural areas. Caregivers across both sites highly rated CTNs, though satisfaction was higher among those in Nebraska and Iowa. CONCLUSIONS Innovative approaches to care delivery in dementia are crucial. Care navigation offers a feasible model to train unlicensed people to deliver care as a way to deliver larger-scale support for the growing population of adults living with dementia and their caregivers.
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Affiliation(s)
- Alissa Bernstein
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Krista L Harrison
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Dulaney
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Merrilees
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Angela Bowhay
- Department of Internal Medicine, Division of Geriatrics, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Julia Heunis
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jeff Choi
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Julie E Feuer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amy M Clark
- Department of Internal Medicine, Division of Geriatrics, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kirby Lee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Tamara L Braley
- Department of Internal Medicine, Division of Geriatrics, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Stephen J Bonasera
- Department of Internal Medicine, Division of Geriatrics, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Christine S Ritchie
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Dan Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine L Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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13
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Training prostate cancer survivors and caregivers to be peer navigators: a blended online/in-person competency-based training program. Support Care Cancer 2020; 29:1235-1244. [PMID: 32613373 DOI: 10.1007/s00520-020-05586-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Cancer navigation improves access to support and reduces barriers to care; however, appropriate training of navigators is essential. We developed the TrueNTH Peer Navigation Training Program (PNTP), a competency-based, blended online/in-person course. In this study, we evaluate the feasibility, acceptability, and effectiveness of the PNTP among prostate cancer (PC) survivors (patients, caregivers). METHODS We employed an explanatory mixed method study design consisting of course usage data, pre-/post-questionnaires, and focus groups informed by the Kirkpatrick framework and self-efficacy theory. RESULTS Three cohorts in two Canadian cities (n = 26) received the PNTP. Participants were motivated to support others like themselves (n = 20), fill a gap (n = 7), pay it forward (n = 6), and offer expertise (n = 4). Recruitment, retention, and questionnaire completion were 96.7%, 89.6%, and 92%. Participants contributed a total of 426 posts to the online forums (2 to 3 posts per participant/module). Satisfaction was 9.4/10 (SD = 0.7) and usability was 84.5/100 (SD = 10.1). All learning outcomes increased: understanding of learning objectives t(23) = - 6.12, p < 0.0001; self-efficacy to perform competencies t(23) = - 4.8, p < 0.0001; and eHealth literacy t(23) = - 4.4, p < 0.0001. Participants viewed the PTNP as intensive but manageable, improving knowledge and confidence and enhancing listening skills. Participants valued the flexibility of online learning, interactive online learning, in-person interactions for relationship building, and authentic role-playing for skill development. CONCLUSIONS A facilitated online training program with in-person components is a highly acceptable and effective format to train PC survivors to become peer navigators. This competency-based peer navigator training program and delivery format may serve as a useful model for other cancer volunteer programs.
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Van Keer RL, Fernandez SM, Bilsen J. Intercultural mediators in Belgian hospitals: Demographic and professional characteristics and work experiences. PATIENT EDUCATION AND COUNSELING 2020; 103:165-172. [PMID: 31349964 DOI: 10.1016/j.pec.2019.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the 1) socio-demographic characteristics, 2) working environment, 3) tasks and responsibilities and 4) work experiences of intercultural mediators (IMs) working in Belgian hospitals. METHODS Cross-sectional quantitative survey among all IMs working in Flemish and Brussels hospitals (n = 66). Data were descriptively analyzed. Meaningful associations between variables were also studied. RESULTS Most IMs are young women from first- and second-generation migrant groups with different levels of education. They work under different superiors and most IMs are not employed full-time. They work mainly with patients from their own ethnic group. Mostly they intervene directly in daily intercultural communication, as per their official task description, but they also perform other tasks, such as offering support to patients/families/staff/management. IMs would prefer more of the tasks they perform to be formalized. Furthermore, they want to have policy-making responsibilities. IMs have positive and negative work experiences, e.g. working overtime. CONCLUSIONS IMs' socio-demographic characteristics (ethnic origin - sex - education) and official task description is only adapted to needs in the workplace to a limited extent. Furthermore, intercultural mediation is poorly integrated into hospitals' organizational structure. PRACTICE IMPLICATIONS Different measures are needed, including tailored education and offering IMs enough organizational support and policy responsibilities.
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Affiliation(s)
- Rose-Lima Van Keer
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
| | - Sarah Machado Fernandez
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
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15
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Roland KB, Higa DH, Leighton CA, Mizuno Y, DeLuca JB, Koenig LJ. Client Perspectives and Experiences With HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis. Health Promot Pract 2019; 21:25-36. [PMID: 31597497 DOI: 10.1177/1524839919875727] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient navigation is increasingly utilized to link and (re)engage persons with HIV to care. Understanding client experiences with HIV patient navigation can facilitate intervention design and translation of evidence to practice. We conducted a qualitative meta-synthesis of client experiences with HIV patient navigation. Data were analyzed using thematic synthesis. We identified seven relevant studies; all collected data via in-depth interviews with persons with HIV who participated in HIV patient navigation. Four interrelated themes emerged from analysis that pertain to (1) the complexity of the health and social service environment and the holistic approaches taken by the navigator, (2) the profound significance of the client-navigator relationship, (3) client reluctance to end the navigation program, and (4) client self-efficacy and feelings of hope and psychological change as a result of their navigation experience. The unifying theme across all studies was the value and impact of the client-navigator relationship on client experience and quality of life. Programs should consider hiring navigators who possess strong relational skills and are peers of the clients, and clearly delineating the role of the navigator. Research should examine the impact of the client-navigator relationship on client outcomes and further investigate how participating in patient navigation affects client self-efficacy, client resiliency, and the role of posttraumatic growth to achieve improved HIV outcomes. This review underscores the significance of the relationship within intensive, multilevel interventions for individuals and communities marginalized and isolated from health and social service systems.
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Affiliation(s)
| | - Darrel H Higa
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yuko Mizuno
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia B DeLuca
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda J Koenig
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Cervantes L, Hasnain-Wynia R, Steiner JF, Chonchol M, Fischer S. Patient Navigation: Addressing Social Challenges in Dialysis Patients. Am J Kidney Dis 2019; 76:121-129. [PMID: 31515136 DOI: 10.1053/j.ajkd.2019.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/15/2019] [Indexed: 01/13/2023]
Abstract
Members of racial and ethnic minority groups make up nearly 50% of US patients with end-stage kidney disease and face a disproportionate burden of socioeconomic challenges (ie, low income, job insecurity, low educational attainment, housing instability, and communication challenges) compared with non-Hispanic whites. Patients with end-stage kidney disease who face social challenges often have poor patient-centered and clinical outcomes. These challenges may have a negative impact on quality-of-care performance measures for dialysis facilities caring for primarily minority and low-income patients. One path toward improving outcomes for this group is to develop culturally tailored interventions that provide individualized support, potentially improving patient-centered, clinical, and health system outcomes by addressing social challenges. One such approach is using community-based culturally and linguistically concordant patient navigators, who can serve as a bridge between the patient and the health care system. Evidence points to the effectiveness of patient navigators in the provision of cancer care and, to a lesser extent, caring for people with chronic kidney disease and those who have undergone kidney transplantation. However, little is known about the effectiveness of patient navigators in the care of patients with kidney failure receiving dialysis, who experience a number of remediable social challenges.
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Affiliation(s)
- Lilia Cervantes
- Division of Hospital Medicine, Denver Health, Denver, CO; Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Denver, CO; Office of Research, Denver Health, Denver, CO.
| | | | - John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Denver, CO
| | - Stacy Fischer
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Denver, CO
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Strohbach A, Hu F, Martinez NG, Yee LM. Evaluating the use of text message communication in a postpartum patient navigation program for publicly insured women. PATIENT EDUCATION AND COUNSELING 2019; 102:753-759. [PMID: 30448040 PMCID: PMC6440841 DOI: 10.1016/j.pec.2018.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/25/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare communication between navigators and women according to follow-up status in a postpartum patient navigation program ("Navigating New Motherhood" [NNM]). METHODS This is a mixed methods secondary analysis of text message and email transcripts from NNM. Transcripts were analyzed by number of messages sent, received, and unanswered. Message themes were qualitatively analyzed using constant comparative technique. Bivariable and multivariable tests were conducted. RESULTS Most women (98.2%) communicated with navigators via text message. Women who completed postpartum follow-up sent and received more texts than women who did not (7.8 vs. 3.7, p < 0.001 and 11.5 vs. 8.0, p < 0.05, respectively); exchange of ≥6 messages was associated with greater odds of follow-up (adjusted odds ratio 2.89, 95% CI1.13-7.41). Lack of patient response was also associated with lack of follow-up (p < 0.001). Four categories of message themes were identified: Rapport-building, Postpartum Care Coordination, Maternal Health, and Motherhood. Message threads with more Rapport-building or Maternal Health messages were associated with more frequent patient follow-up (p < 0.01 and p < 0.05, respectively), as was average number of emoticons per message thread (2.1 vs. 1.2, p = 0.01). CONCLUSION More frequent and multidimensional communication was associated with follow-up in a postpartum patient navigation program. PRACTICE IMPLICATIONS Text messaging can serve as a favorable communication platform within patient navigation.
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Affiliation(s)
- Angelina Strohbach
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fengling Hu
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Amherst College, Amherst, MA, USA
| | - Noelle G Martinez
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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18
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Beverly EA, Hamel-Lambert J, Jensen LL, Meeks S, Rubin A. A qualitative process evaluation of a diabetes navigation program embedded in an endocrine specialty center in rural Appalachian Ohio. BMC Endocr Disord 2018; 18:50. [PMID: 30053846 PMCID: PMC6064115 DOI: 10.1186/s12902-018-0278-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes in the United States has reached epidemic proportions and the people of Appalachia have been disproportionately affected by this disease. Strategies that complement standard diabetes care are critically important to mitigate the risk of complications, reduce health expenditures, and improve the quality of life of patients living in rural Appalachia. The purpose of this study was to conduct a qualitative process evaluation of a patient navigation program for diabetes after its first year of implementation. METHODS The process evaluation assessed how the Diabetes Navigation Program was delivered as well as how it was experienced by the navigators, providers, health administrators, and office staff at an endocrine specialty center in rural Appalachian Ohio. We employed total population sampling to conduct in-depth, face-to-face interviews with all providers, health administrators, staff, and navigators at a Diabetes Endocrine Center. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 11 software. RESULTS Seventeen individuals (providers n = 5, health administrators n = 4, office staff members n = 3, and navigators n = 5) participated in in-depth, face-to-face interviews (age = 44.7 ± 11.6 years, 82.4% female, 94.1% white, 13.3 ± 9.6 years work experience). Fidelity of implementation: The navigation team carried out most of the activities denoted in the Work Plan, therefore the program was implemented somewhat successfully. Qualitative analysis revealed three themes: 1) The navigator addresses sources of health disparities: All participants described the role of the diabetes navigator as someone who is knowledgeable about diabetes and able to identify and address health disparities. 2) The navigators are the eyes in the community and the patients' homes: Navigators offered providers and clinic staff a rare glimpse into the personal lives of patients, which led to the identification of unrecognized barriers. 3) Difficulties with cross-system integration of services: Differences in the organizational culture and vision of the specialty center and navigation office contributed to systemic barriers. CONCLUSIONS Overall, this process evaluation highlights the importance of coordinating providers, health administrators, medical office staff, and navigators to address barriers to diabetes care. Forthcoming research is needed to document the clinical effectiveness and sustainability of the Diabetes Navigation Program in rural Appalachia.
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Affiliation(s)
- Elizabeth A. Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
- The Diabetes Institute, Ohio University, Athens, OH 45701 USA
| | - Jane Hamel-Lambert
- Department of Pediatric Psychology, Nationwide Children’s Hospital, Westerville, OH 43081 USA
- Department of Clinical Pediatrics, Ohio State University, Columbus, OH 43210 USA
| | - Laura L. Jensen
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
| | - Sue Meeks
- Community Service Programs, Ohio University Heritage College of Osteopathic Medicine, Athens, OH USA
| | - Anne Rubin
- Southeastern Ohio Legal Services, Athens, OH USA
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19
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Palomino H, Peacher D, Ko E, Woodruff SI, Watson M. Barriers and Challenges of Cancer Patients and Their Experience with Patient Navigators in the Rural US/Mexico Border Region. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:112-118. [PMID: 26362872 DOI: 10.1007/s13187-015-0906-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Patient navigation is a widely used approach to minimize health disparities among socioeconomically marginalized cancer patients. Although patient navigation is widely used, there is a dearth of studies exploring patient experience with navigators among rural cancer patients. This qualitative study explores the challenges and barriers to cancer care faced by cancer patients living in a US/Mexico border region in Southern California. We individually interviewed 22 cancer patients, most of whom were Latino. Data were analyzed using constant comparison with a reiterative analysis method. The main themes relating to barriers to care and experiences with patient navigators include the following: (1) removing financial barriers, (2) coordinating services, and (3) providing therapeutic interventions. The cancer patients highly valued the navigators for their knowledge about community resources, support, and advocacy. This study suggests that it is imperative that navigators know the regional and binational health care utilization issues that impact patients' access to cancer care.
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Affiliation(s)
- Helen Palomino
- Cancer Resource Center of the Desert, 444 So. 8th Street Ste. B-3, El Centro, CA, 92243, USA
| | - Diana Peacher
- Cancer Resource Center of the Desert, 444 So. 8th Street Ste. B-3, El Centro, CA, 92243, USA
| | - Eunjeong Ko
- San Diego State University, School of Social Work, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
| | - Susan I Woodruff
- Center for Alcohol and Drug Studies and Services, San Diego State University, School of Social Work, 6386 Alvarado Court Ste 224, San Diego, CA, 92120, USA
| | - Mercedes Watson
- Cancer Resource Center of the Desert, 444 So. 8th Street Ste. B-3, El Centro, CA, 92243, USA
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20
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Weeks LE, McInnis-Perry G, MacQuarrie C, Jovanovic S. Insights Into Roles for Health-Care Professionals in Meeting the Needs of Older Adults and Unpaid Caregivers During Health-Care Transitions. Can J Nurs Res 2016; 48:70-79. [PMID: 28841077 DOI: 10.1177/0844562116676579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We provided insights from older adults, their unpaid caregivers, and health-care professionals into specific roles for professionals within the health system to better meet the needs of community-dwelling older adults and their unpaid caregivers experiencing transitions between health services. We used a qualitative approach to collect data within one Canadian province from older adults and unpaid caregivers of older adults who participated in focus groups ( n = 98) and professionals working in the health system who participated in an online survey ( n = 52). Questions included experiences with health service transitions, strengths, challenges, and suggestions to improve transitions. Thematic analysis resulted in identifying seven specific roles for professionals in supporting health-care transitions: information and education, planning for future health needs, supporting the acceptance of necessary care, facilitating access to the right services at the right time, facilitating communication between services, facilitating the discharge planning process and advocacy for older adults and unpaid caregivers. Our results based on evidence from older adults, unpaid caregivers, and health-care professionals will inform future research and further development of the instrumental and relational roles for professionals supporting older adults and their caregivers experiencing health-care transitions.
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Affiliation(s)
- Lori E Weeks
- 1 School of Nursing, Dalhousie University, Halifax, NS, Canada
| | | | - Colleen MacQuarrie
- 3 Department of Psychology, University of Prince Edward Island, Charlottetown, Canada
| | - Sanja Jovanovic
- 4 Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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21
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Simon MA, Samaras AT, Nonzee NJ, Hajjar N, Frankovich C, Bularzik C, Murphy K, Endress R, Tom LS, Dong X. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:27-33. [PMID: 27594792 PMCID: PMC5001622 DOI: 10.4137/cmwh.s39136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 12/02/2022]
Abstract
Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented.
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Affiliation(s)
- Melissa A Simon
- Associate Professor, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Athena T Samaras
- Research Assistant, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Narissa J Nonzee
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.; Clinical Research Associate, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nadia Hajjar
- Patient Navigator, DuPage Navigation Project, Access DuPage, Carol Stream, IL, USA
| | - Carmi Frankovich
- Patient Navigator, DuPage Navigation Project, Access DuPage, Carol Stream, IL, USA
| | - Charito Bularzik
- Patient Navigator, DuPage Navigation Project, Access DuPage, Carol Stream, IL, USA
| | - Kara Murphy
- Executive Director, Access DuPage, Carol Stream, IL, USA
| | - Richard Endress
- President, DuPage Health Coalition, Access DuPage, Carol Stream, IL, USA
| | - Laura S Tom
- Clinical Research Associate, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - XinQi Dong
- Professor, Department of Medicine, Rush Institute for Healthy Aging, Rush University, Chicago, IL, USA
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de la Riva EE, Hajjar N, Tom LS, Phillips S, Dong X, Simon MA. Providers' Views on a Community-Wide Patient Navigation Program: Implications for Dissemination and Future Implementation. Health Promot Pract 2016; 17:382-90. [PMID: 27009130 PMCID: PMC5600160 DOI: 10.1177/1524839916628865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The DuPage Patient Navigation Collaborative (DPNC) adapted and scaled the Patient Navigation Research Program's intervention model to navigate uninsured suburban DuPage County women with an abnormal breast or cervical cancer screening result. Recent findings reveal the effectiveness of the DPNC in addressing patient risk factors for delayed follow-up, but gaps remain as patient measures may not adequately capture navigator impact. Using semistructured interviews with 19 DPNC providers (representing the county health department, clinics, advocacy organizations, and academic partners), this study explores the critical roles of the DPNC in strengthening community partnerships and enhancing clinical services. Findings from these provider interviews revealed that a wide range of resources existed within DuPage but were often underused. Providers indicated that the DPNC was instrumental in fostering community partnerships and that navigators enhanced the referral processes, communications, and service delivery among clinical teams. Providers also recommended expanding navigation to mental health, women's health, and for a variety of chronic conditions. Considering that many in the United States have recently gained access to the health care system, clinical teams might benefit by incorporating navigators who serve a dual working purpose embedded in the community and clinics to enhance the service delivery for vulnerable populations.
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Affiliation(s)
| | | | - Laura S Tom
- Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Sara Phillips
- Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - XinQi Dong
- Rush University Medical Center, Chicago, IL, USA
| | - Melissa A Simon
- Northwestern University-Feinberg School of Medicine, Chicago, IL, USA Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
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Meneses K, Landier W, Dionne-Odom JN. Vulnerable Population Challenges in the Transformation of Cancer Care. Semin Oncol Nurs 2016; 32:144-53. [PMID: 27137471 DOI: 10.1016/j.soncn.2016.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To consider current trends and future strategies that will bring about change in cancer care delivery for vulnerable populations. DATA SOURCES Institute of Medicine reports, literature review, clinical practice observations and experiences. CONCLUSION Vulnerable populations are older adults, both minorities and the underserved, children, and individuals at end of life. These groups pose unique challenges that require health system changes and innovative nursing models to assure access to patient-centered care in the future. IMPLICATIONS FOR NURSING PRACTICE In the future, attention to the needs of vulnerable populations, the growing aging cancer population and the improved outcomes in the pediatric and adolescent cancer population will all require new nursing services and models of care. System changes where nursing roles are critical to support the transition to earlier palliative care are projected.
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Race/Ethnicity, Primary Language, and Income Are Not Demographic Drivers of Mortality in Breast Cancer Patients at a Diverse Safety Net Academic Medical Center. Int J Breast Cancer 2015; 2015:835074. [PMID: 26605089 PMCID: PMC4641184 DOI: 10.1155/2015/835074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/11/2015] [Indexed: 12/29/2022] Open
Abstract
Objective. To examine the impact of patient demographics on mortality in breast cancer patients receiving care at a safety net academic medical center. Patients and Methods. 1128 patients were diagnosed with breast cancer at our institution between August 2004 and October 2011. Patient demographics were determined as follows: race/ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and AJCC tumor stage. Multivariate logistic regression analysis was performed to identify factors related to mortality at the end of follow-up in March 2012. Results. There was no significant difference in mortality by race/ethnicity, primary language, insurance type, or income in the multivariate adjusted model. An increased mortality was observed in patients who were single (OR = 2.36, CI = 1.28–4.37, p = 0.006), age > 70 years (OR = 3.88, CI = 1.13–11.48, p = 0.014), and AJCC stage IV (OR = 171.81, CI = 59.99–492.06, p < 0.0001). Conclusions. In this retrospective study, breast cancer patients who were single, presented at a later stage, or were older had increased incidence of mortality. Unlike other large-scale studies, non-White race, non-English primary language, low income, or Medicaid insurance did not result in worse outcomes.
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Ragas DM, Nonzee NJ, Tom LS, Phisuthikul AM, Luu TH, Dong X, Simon MA. What women want: patient recommendations for improving access to breast and cervical cancer screening and follow-up. Womens Health Issues 2015; 24:511-8. [PMID: 25213744 DOI: 10.1016/j.whi.2014.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/16/2014] [Accepted: 06/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net. METHODS Semi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers, free clinics, or an academic cancer center in the Chicago metropolitan area. FINDINGS Of the 138 women interviewed in the parent study, 52 women provided recommendations for improving access to screening and follow-up care. Most were between 41 and 65 years old (62%) and African American (60%) or White (25%). Recommendations included strengthening community-based health education with more urgent messaging, strategic partnerships, and active learning experiences to increase patient engagement, which women regarded as a key driver of access. Women also suggested increasing access by way of changes to health care delivery systems and policy, including more direct patient-provider and patient-clinic communications, addressing delays caused by high patient volume, combining preventive services, expanding insurance coverage, and adjusting screening guidelines. CONCLUSIONS This exploratory study demonstrates important insights from the patient lens that may help to increase the acceptability and efficacy of community and clinical interventions aimed at improving access to breast and cervical cancer screening and follow-up. Further research is needed to identify appropriate integration of patient input into interventions, practice, and policy change.
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Affiliation(s)
- Daiva M Ragas
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Narissa J Nonzee
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Laura S Tom
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois
| | - Ava M Phisuthikul
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Thanh Ha Luu
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - XinQi Dong
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
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Meade CD, Wells KJ, Arevalo M, Calcano ER, Rivera M, Sarmiento Y, Freeman HP, Roetzheim RG. Lay navigator model for impacting cancer health disparities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:449-57. [PMID: 24683043 PMCID: PMC4133280 DOI: 10.1007/s13187-014-0640-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This paper recounts experiences, challenges, and lessons learned when implementing a lay patient navigator program to improve cancer care among medically underserved patients who presented in a primary care clinic with a breast or colorectal cancer abnormality. The program employed five lay navigators to navigate 588 patients. Central programmatic elements were the following: (1) use of bilingual lay navigators with familiarity of communities they served; (2) provision of training, education, and supportive activities; (3) multidisciplinary clinical oversight that factored in caseload intensity; and (4) well-developed partnerships with community clinics and social service entities. Deconstruction of healthcare system information was fundamental to navigation processes. We conclude that a lay model of navigation is well suited to assist patients through complex healthcare systems; however, a stepped care model that includes both lay and professional navigation may be optimal to help patients across the entire continuum.
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Affiliation(s)
- Cathy D Meade
- Division of Population Science, Moffitt Cancer Center, 12902 Magnolia Drive, Fow-Edu, Tampa, FL, 33612, USA,
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Phillips SS, Tom LS, Bularzik C, Simon MA. Time and Motion Study of a Community Patient Navigator. AIMS Public Health 2014; 1:51-59. [PMID: 29546075 PMCID: PMC5689794 DOI: 10.3934/publichealth.2014.2.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/31/2014] [Indexed: 11/22/2022] Open
Abstract
Research on patient navigation has focused on validating the utility of navigators by defining their roles and analyzing their effects on patient outcomes, patient satisfaction, and cost effectiveness. Patient navigators are increasingly used outside the research context, and their roles without research responsibilities may look very different. This pilot study captured the activities of a community patient navigator for uninsured women with a positive screening test for breast cancer, using a time and motion approach over a period of three days. We followed the actions of this navigator minute by minute to assess the relative ratios of actions performed and to identify areas for time efficiency improvement to increase direct time with patients. This novel approach depicts the duties of a community patient navigator no longer fettered by navigation logs, research team meetings, surveys, and the consent process. We found that the community patient navigator was able to spend more time with patients in the clinical context relative to performing paperwork or logging communication with patients as a result of her lack of research responsibilities. By illuminating how community patient navigation functions as separate from the research setting, our results will inform future hiring and training of community patient navigators, system design and operations for improving the efficiency and efficacy of navigators, and our understanding of what community patient navigators do in the absence of research responsibilities.
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Affiliation(s)
- Sara S Phillips
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.,Rush Medical College, Chicago, IL, 60612, USA
| | - Laura S Tom
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Melissa A Simon
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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