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Robinson L, Trevors Babici L, Tedesco A, Spaner D, Morey T, Dosani N. Assessing the impact of a health navigator on improving access to care and addressing the social needs of palliative care patients experiencing homelessness: A service evaluation. Palliat Med 2022; 37:646-651. [PMID: 36576315 PMCID: PMC10074742 DOI: 10.1177/02692163221146812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Health navigators are healthcare professionals who specialize in care coordination, case management, navigating transitions, and reducing barriers to care. There is limited literature on the impact of health navigators on community-based palliative care for people experiencing homelessness. AIM We devised key performance indicators in nine categories with the aim to quantify the impact of a health navigator on the delivery of palliative care to patients experiencing homelessness. DESIGN Data were collected prospectively for all patient encounters involving a health navigator from July 2020 to 2021 and reviewed to determine the distribution of the health navigator's role and the ways in which patient care was impacted. SETTING AND PARTICIPANTS This study was conducted in Toronto, Ontario with the Palliative Education and Care for the Homeless (PEACH) Program. At any one time, the PEACH health navigator served a total of 50 patients. RESULTS We identified five key areas of the health navigator role including (1) facilitating access (2) coordinating care (3) addressing social determinants of health (4) advocating for patients, and (5) counselling patients and loved ones. The health navigator role was split evenly between activities pertaining to palliative care for structurally vulnerable populations and community-based palliative care for the general population. To achieve high impact outcomes, a considerable investment of time and energy was required of the health navigator, speaking to the importance of adequate and sustainable funding. CONCLUSIONS These findings underscore the potential for health navigators to add value to community-based palliative care teams, especially those caring for structurally vulnerable populations.
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Affiliation(s)
- Lilian Robinson
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Leeann Trevors Babici
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada.,Second Mile Club, Kensington Health, Toronto, ON, Canada
| | - Alissa Tedesco
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Donna Spaner
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Trevor Morey
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Naheed Dosani
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
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de Witt A, Matthews V, Bailie R, Valery PC, Adams J, Garvey G, Martin JH, Cunningham FC. Aboriginal and Torres Strait Islander patients' cancer care pathways in Queensland: Insights from health professionals. Health Promot J Austr 2021; 33:701-710. [PMID: 34767657 DOI: 10.1002/hpja.556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To identify points for improvements within the health system where Aboriginal and Torres Strait Islander cancer patients may experience a lack of continuity in their cancer care. The optimal care pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) framework was utilised as a tool in this work. METHODS Semi-structured interviews were conducted with health professionals at the primary health care (PHC) and hospital setting. Data were categorised into six steps using the OCP framework. RESULTS This study identified multiple time-points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients. In addition, the provision of person-centred care and adequate education tailored to patients' and health professionals' needs can help minimise the likelihood of patients experiencing a lack of continuity in their cancer care. Participants were recruited from an urban hospital (n = 9) and from six Aboriginal Community Controlled Health Services (n = 17) across geographical locations in Queensland. The provision of culturally competent care, effective communication, coordination and collaboration between services along the cancer pathway from prevention and early diagnosis through to end-of-life care were highlighted as important to enhance care continuity for Indigenous Australians. CONCLUSION The implementation of recommendations outlined in the OCP framework may help with improving cancer care continuity for Indigenous patients with cancer. SUMMARY Aboriginal and Torres Strait Islander people can sometimes find cancer care pathways complex and difficult to navigate. This study identified points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients which could potentially lead to improved outcomes.
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Affiliation(s)
- Audra de Witt
- Menzies School of Health Research, Brisbane QLD, Charles Darwin University, Darwin, NT, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Sydney, NSW, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Sydney, NSW, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Southside Clinical School, University of Queensland, Brisbane, QLD, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane QLD, Charles Darwin University, Darwin, NT, Australia
| | - Jennifer H Martin
- Southside Clinical School, University of Queensland, Brisbane, QLD, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Frances C Cunningham
- Menzies School of Health Research, Brisbane QLD, Charles Darwin University, Darwin, NT, Australia
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Communication, Collaboration and Care Coordination: The Three-Point Guide to Cancer Care Provision for Aboriginal and Torres Strait Islander Australians. Int J Integr Care 2020; 20:10. [PMID: 32565760 PMCID: PMC7292184 DOI: 10.5334/ijic.5456] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To explore health professionals’ perspectives on communication, continuity and between-service coordination for improving cancer care for Indigenous people in Queensland. Methods: Semi-structured interviews were conducted in a purposive sample of primary health care (PHC) services in Queensland with Indigenous and non-Indigenous health professionals who had experience caring for Indigenous cancer patients in the PHC and hospital setting. The World Health Organisation integrated people-centred health services framework was used to analyse the interview data. Results: Seventeen health staff from six Aboriginal Community Controlled Services and nine health professionals from one tertiary hospital participated in this study. PHC sites were in urban, regional and rural settings and the hospital was in a major city. Analysis of the data suggests that timely communication and information exchange, collaborative approaches, streamlined processes, flexible care delivery, and patient-centred care and support were crucial in improving the continuity and coordination of care between the PHC service and the treating hospital. Conclusion: Communication, collaboration and care coordination are integral in the provision of quality cancer care for Indigenous Australians. It is recommended that health policy and funding be designed to incorporate these aspects across services and settings as a strategy to improve cancer outcomes for Indigenous people in Queensland.
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Crezee IHM, Roat CE. Bilingual patient navigator or healthcare interpreter: What’s the difference and why does it matter? COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1582576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ineke H. M. Crezee
- Auckland University of Technology, Culture and Society, Room AF313, North Campus, Northcote, Auckland, 0627, New Zealand
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5
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Tolma EL, Stoner JA, Thomas C, Engelman K, Li J, Dichkov A, Neely N. Conducting a formative evaluation of an intervention promoting mammography screening in an American Indian community: The Native Women's Health Project. AMERICAN JOURNAL OF HEALTH EDUCATION 2018; 50:52-65. [PMID: 31289604 PMCID: PMC6615737 DOI: 10.1080/19325037.2018.1552216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women. However, there are very few published studies describing the evaluation of breast health promotion programs among AI/AN women. PURPOSE To describe the formative evaluation of a multi-component intervention to promote mammography screening in an AI community in rural Oklahoma. METHODS A comprehensive process evaluation plan with emphasis on context, reach, dose received, dose delivered, and fidelity was developed. Data collection included mixed research methodology and impact was assessed via one group pre/post research design. Data analysis consisted of descriptive statistical analysis and content analysis. The study utilized a community-based participatory research (CBPR) approach. RESULTS Process evaluation revealed a relatively high reach within the priority population for both components (clinic and community) and a moderate implementation. Focus group research showed that participants were overall satisfied with program implementation. The intervention was feasible to implement in real-world settings. TRANSLATION TO HEALTH EDUCATION PRACTICE Community-based evaluation of breast health promotion programs among AI communities is challenging, as one has to balance methodological rigor with practical constraints. The use of an evaluation plan, mixed methods and a collaborative approach are useful tools in conducting the evaluation.
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Affiliation(s)
- Eleni L Tolma
- Department of Social and Behavioral Sciences, Faculty of Public Health, Kuwait University Health Sciences Center, P.O. Box 24923, Safat, 13110 Kuwait
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB 309, Oklahoma City, OK 73126, x 49480
| | - Cara Thomas
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126
| | - Kimberly Engelman
- Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66160
| | - Ji Li
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB 203, Oklahoma City, OK 73104, x 30126
| | - Aleksandar Dichkov
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126
| | - Norma Neely
- American Indian Institute, University of Oklahoma, 1639 Cross Center Drive, Norman, OK 73019
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Phillips S, Villalobos AVK, Crawbuck GSN, Pratt-Chapman ML. In their own words: patient navigator roles in culturally sensitive cancer care. Support Care Cancer 2018; 27:1655-1662. [PMID: 30109486 PMCID: PMC6449285 DOI: 10.1007/s00520-018-4407-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
Purpose Patient navigation has emerged as a promising strategy in reducing disparities among diverse cancer patients. However, little is known about navigators’ own perspectives on their roles in providing culturally competent care. The purpose of the present study is to describe these self-identified roles. Methods Data were collected from an online survey with a convenience sample of cancer patient navigators. Using NVivo 10, qualitative content analysis was conducted on free text responses to the question: “In your opinion, what is the role of a patient navigator or nurse navigator in the provision of culturally sensitive care to patients?” Frequencies of each navigator-identified role mentioned were tabulated. Results Of 294 respondents, 50.7% (n = 149) provided a response to the question of interest. Respondents described the following 11 interrelated navigator roles in the provision of culturally competent care: (1) assess and understand patient needs, (2) tailor care to patient, (3) build rapport/open communication, (4) facilitate communication between patient and health care team, (5) educate/provide resources to the patient, (6) advocate, (7) self-motivated learning, (8) address barriers to care, (9) involve/meet the needs of family or support people, (10) educate/support health care team, and (11) support patient empowerment in care. Conclusions Patient navigators are uniquely well-positioned to improve cultural competence of cancer care given their role as liaison to patients and providers. Cancer care settings should use navigators with direct knowledge of patient culture whenever possible; however, communication and cultural competence training is highly recommended for all navigators given the diversity of patient 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
| | - Aubrey V K Villalobos
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC, 20037, USA
| | - Graham S N Crawbuck
- 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 L 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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Ranaghan C, Boyle K, Meehan M, Moustapha S, Fraser P, Concert C. Effectiveness of a patient navigator on patient satisfaction in adult patients in an ambulatory care setting: a systematic review. ACTA ACUST UNITED AC 2018; 14:172-218. [PMID: 27635752 DOI: 10.11124/jbisrir-2016-003049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND One approach to overcoming healthcare system barriers and facilitating timely access to quality care and patient satisfaction is with a patient navigator. A patient navigator is a trained person who individually assists patients, families and caregivers navigate the healthcare system barriers efficiently and effectively at any point along the care continuum, improving patient care at all levels of an organization. OBJECTIVES To synthesize the best available evidence on the effectiveness of a patient navigator on patient satisfaction in adult patients 18 years and older in ambulatory care settings. INCLUSION CRITERIA TYPES OF PARTICIPANTS This review considered studies that involved adults of any ethnicity, race or gender, aged 18 years or older, regardless of diagnoses, stage of illness, whether the illness is acute or chronic or previous treatment, who had been receiving care in an ambulatory care setting. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST This review considered studies on the use of a patient navigator as an additional intervention to usual care for promoting patient satisfaction for adult patients in an ambulatory care setting. Usual care without a patient navigator was considered as a comparator. TYPES OF STUDIES This review considered experimental and observational studies. OUTCOMES The outcome considered was patient satisfaction. SEARCH STRATEGY The literature search included published and unpublished studies in the English Language from 1990 through July 2015. A search of PubMed, CINAHL, Excerpta Medica Database (EMBASE), Academic Search Premier, Cochrane Library, PsycINFO and Health Source: Nursing/Academic Edition, Social Work Abstracts and Web of Science was conducted. A search for gray literature and electronic hand searching of relevant journals was also performed. METHODOLOGICAL QUALITY Two reviewers independently evaluated the included studies for methodological quality utilizing standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION Standardized data extraction tools from Joanna Briggs Institute were used by two independent reviewers for data extraction. DATA SYNTHESIS A statistical meta-analysis was not possible due to heterogeneity between the included studies. Results are presented in a narrative form. RESULTS Four studies were included in this review, two were randomized controlled trials (RCTs), one was a quasi-experimental pre-post-test design study and one was a cohort study. The four studies showed that a patient navigator had clinical benefit for patient satisfaction, care coordination and patient access to timely healthcare services. One RCT reported a mean satisfaction score of 4.3 for navigated patients and 2.9 for non-navigated patients; P < 0.001. A second RCT showed an odds ratio 1.29; 95% confidence interval 0.92-1.82 for navigated versus non-navigated patients. The quasi-experimental pre-test-post-test study showed navigated patient satisfaction with a mean = 11.45 (standard deviation [SD], 3.69) in comparison with the non-navigated patient (mean, 14.95; SD, 1.69) (F = 11.85; P = 0.000). The cohort study demonstrated a mean satisfaction score of 90.7 for navigated patients and 85.5 for non-navigated patients; P = 0.03. The four studies showed no clinically significant results; however, the patient navigator role may promote relationships among the healthcare team, reducing barriers for patient-centered care and enhanced patient satisfaction. CONCLUSION There is a paucity of evidence on the effectiveness of a patient navigator on patient satisfaction. In the four studies selected for inclusion, a patient navigator had a positive effect on patient satisfaction, although none of the studies demonstrated statistical significance with a patient navigator on patient satisfaction. The effect of a patient navigator remains questionable with differences in perceptions on the best individual for the role and the expected role perception and performance. A standardized approach to the role of the patient navigator may maximize health outcomes and positively affect the quality of life for all patients.
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Affiliation(s)
- Coleen Ranaghan
- The Northeast Institute of Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Centre of Excellence
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Corrigan PW, Torres A, Lara JL, Sheehan L, Larson JE. The Healthcare Needs of Latinos with Serious Mental Illness and the Potential of Peer Navigators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:547-557. [PMID: 27236458 PMCID: PMC5997453 DOI: 10.1007/s10488-016-0737-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Latinos with serious mental illness get sick and die much younger than other adults. In this paper, we review findings of a community based participatory research project meant to identify important healthcare needs, barriers to these needs, solutions to the barriers, and the promise of peer navigators as a solution. Findings from focus groups reflected general concerns of people with mental illness (e.g., insurance, engagement, accessibility) and Latinos with serious mental illness (e.g., immigration, language, and family). Feedback and analyses especially focused on the potential of peer navigators. Implications of these findings for integrated care of Latinos with serious mental illness are discussed.
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Affiliation(s)
- Patrick W Corrigan
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA
| | - Alessandra Torres
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA
| | - Juana L Lara
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA.
| | - Lindsay Sheehan
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA
| | - Jonathon E Larson
- Illinois Institute of Technology, 3424 South State St. First Floor, Room 1B9-2, Chicago, IL, 60616, USA
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9
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Ayers BL, Hawley NL, Purvis RS, Moore SJ, McElfish PA. Providers' perspectives of barriers experienced in maternal health care among Marshallese women. Women Birth 2017; 31:e294-e301. [PMID: 29126795 DOI: 10.1016/j.wombi.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
PROBLEM Pacific Islanders are disproportionately burdened by poorer maternal health outcomes with higher rates of pre-term births, low birth weight babies, infant mortality, and inadequate or no prenatal care. PURPOSE The purpose of this study was twofold: (1) to explore maternal health care providers' perceptions and experiences of barriers in providing care to Marshallese women, and (2) providers perceived barriers of access to care among Marshallese women. This is the first paper to explore perceived barriers to maternal health care among a Marshallese community from maternal health care providers' perspectives in the United States. METHODS A phenomenological, qualitative design, using a focus group and in-depth interviews with 20 maternal health care providers residing in northwest Arkansas was chosen. FINDINGS Several perceived barriers were noted, including transportation, lack of health insurance, communication and language, and socio-cultural barriers that described an incongruence between traditional and Western medical models of care. There was an overall discord between the collectivist cultural identity of Marshallese families and the individualistic maternal health care system that merits further research. DISCUSSION Solutions to these barriers, such as increased cultural competency training for maternal health care providers and the incorporation of community health workers are discussed.
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Affiliation(s)
- Britni L Ayers
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States.
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
| | - Sarah J Moore
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
| | - Pearl A McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, AR, United States.
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10
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DeSalvo JM, Young GS, Krok-Schoen JL, Paskett ED. Characterizing Time to Diagnostic Resolution After an Abnormal Cancer Screening Exam in Older Adult Participants in the Ohio Patient Navigation Research Program. J Aging Health 2017. [PMID: 28649914 DOI: 10.1177/0898264317715184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to test the effectiveness of a patient navigation (PN) intervention to reduce time to diagnostic resolution among older adults age ≥65 years versus those <65 years with abnormal breast, cervical, or colorectal cancer screening exams participating in the Ohio Patient Navigation Research Program (OPNRP). METHOD The OPNRP utilized a nested cohort group-randomized trial design to randomize 862 participants ( n = 67 for ≥65 years; n = 795 for <65 years) to PN or usual care conditions. A shared frailty Cox model tested the effect of PN on time to resolution. RESULTS Older adult participants randomized to PN achieved a 6-month resolution rate that was 127% higher than those randomized to usual care ( p = .001). This effect was not significantly different from participants <65 years. DISCUSSION PN significantly reduced time to diagnostic resolution among older adults beginning 6 months after an abnormal cancer screening exam. Health care systems should include this population in PN programs to reduce cancer disparities.
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Bernardes CM, Martin J, Cole P, Kitchener T, Cowburn G, Garvey G, Walpole E, Valery PC. Lessons learned from a pilot study of an Indigenous patient navigator intervention in Queensland, Australia. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28513056 DOI: 10.1111/ecc.12714] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 01/08/2023]
Abstract
Indigenous patient navigator (IPN) programmes show promise in addressing barriers to cancer care and facilitation of patient self-efficacy. The purpose of this paper is to describe and reflect upon the experience of training an IPN and implementation of the intervention in the Australian context with Indigenous cancer patients. Randomised clinical trial might provide the best available evaluation measure of an intervention but caution should be taken in the implementation process. Socio-cultural aspects and training can affect the conduct of this type of intervention. We report here five issues needing consideration prior to implementing such intervention. Specifically: (1) recognition of the collective bonds within Indigenous community and understanding by IPN of the degree of personal assistance perceived as not intrusive by the patient; (2) conduct ongoing evaluation of the different role of an IPN involved in this intervention care provider vs. researcher. (3) meaningful engagement develops from a trusting/collaborative relationship between research team and study site staff which may not occur in the study time frame; (4) existing skills as well as training provided may not translate in the IPN understanding and aligning with the study objectives/research values; (5) recruitment of participants requires innovative and highly flexible strategies to be successful.
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Affiliation(s)
- C M Bernardes
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Menzies School of Health Research, Brisbane, QLD, Australia
| | - J Martin
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - P Cole
- Ipswich Hospital, Brisbane, QLD, Australia
| | - T Kitchener
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - G Cowburn
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - G Garvey
- Menzies School of Health Research, Brisbane, QLD, Australia.,Charles Darwin University, Darwin, NT, Australia
| | - E Walpole
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Menzies School of Health Research, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
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12
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Grimes C, Dankovchik J, Cahn M, Warren-Mears V. American Indian and Alaska Native Cancer Patients' Perceptions of a Culturally Specific Patient Navigator Program. J Prim Prev 2017; 38:121-135. [PMID: 27838858 PMCID: PMC5313295 DOI: 10.1007/s10935-016-0458-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lack of access to care, funding limitations, cultural, and social barriers are challenges specific to tribal communities that have led to adverse cancer outcomes among American Indians/Alaska Natives (AI/AN). While the cancer navigator model has been shown to be effective in other underserved communities, it has not been widely implemented in Indian Country. We conducted in-depth interviews with 40 AI/AN patients at tribal clinics in Idaho and Oregon. We developed the survey instrument in partnership with community members to ensure a culturally appropriate semi-structured questionnaire. Questions explored barriers to accessing care, perceptions of the navigator program, satisfaction, and recommendations. AI/AN cancer patients reported physical, emotional, financial, and transportation barriers to care, but most did not feel there were any cultural barriers to receiving care. Navigator services most commonly used included decision making, referrals, transportation, scheduling appointments, and communication. Satisfaction with the program was high. Our study provides a template to develop a culturally appropriate survey instrument for use with an AI/AN population, which could be adapted for use with other indigenous patient populations. Although our sample was small, our qualitative analysis facilitated a deeper understanding of the barriers faced by this population and how a navigator program may best address them. The results reveal the strengths and weakness of this program, and provide baseline patient satisfaction numbers which will allow future patient navigator programs to better create evaluation benchmarks.
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Affiliation(s)
- Carol Grimes
- Northwest Portland Area Indian Health Board, 918 NE Rosa Parks Way, Portland, OR, 97211, USA
| | - Jenine Dankovchik
- Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, OR, 97201, USA.
| | - Megan Cahn
- College of Public Health and Human Sciences, Oregon State University, 6430 SE Ogden St., Portland, OR, 97206, USA
| | - Victoria Warren-Mears
- Northwest Tribal Epidemiology Center, 2121 SW Broadway, Suite 300, Portland, OR, 97201, USA
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13
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Corrigan PW, Kraus DJ, Pickett SA, Schmidt A, Stellon E, Hantke E, Lara JL. Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness. Psychiatr Serv 2017; 68:264-270. [PMID: 28093056 PMCID: PMC5371353 DOI: 10.1176/appi.ps.201600134] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the impact of a peer navigator program (PNP) developed by a community-based participatory research team and used with a group of African Americans with serious mental illness who were homeless. METHODS Sixty-seven research participants were randomly assigned to receive PNP or treatment as usual (control) for one year. Data on general health and mental health, recovery, and quality of life were collected at baseline and at four, eight, and 12 months. RESULTS Findings from group × trial analyses of variance of omnibus measures of the four constructs showed significant impact over the year for participants in PNP compared with those in the control group, with analyses showing small to moderate effect sizes: general health status (η2=.24), psychological experience of physical health (η2=.42), recovery (η2=.36), and quality of life (η2=.14). These differences emerged even though both groups showed significant reductions in homelessness and increases in insurance coverage. CONCLUSIONS Implications for improving in-the-field health care for this population are discussed. Whether these results occurred because navigators were peers per se needs to be examined in future research.
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Affiliation(s)
- Patrick W Corrigan
- Dr. Corrigan, Ms. Kraus, Ms. Schmidt, and Ms. Lara are with the Illinois Institute of Technology, Chicago. Dr. Pickett is with Advocates for Human Potential, Inc., Chicago. Mr. Stellon and Mr. Hantke are with Heartland Health Outreach, Chicago
| | - Dana J Kraus
- Dr. Corrigan, Ms. Kraus, Ms. Schmidt, and Ms. Lara are with the Illinois Institute of Technology, Chicago. Dr. Pickett is with Advocates for Human Potential, Inc., Chicago. Mr. Stellon and Mr. Hantke are with Heartland Health Outreach, Chicago
| | - Susan A Pickett
- Dr. Corrigan, Ms. Kraus, Ms. Schmidt, and Ms. Lara are with the Illinois Institute of Technology, Chicago. Dr. Pickett is with Advocates for Human Potential, Inc., Chicago. Mr. Stellon and Mr. Hantke are with Heartland Health Outreach, Chicago
| | - Annie Schmidt
- Dr. Corrigan, Ms. Kraus, Ms. Schmidt, and Ms. Lara are with the Illinois Institute of Technology, Chicago. Dr. Pickett is with Advocates for Human Potential, Inc., Chicago. Mr. Stellon and Mr. Hantke are with Heartland Health Outreach, Chicago
| | - Ed Stellon
- Dr. Corrigan, Ms. Kraus, Ms. Schmidt, and Ms. Lara are with the Illinois Institute of Technology, Chicago. Dr. Pickett is with Advocates for Human Potential, Inc., Chicago. Mr. Stellon and Mr. Hantke are with Heartland Health Outreach, Chicago
| | - Erin Hantke
- Dr. Corrigan, Ms. Kraus, Ms. Schmidt, and Ms. Lara are with the Illinois Institute of Technology, Chicago. Dr. Pickett is with Advocates for Human Potential, Inc., Chicago. Mr. Stellon and Mr. Hantke are with Heartland Health Outreach, Chicago
| | - Juana Lorena Lara
- Dr. Corrigan, Ms. Kraus, Ms. Schmidt, and Ms. Lara are with the Illinois Institute of Technology, Chicago. Dr. Pickett is with Advocates for Human Potential, Inc., Chicago. Mr. Stellon and Mr. Hantke are with Heartland Health Outreach, Chicago
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Tolma EL, Engelman K, Stoner JA, Thomas C, Joseph S, Li J, Blackwater C, Henderson JN, Carson LD, Neely N, Edwards T. The Design of a Multi-component Intervention to Promote Screening Mammography in an American Indian Community: The Native Women's Health Project. AIMS Public Health 2016; 3:933-955. [PMID: 29546205 PMCID: PMC5690415 DOI: 10.3934/publichealth.2016.4.933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women in the US. This article describes the design and implementation of a culturally sensitive intervention to promote breast health among AI/AN women through a hybrid model that incorporates clinical and community-based approaches. This is one of the first studies using this model addressing breast cancer disparities among AI/AN populations in the US. METHODS The Theory of Planned Behavior was used as the guiding framework of the intervention and Community Based Participatory Research was the primary vehicle for the intervention planning and implementation. Three preliminary studies took place that aimed to identify qualitatively and quantitatively what deterred or encouraged AI women to get past or future mammograms. The research results were shared with community members who, through a prioritization process, identified the theoretical focus of the intervention and its corresponding activities. The priority population consisted of AI women ages 40-74, with no recent mammogram, and no breast cancer history. RESULTS The intervention centered on the promotion of social modeling and physician recommendation. The main corresponding activities included enhancing patient-physician communication about screening mammography through a structured dialogue, receipt of a breast cancer brochure, participation in an inter-generational discussion group, and a congratulatory bracelet upon receipt of a mammogram. Environmental and policy related changes also were developed. CONCLUSION Creating a theory-based, culturally-sensitive intervention through tribal participatory research is a challenging approach towards eliminating breast cancer disparities among hard-to-reach populations.
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Affiliation(s)
- Eleni L. Tolma
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kimberly Engelman
- Department of Preventive Medicine and Public Health, University of Kansas, Kansas City, KS, USA
| | - Julie A. Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cara Thomas
- Tecumseh Early Head Start, Tecumseh, OK, USA
| | - Stephanie Joseph
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ji Li
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - J. Neil Henderson
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - L. D. Carson
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Norma Neely
- American Indian Institute, University of Oklahoma, Norman, OK, USA
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15
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Becker SA, Foxall M. An Analysis of Health Behavior Theories Applied to Breast-Screening Behavior for Relevance With American Indian Women. J Transcult Nurs 2016; 17:272-9. [PMID: 16757667 DOI: 10.1177/1043659606288372] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This article reviews studies of the efficacy of breast-screening interventions and their related theories that have had a positive effect in influencing women to use mammography and assesses the potential of various behavioral models for use with American Indian women. The study involved a search of literature in nursing and other health fields. Both communityand practice-based interventions have incorporated elements of various theoretical models. Because of its adaptability, the modified health behavior model appears most relevant for designing interventions to encourage mammography use among American Indian women.
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16
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Marshall JK, Mbah OM, Ford JG, Phelan-Emrick D, Ahmed S, Bone L, Wenzel J, Shapiro GR, Howerton M, Johnson L, Brown Q, Ewing A, Pollack CE. Effect of Patient Navigation on Breast Cancer Screening Among African American Medicare Beneficiaries: A Randomized Controlled Trial. J Gen Intern Med 2016; 31:68-76. [PMID: 26259762 PMCID: PMC4700012 DOI: 10.1007/s11606-015-3484-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 01/12/2015] [Accepted: 02/04/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is growing evidence that patient navigation improves breast cancer screening rates; however, there are limited efficacy studies of its effect among African American older adult women. OBJECTIVE To evaluate the effect of patient navigation on screening mammography among African American female Medicare beneficiaries in Baltimore, MD. DESIGN The Cancer Prevention and Treatment Demonstration (CPTD), a multi-site study, was a randomized controlled trial conducted from April 2006 through December 2010. SETTING Community-based and clinical setting. PARTICIPANTS The CPTD Screening Trial enrolled 1905 community-dwelling African American female Medicare beneficiaries who were ≥65 years of age and resided in Baltimore, MD. Participants were recruited from health clinics, community centers, health fairs, mailings using Medicare rosters, and phone calls. INTERVENTIONS Participants were randomized to either: printed educational materials on cancer screening (control group) or printed educational materials + patient navigation services designed to help participants overcome barriers to cancer screening (intervention group). MAIN MEASURE Self-reported receipt of mammography screening within 2 years of the end of the study. KEY RESULTS The median follow-up period for participants in this analysis was 17.8 months. In weighted multivariable logistic regression analyses, women in the intervention group had significantly higher odds of being up to date on mammography screening at the end of the follow-up period compared to women in the control group (odds ratio [OR] 2.26, 95 % confidence interval [CI]1.59-3.22). The effect of the intervention was stronger among women who were not up to date with mammography screening at enrollment (OR 3.63, 95 % CI 2.09-6.38). CONCLUSION Patient navigation among urban African American Medicare beneficiaries increased self-reported mammography utilization. The results suggest that patient navigation for mammography screening should focus on women who are not up to date on their screening.
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Affiliation(s)
| | - Olive M Mbah
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jean G Ford
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA.
| | - Darcy Phelan-Emrick
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lee Bone
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Wenzel
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Gary R Shapiro
- Health Partners Cancer Program and Institute for Education and Research, Minneapolis, MN, USA
| | - Mollie Howerton
- Centers for Medicare and Medicaid Services, Baltimore, MD, USA
| | | | | | - Altovise Ewing
- Formerly of the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Craig Evan Pollack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Cuesta-Briand B, Bessarab D, Shahid S, Thompson SC. Addressing unresolved tensions to build effective partnerships: lessons from an Aboriginal cancer support network. Int J Equity Health 2015; 14:122. [PMID: 26537924 PMCID: PMC4634592 DOI: 10.1186/s12939-015-0259-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 10/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Cancer is the second leading cause of death among Aboriginal and Torres Strait Islander people and their survival once diagnosed with cancer is lower compared to that of other Australians. This highlights the need to improve cancer-related health services for Indigenous Australians although how to achieve this remains unclear. Cancer support groups provide emotional and practical support, foster a sense of community and belonging and can improve health outcomes. However, despite evidence on their positive effects on people affected by cancer, there is scarce information on the function and effectiveness of Indigenous-specific cancer peer-support programs in Australia. Using qualitative data from an evaluation study, this paper explores different understandings of how a cancer support group should operate and the impact of unresolved tensions following the establishment of an Indigenous women cancer peer-support network in a regional town in Western Australia. Methods Data were collected through semi-structured interviews with 24 participants purposively selected among Indigenous and mainstream healthcare service providers, and group members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. NVivo was used to manage the data and assist in the data analysis. Rigour was enhanced through team member checking, coding validation and peer debriefing. Results Flexibility and a resistance to formal structuring were at the core of how the group operated. It was acknowledged that the network partly owned its success to its fluid approach; however, most mainstream healthcare service providers believed that a more structured approach was needed for the group to be sustainable. This was seen as acting in opposition to the flexible, organic approach considered necessary to adequately respond to Indigenous women’s needs. At the core of these tensions were opposing perspectives on the constructs of ‘structure’ and ‘flexibility’ between Indigenous and non-Indigenous participants. Conclusions Despite the group’s achievements, unresolved tensions between opposing perspectives on how a support group should operate negatively impacted on the working relationship between the group and mainstream service providers, and posed a threat to the Network’s sustainability. Our results support the need to acknowledge and address different perspectives and world views in order to build strong, effective partnerships between service providers and Indigenous communities.
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Affiliation(s)
- Beatriz Cuesta-Briand
- Western Australian Centre for Rural Health, University of Western Australia, UWA, M706, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, UWA, Perth, Australia.
| | - Shaouli Shahid
- Western Australian Centre for Rural Health, University of Western Australia, UWA, M706, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia, UWA, M706, 35 Stirling Highway, Crawley, WA, 6009, Australia.
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18
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Graham S, Guy RJ, Wand HC, Kaldor JM, Donovan B, Knox J, McCowen D, Bullen P, Booker J, O'Brien C, Garrett K, Ward JS. A sexual health quality improvement program (SHIMMER) triples chlamydia and gonorrhoea testing rates among young people attending Aboriginal primary health care services in Australia. BMC Infect Dis 2015; 15:370. [PMID: 26329123 PMCID: PMC4557217 DOI: 10.1186/s12879-015-1107-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 08/19/2015] [Indexed: 11/18/2022] Open
Abstract
Background In Australia, chlamydia is the most commonly notifiable infection and over the past ten years chlamydia and gonorrhoea notification rates have increased. Aboriginal compared with non-Aboriginal Australians have the highest notifications rates of chlamydia and gonorrhoea. Regular testing of young people for chlamydia and gonorrhoea is a key prevention strategy to identify asymptomatic infections early, provide treatment and safe sex education. This study evaluated if a sexual health quality improvement program (QIP) known as SHIMMER could increase chlamydia and gonorrhoea testing among young people attending four Aboriginal primary health care services in regional areas of New South Wales, Australia. Methods We calculated the proportion of 15–29 year olds tested and tested positivity for chlamydia and gonorrhoea in a 12-month before period (March 2010-February 2011) compared with a 12-month QIP period (March 2012-February 2013). Logistic regression was used to assess the difference in the proportion tested for chlamydia and gonorrhoea between study periods by gender, age group, Aboriginal status and Aboriginal primary health service. Odds ratios (OR) and their 95 % confidence intervals (CIs) were calculated with significance at p < 0.05. Results In the before period, 9 % of the 1881 individuals were tested for chlamydia, compared to 22 % of the 2259 individuals in the QIP period (OR): 1.43, 95 % CI: 1.22-1.67). From the before period to the QIP period, increases were observed in females (13 % to 25 %, OR: 1.32, 95 % CI: 1.10-1.59) and males (3 % to 17 %, OR: 1.85, 95 % CI: 1.36-2.52). The highest testing rate in the QIP period was in 15–19 year old females (16 % to 29 %, OR: 1.02, 95 % CI: 0.75-1.37), yet the greatest increase was in 20–24 year olds males (3 % to 19 %, OR: 1.65, 95 % CI: 1.01-2.69). Similar increases were seen in gonorrhoea testing. Overall, there were 70 (11 %) chlamydia diagnoses, increasing from 24 in the before to 46 in the QIP period. Overall, 4 (0.7 %) gonorrhoea tests were positive. Conclusions The QIP used in SHIMMER almost tripled chlamydia and gonorrhoea testing in young people and found more than twice as many chlamydia infections. The QIP could be used by other primary health care centres to increase testing among young people.
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Affiliation(s)
- Simon Graham
- Kirby Institute, UNSW Australia, Sydney, Australia. .,Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | | | | | | | - Basil Donovan
- Kirby Institute, UNSW Australia, Sydney, Australia. .,Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia.
| | - Janet Knox
- Kirby Institute, UNSW Australia, Sydney, Australia.
| | - Debbie McCowen
- Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia.
| | - Patricia Bullen
- Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia.
| | - Julie Booker
- Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia.
| | - Chris O'Brien
- Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia.
| | - Kristine Garrett
- Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia.
| | - James S Ward
- South Australian Health and Medical Research Institute, Adelaide, Australia.
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19
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Ranaghan CP, Boyle K, Fraser P, Meehan M, Moustapha S, Concert C. The effectiveness of a patient navigator on patient satisfaction in adult patients in ambulatory care settings: a systematic review protocol. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513080-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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20
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Treloar C, Jackson C, Gray R, Newland J, Wilson H, Saunders V, Johnson P, Brener L. Care and treatment of hepatitis C among Aboriginal people in New South Wales, Australia: implications for the implementation of new treatments. ETHNICITY & HEALTH 2015; 21:39-57. [PMID: 25665723 DOI: 10.1080/13557858.2015.1004870] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Despite Aboriginal Australians being over-represented in populations of people living with hepatitis C (HCV), there is a dearth of research to guide policy and programme development in the area of care and treatment, particularly relating to new HCV treatments. METHOD In-depth interviews were conducted with 39 people identifying as Aboriginal Australians and living with HCV in New South Wales. RESULTS Participants' experiences were characterised by a lack of detailed or appropriate information provided at diagnosis, high levels of stigma associated with HCV and low overall knowledge of HCV as reported for themselves and their communities. Despite poor diagnosis experiences, participants had undertaken changes to their lifestyle, especially in relation to alcohol use, in order to promote liver health. Concerns about treatment side effects and efficacy impacted participants' decisions to undertake treatment. Eleven participants had undertaken HCV treatment in a variety of care models with a peer worker and in prison. CONCLUSIONS The similarities between concerns and experiences of Aboriginal people and other populations living with HCV do not suggest that services and strategies to engage these populations should also be the same. These results suggest that further engagement of the primary care sector in HCV care is important as well as increasing Aboriginal community knowledge of HCV. A variety of service models should be available to meet individuals' preferences, including those offered within Aboriginal community controlled health services emphasising holistic notions of health, and supported by information and communication programmes using principles of health literacy relevant to Aboriginal people.
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Affiliation(s)
- Carla Treloar
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Clair Jackson
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Rebecca Gray
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Jamee Newland
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Hannah Wilson
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Veronica Saunders
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Priscilla Johnson
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Loren Brener
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
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21
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Treloar C, Rance J, Bath N, Everingham H, Micallef M, Day C, Hazelwood S, Grebely J, Dore GJ. Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:992-8. [PMID: 25697089 DOI: 10.1016/j.drugpo.2015.01.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/12/2014] [Accepted: 01/07/2015] [Indexed: 12/30/2022]
Abstract
AIM Peer support services have been shown to be beneficial in increasing uptake and adherence to treatment in other areas but few examples of these services exist in hepatitis C (HCV) care. This study examined the performance of two community-controlled peer support services operating within a larger study aimed at increasing access to HCV care and treatment for opiate substitution treatment (OST) clients, ETHOS. METHODS Semi-structured interviews were conducted in two clinics with three groups of participants: clients (n=31), staff (n=8) and peer workers (n=3) and examined the operation of the service in relation to process, outputs and impacts. RESULTS There was a very strong positive response to the peer worker services reported by staff and clients who had and had not interacted with a peer worker. A number of changes were reported that were not explicit goals of the service including providing access to additional services for clients and staff, peer workers acting as mediators between clients and staff and a less tangible notion of a changing "feel" of the clinic to a more positive and client-friendly social and physical space. Explicit goals of the service were also reported in peer workers supporting clients to consider and prepare for treatment (via blood tests and other assessments) as well as provide information and support about treatment. CONCLUSIONS The peer support service was acceptable to clients and clinic staff. All groups of participants noted that the service met its goals of engaging clients, building trusting relationships and providing instrumental support for clients to access HCV treatment. Peer workers may also contribute to more effective deployment of health resources by preparing clients for clinical engagement with HCV health workers.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Jake Rance
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Nicky Bath
- NSW Users and AIDS Association, Inc., Sydney, NSW, Australia
| | - Hope Everingham
- NSW Users and AIDS Association, Inc., Sydney, NSW, Australia
| | | | - Carolyn Day
- Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sue Hazelwood
- Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
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Green G, Davison C, Bradby H, Krause K, Mejías FM, Alex G. Pathways to care: how superdiversity shapes the need for navigational assistance. SOCIOLOGY OF HEALTH & ILLNESS 2014; 36:1205-1219. [PMID: 25040675 DOI: 10.1111/1467-9566.12161] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The recently developed sociological concept of superdiversity provides a potentially interesting and useful way of developing an understanding of life in contemporary Europe. Here we report on research based on individual narratives about access to health care, as described by a range of people from very different sociocultural backgrounds in four European countries. This article notes the frequent appearance in first-person narratives of the need for navigational assistance in the form of knowledge, cultural competence and orientation that facilitate the identification and use of pathways to health care. Our dataset of 24 semi-structured interviews suggests that, in the context of needing health care, the feeling of being a 'stranger in a strange land' is common in people from a wide range of backgrounds. In social settings characterised by transnationalism and cultural heterogeneity, it is important to understand the need for navigational assistance, particularly at times of uncertainty, in the design and delivery of health services. The relationship between the inhabitants of contemporary Europe and the healthcare systems available in the places where they live is dominated by both complexity and contingency - and this is the cultural field in which navigation operates.
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Affiliation(s)
- Gill Green
- School of Health and Human Sciences, University of Essex, Essex
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23
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Fernandes R, Riklon S, Langidrik JR, Williams SN, Kabua N. Collaboration between a US Academic Institution and International Ministry of Health to develop a culturally appropriate palliative care navigation curriculum. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2014; 2:275-9. [PMID: 26250636 DOI: 10.1016/j.hjdsi.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 08/10/2014] [Accepted: 08/13/2014] [Indexed: 11/18/2022]
Abstract
Implementation lessons: (1) The development and testing of a culturally appropriate palliative care navigation curriculum for countries facing high cancer and non-communicable diseases burden requires collaboration with the local Ministry of Health. (2) Lay volunteers from non-governmental and faith-based organizations are potential candidates to provide patient navigation services.
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Affiliation(s)
- Ritabelle Fernandes
- The Pacific Islands Geriatric Education Center and the John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, Division of Palliative Medicine, John A. Burns School of Medicine, University of Hawaii, United States.
| | - Sheldon Riklon
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, United States
| | | | - Shellie N Williams
- Division of Geriatric Medicine, Department of Medicine, University of Chicago Medical Center, United States
| | - Neiar Kabua
- National Comprehensive Cancer Control Program, Ministry of Health, Republic of the Marshall Islands
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24
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Lorhan S, Dennis D, van der Westhuizen M, Hodgson S, Berrang T, Daudt H. The experience of people with lung cancer with a volunteer-based lay navigation intervention at an outpatient cancer center. PATIENT EDUCATION AND COUNSELING 2014; 96:237-248. [PMID: 24862912 DOI: 10.1016/j.pec.2014.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/10/2014] [Accepted: 05/01/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe the experiences of patients with lung cancer with a volunteer-based lay navigation intervention. METHODS Forty patients with newly diagnosed lung cancer enrolled in a three-step navigation intervention delivered by trained volunteer lay navigators (VLNs), beginning prior to their first oncologist's appointment and ending before the start of treatment. Methodological triangulation of data was used in a mixed method study design. Cases were categorized based on the predominant needs met by the VLN: emotional, practical/informational, family, and complex. Data were analyzed using framework analysis. RESULTS The provision of emotional support, information, and referrals to other services by the VLN were of particular benefit to the patient and their families. Satisfaction with the program and its timing was high; it was considered an effective means for patients to share concerns and have their needs attended to before starting treatment. CONCLUSION This study demonstrates capacity for lay volunteers to address the multifaceted needs of lung cancer patients during their transition from primary care in the diagnosis to treatment phase. PRACTICE IMPLICATIONS Using volunteers as navigators offers an opportunity to meet patient needs with minimal resources, increase access to services for patients, and improve the sustainability of the program.
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Eschiti V, Lauderdale J, Burhansstipanov L, Weryackwe-Sanford S, Weryackwe L, Flores Y. Developing cancer-related educational content and goals tailored to the Comanche Nation. Clin J Oncol Nurs 2014; 18:E26-31. [PMID: 24675267 DOI: 10.1188/14.cjon.e26-e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-related educational content and goals should be modified to the needs of Native Americans to ensure adherence to healthy lifestyles. The current article describes the development of cancer-related educational modules that include creating behavioral goals specific to the people of the Comanche Nation. A community-based participatory research approach was used to conduct focus groups in the Comanche Nation and obtain feedback related to cancer-related educational modules and behavioral goals. Content analysis, verbatim transcriptions, field notes, and observations were used to analyze data and create five major themes. Comanche people need cancer educational modules and goals tailored to their culture to become engaged and maintain interest, thereby improving the likelihood of increasing cancer-related knowledge. Oncology nurses should respect guidance provided by Comanche community members to adapt cancer-related education materials and processes, as well as goal development, to address cultural concepts. When Comanche community members become knowledgeable and work toward healthy behavioral change, cancer health disparities may decrease.
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Affiliation(s)
| | - Jana Lauderdale
- Office of Diversity and Inclusion in the School of Nursing, Vanderbilt University, Nashville, TN
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26
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Krebs LU, Burhansstipanov L, Watanabe-Galloway S, Pingatore NL, Petereit DG, Isham D. Navigation as an intervention to eliminate disparities in American Indian communities. Semin Oncol Nurs 2014; 29:118-27. [PMID: 23651681 DOI: 10.1016/j.soncn.2013.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify the role of patient navigation in decreasing health care disparities through an exemplar of a successful patient navigation program for American Indian populations living in the Northern and Southern Plains of the United States. DATA SOURCES Published literature and data from the Native Navigators and the Cancer Continuum study. CONCLUSION Native Patient Navigators successfully collaborated with local American Indian organizations to provide cancer education through a series of 24-hour workshops. These workshops increased community knowledge about cancer, influenced cancer screening behaviors, and increased the visibility and availability of the navigators to provide navigation services. IMPLICATIONS FOR NURSING PRACTICE Reaching those with health care disparities requires multiple strategies. Collaborating with patient navigators who are embedded within and trusted by their communities helps to bridge the gap between patients and providers, increases adherence to care recommendations, and improves quality of life and survival.
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Affiliation(s)
- Linda U Krebs
- University of Colorado, College of Nursing, Aurora, CO 80045, USA.
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Corrigan PW, Pickett S, Batia K, Michaels PJ. Peer navigators and integrated care to address ethnic health disparities of people with serious mental illness. SOCIAL WORK IN PUBLIC HEALTH 2014; 29:581-93. [PMID: 25144699 PMCID: PMC5371355 DOI: 10.1080/19371918.2014.893854] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 02/10/2014] [Indexed: 05/25/2023]
Abstract
People of color with serious mental illnesses experience high rates of morbidity and mortality. Patient navigators, developed for cancer care, may help this group benefit from integrated care. This review examined patient navigators' key ingredients for cancer care for relevance to patients of color for application of peer services to psychiatric goals. Among cancer patients, navigators lead to greater treatment engagement and improved health outcomes for ethnic minority groups. Research also suggests peers can improve integrated care by providing effective psychiatric services to individuals with mental illness. Ongoing research examines peer navigators' impact on integrated care for patients of color.
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Affiliation(s)
- Patrick W Corrigan
- a Lewis College of Human Sciences, Illinois Institute of Technology , Chicago , Illinois , USA
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Treloar C, Gray R, Brener L, Jackson C, Saunders V, Johnson P, Harris M, Butow P, Newman C. "I can't do this, it's too much": building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people, their carers and health workers. Int J Public Health 2013; 59:373-9. [PMID: 23604078 DOI: 10.1007/s00038-013-0466-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 03/04/2013] [Accepted: 04/09/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Social inclusion theory has been used to understand how people at the margins of society engage with service provision. The aim of this paper was to explore the cancer care experiences of Aboriginal people in NSW using a social inclusion lens. METHODS Qualitative interviews were conducted with 22 Aboriginal people with cancer, 18 carers of Aboriginal people and 16 health care workers. RESULTS Participants' narratives described experiences that could be considered to be situational factors in social inclusion such as difficulties in managing the practical and logistic aspects of accessing cancer care. Three factors were identified as processes of social inclusion that tied these experiences together including socio-economic security, trust (or mistrust arising from historic and current experience of discrimination), and difficulties in knowing the system of cancer treatment. CONCLUSIONS These three factors may act as barriers to the social inclusion of Aboriginal people in cancer treatment. This challenges the cancer care system to work to acknowledge these forces and create practical and symbolic responses, in partnership with Aboriginal people, communities and health organisations.
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Affiliation(s)
- Carla Treloar
- National Centre in HIV Social Research, University of New South Wales, Sydney, NSW, 2052, Australia,
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Tolma E, Batterton C, Hamm RM, Thompson D, Engelman KK. American Indian Women and Screening Mammography. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2012.10599214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Eleni Tolma
- a Department of Health Promotion Sciences , University of Oklahoma Health Sciences Center , Oklahoma City , OK , 73190
| | - Chasity Batterton
- b Department of Health Administration and Policy College of Public Health , University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , 73190
| | - Robert M. Hamm
- c Department of Family and Preventive Medicine , University of Oklahoma Health Sciences Center , Oklahoma City , OK , 73104
| | - David Thompson
- d Department of Biostatistics and Epidemiology, College of Public Health , University of Oklahoma Health Science Center , Oklahoma City , Oklahoma , 73190
| | - Kimberly K. Engelman
- e Department of Preventive Medicine and Public Health , University of Kansas School of Medicine , Kansas City , KS , 66160
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Raphael JL, Rueda A, Lion KC, Giordano TP. The role of lay health workers in pediatric chronic disease: a systematic review. Acad Pediatr 2013; 13:408-20. [PMID: 24011745 PMCID: PMC3802546 DOI: 10.1016/j.acap.2013.04.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/11/2013] [Accepted: 04/26/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Children with chronic diseases represent a high-cost and resource-intensive population of children. With continued gaps in chronic disease management and persistent fragmentation in the health care system, stakeholders are seeking new strategies to address the needs of these children. OBJECTIVE We sought to systematically assess the effectiveness of lay health worker interventions in improving health care utilization, symptom management, and family psychosocial outcomes for children with chronic conditions. DATA SOURCE PubMed, PsycINFO, and Web of Science (January 1961 to February 2013). STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS We developed a strategy to search citations to identify relevant articles. Search terms included randomized controlled trial (RCT), lay worker, parent mentor, peer mentor, peer educator, community health workers, community health aids, patient advocate, patient facilitator, patient liaison, promotoras(es), care ambassadors, patient navigator, and nonprofessional. Additional studies were identified by searching the reference lists of retrieved articles and contacting clinical experts. RCTs of lay health worker interventions for children with chronic conditions were included. Studies were restricted to those concentrated on children 0-18 years of age with chronic illnesses. STUDY APPRAISAL AND SYNTHESIS METHODS Abstracts were independently screened by 2 reviewers. Articles with relevant abstracts underwent full text review and were evaluated for inclusion criteria. A structured tool was used to abstract data from selected articles. Because of the heterogeneous interventions and outcomes, we did not conduct a meta-analysis. RESULTS The search yielded 736 unique articles, of which 17 met inclusion criteria. All interventions focused on specific conditions: asthma, type I diabetes, obesity, and failure to thrive. Interventions were heterogeneous in frequency, mode, and duration of interactions between lay health workers and subjects. Several interventions were multifaceted, including both one-on-one and group interactions. Improved outcomes most commonly reported were reduced urgent care use, decreases in symptoms, fewer missed work and school days, and increased parental quality of life. One study demonstrated that lay health worker interventions were cost-effective. CONCLUSIONS Lay health workers interventions in children with chronic conditions may lead to modest improvements in urgent care use, symptoms, and parental psychosocial outcomes. Such interventions may also be cost-effective. Future research should focus on interventions targeted toward other chronic conditions such as sickle cell disease or cystic fibrosis and medically complex children whose conditions are noncategorical.
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Affiliation(s)
- Jean L. Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Anna Rueda
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - K. Casey Lion
- Department of Pediatrics, University of Washington, Seattle, WA,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
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Braun KL, Kagawa-Singer M, Holden AEC, Burhansstipanov L, Tran JH, Seals BF, Corbie-Smith G, Tsark JU, Harjo L, Foo MA, Ramirez AG. Cancer patient navigator tasks across the cancer care continuum. J Health Care Poor Underserved 2012; 23:398-413. [PMID: 22423178 DOI: 10.1353/hpu.2012.0029] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cancer patient navigation (PN) programs have been shown to increase access to and utilization of cancer care for poor and underserved individuals. Despite mounting evidence of its value, cancer patient navigation is not universally understood or provided. We describe five PN programs and the range of tasks their navigators provide across the cancer care continuum (education and outreach, screening, diagnosis and staging, treatment, survivorship, and end-of-life). Tasks are organized by their potential to make cancer services understandable, available, accessible, affordable, appropriate, and accountable. Although navigators perform similar tasks across the five programs, their specific approaches reflect differences in community culture, context, program setting, and funding. Task lists can inform the development of programs, job descriptions, training, and evaluation. They also may be useful in the move to certify navigators and establish mechanisms for reimbursement for navigation services.
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Affiliation(s)
- Kathryn L Braun
- Public Health, University of Hawai‘i, Honolulu, HI 96813, USA.
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Eschiti V, Burhansstipanov L, Watanabe-Galloway S. Native cancer navigation: the state of the science. Clin J Oncol Nurs 2012; 16:73-82, 89. [PMID: 22297010 DOI: 10.1188/12.cjon.73-82] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this literature review is to determine the current state of the science for the effectiveness of patient navigation on improving outcomes of cancer care across the continuum among Native Americans. The research will help healthcare professionals ascertain potential evidence-based practice guidelines and gaps in knowledge, which may provide direction for future research. Data synthesis included the use of Native navigation for cancer care, which has been demonstrated in limited, nonrandomized studies to improve cancer knowledge, access to care, and quality of life for Native Americans. Those studies had limitations, including small sample size, self-report of outcome measures, and lack of randomization. Evidence is insufficient to conclude that the use of Native navigation is superior to usual cancer care for Native American patients. Oncology nurses have a role in training personnel to serve as cancer navigators. Nurses need to be supportive of culturally appropriate navigation programs and know about services provided by navigators. In addition, nurse educators need to encourage Native Americans in their communities to consider choosing nursing as a profession. If an oncology nurse has an interest in research, opportunities exist to assist with or conduct research projects regarding Native cancer navigation. A particular need exists for addressing the gaps in research identified in this article.
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Affiliation(s)
- Valerie Eschiti
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
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Whop LJ, Valery PC, Beesley VL, Moore SP, Lokuge K, Jacka C, Garvey G. Navigating the cancer journey: a review of patient navigator programs for Indigenous cancer patients. Asia Pac J Clin Oncol 2012; 8:e89-96. [PMID: 22897931 DOI: 10.1111/j.1743-7563.2012.01532.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient navigator programs have evolved to facilitate access to care and improve outcomes for Indigenous cancer patients. We reviewed the scientific literature on patient navigator programs in Indigenous people with cancer. We conducted a review of the published literature up to 13 April 2011. PubMed, MEDLINE and CINAHL databases were searched for original articles on Indigenous patient navigation programs. The review produced eight relevant articles covering two specific programs, the Native Sisters Program and the Walking Forward Program. Program descriptions, patient navigator's roles, cultural aspects and the impact of the programs were described. Patient navigators' roles in the programs varied, as did their qualifications, but importantly, all were Indigenous. Both programs aimed to increase participation in screening, remove barriers to treatment and decrease mortality. The Native Sisters Program documented an increase in adherence to breast screening among navigated American Indian participants, although there were substantial differences in the baseline screening adherence between navigated and non-navigated participants. The Walking Forward Program yielded on average 3 fewer days of treatment delays for navigated American Indians than for non-navigated American Indians. However, adjustments for socioeconomic characteristics and disease characteristics were not described. Although preliminary outcomes are seemingly positive, further rigorous evaluation of quantitative impacts are needed.
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Affiliation(s)
- Lisa J Whop
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Brisbane, Qld 4000, Australia.
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Burhansstipanov L, Dignan M, Jones KL, Krebs LU, Marchionda P, Kaur JS. Comparison of quality of life between Native and non-Native cancer survivors: Native and non-Native cancer survivors' QOL. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:S106-13. [PMID: 22302431 PMCID: PMC3544405 DOI: 10.1007/s13187-012-0318-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This paper compares quality of life (QOL) outcomes between Native American and non-Native cancer survivors. Native Patient Navigators helped Native cancer patients complete a 114-item QOL survey and access survivorship information available on the NACES website. The survey was modified from Ferrell et. al’s QOL measure and assessed the four domains of cancer survivorship: physical, psychological, social, and spiritual. Findings from Native survivors were compared to Ferrell’s findings. This is the first time that QOL outcomes have been compared between Native and Non-Native cancer survivors. Natives scored lower for physical and social QOL, the same for psychological QOL, and higher for spiritual QOL in comparison to non-Natives. Overall QOL scores were the same. Although this is the largest sample of Native cancer survivors reported in peer-reviewed manuscripts, these Native survivorship data are based on a self-selected group and it is unknown if the findings are generalizable to others.
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Affiliation(s)
- Linda Burhansstipanov
- Native American Cancer Research Corporation, 3022 South Nova Road, Pine, CO 80470-7830, USA,
| | - Mark Dignan
- Prevention Research Center, Department of Internal Medicine, Markey Cancer Center, Room CC444, 800 Rose Street, Lexington, KY 40536-0093, USA,
| | - Katherine L. Jones
- Southeastern Program Evaluation, 4623 Hallandale Drive, Batavia, OH 45103, USA,
| | - Linda U. Krebs
- University of Colorado Denver, Anschutz Medical Campus, College of Nursing, Box C288-18, ED2N Room 4209, 13120 East 19th Avenue, Aurora, CO 80045, USA,
| | - Paula Marchionda
- Native American Cancer Research Corporation (NACR), 3110 S. Wadsworth, #103, Lakewood, CO 80227, USA,
| | - Judith Salmon Kaur
- Native American Programs, Spirit of EAGLES, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA,
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Burhansstipanov L, Clark RE, Watanabe-Galloway S, Petereit DG, Eschiti V, Krebs LU, Pingatore NL. Online evaluation programs: benefits and limitations. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:S24-S31. [PMID: 22447646 PMCID: PMC3544411 DOI: 10.1007/s13187-012-0320-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Patient navigation programs are increasing throughout the USA, yet some evaluation measures are too vague to determine what and how navigation functions. Through collaborative efforts an online evaluation program was developed. The goal of this evaluation program is to make data entry accurate, simple, and efficient. This comprehensive program includes major components on staff, mentoring, committees, partnerships, grants/studies, products, dissemination, patient navigation, and reports. Pull down menus, radio buttons, and check boxes are incorporated whenever possible. Although the program has limitations, the benefits of having access to current, up-to-date program data 24/7 are worth overcoming the challenges. Of major benefit is the ability of the staff to tailor summary reports to provide anonymous feedback in a timely manner to community partners and participants. The tailored data are useful for the partners to generate summaries for inclusion in new grant applications.
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Affiliation(s)
- Linda Burhansstipanov
- Native American Cancer Research Corporation (NACR), 3022 South Nova Road, Pine, CO 80470-7830, USA,
| | - Richard E. Clark
- Native American Cancer Research Corporation (NACR), 3022 South Nova Road, Pine, CO 80470-7830, USA,
| | - Shinobu Watanabe-Galloway
- Epidemiology Department, College of Public Health, 984395 University of Nebraska Medical Center, Omaha, NE 68198-4395, USA,
| | - Daniel G. Petereit
- Department of Radiology Oncology, Rapid City Regional Hospital, John T. Vucurevich Cancer, 353 Fairmont Blvd, Rapid City, SD 57701, USA,
| | - Valerie Eschiti
- OUHSC College of Nursing, 1100 North Stonewall Ave, CNB 453, Oklahoma City, OK 73117, USA,
| | - Linda U. Krebs
- College of Nursing, Anschutz Medical Campus, University of Colorado at Denver, Box C288-18, ED2N Room 4209, 13120 East 19th Avenue, Aurora, CO 80045, USA,
| | - Noel L. Pingatore
- Inter-Tribal Council of Michigan, Inc, 2956 Ashmun St., Sault Ste. Marie, MI 49783, USA,
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Burhansstipanov L, Krebs LU, Watanabe-Galloway S, Petereit DG, Pingatore NL, Eschiti V. Preliminary lessons learned from the "Native Navigators and the Cancer Continuum" (NNACC). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:S57-65. [PMID: 22410710 PMCID: PMC3544409 DOI: 10.1007/s13187-012-0316-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This community-based participatory research (CBPR) study was based on patient navigation (Navigator) among three original sites: Colorado, Michigan, and South Dakota. During 2010, the study added two sites: the Comanche Nation and the Muscogee (Creek) Nation (Oklahoma). The intervention includes 24-h of a Navigator-implemented cancer education program that addresses the full continuum of cancer care. The partners include agreements with up to two local Native American organizations each year, called Memorandum Native Organizations, who have strong relationships with local American Indians. Family fun events are used to initiate the series of workshops and to collect baseline data and also to wrap up and evaluate the series 3 months following the completion of the workshop series. Evaluation data are collected using an audience response system (ARS) and stored using an online evaluation program. Among the lessons learned to date are: the Institutional Review Board processes required both regional and national approvals and took more than 9 months. All of the workshop slides were missing some components and needed refinements. The specifics for the Memorandum Native Organization deliverables needed more details. The ARS required additional training sessions, but once learned the Navigator use the ARS well. Use of the NACR website for a password-protected page to store all NNACC workshop and training materials was easier to manage than use of other online storage programs. The community interest in taking part in the workshops was greater than what was anticipated. All of the Navigators' skills are improving and all are enjoying working with the community.
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Affiliation(s)
- Linda Burhansstipanov
- Native American Cancer Research Corporation (NACR), 3022 South Nova Road, Pine, CO 80470-7830, USA
| | - Linda U. Krebs
- College of Nursing, University of Colorado Denver, ED2N Room 4209, 13120 East 19th Avenue, P.O. Box 6511, Aurora, CO 80045, USA
| | - Shinobu Watanabe-Galloway
- Epidemiology Department, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4395, USA
| | - Daniel G. Petereit
- Department of Radiology Oncology, Rapid City Regional Hospital, John T. Vucurevich Cancer, 353 Fairmont Blvd, Rapid City, SD 57701, USA
| | - Noel L. Pingatore
- Inter-Tribal Council of Michigan, Inc., 2956 Ashmun St., Sault Ste. Marie, MI 49783, USA
| | - Valerie Eschiti
- OUHSC College of Nursing, 1100 North Stonewall Ave, CNB 453, Oklahoma City, OK 73117, USA
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Manderson B, McMurray J, Piraino E, Stolee P. Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:113-127. [PMID: 21995806 DOI: 10.1111/j.1365-2524.2011.01032.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Transitions between various healthcare services are potential points for fragmented care and can be confusing and complicated for patients, formal and informal caregivers. These challenges are compounded for older adults with chronic disease, as they receive care from many providers in multiple care settings. System navigation has been suggested as an innovative strategy to address these challenges. While a number of navigation models have been developed, there is a lack of consensus on the desired characteristics and effectiveness of this role. We conducted a systematic literature review to describe existing navigator models relevant to chronic disease management for older adults and to investigate the potential impact of each model. Relevant literature was identified using five electronic databases - Medline, CINAHL, the Cochrane database, Embase and PsycINFO between January 1999 and April 2011. Following a recommended process for health services research literature reviews, exclusion and inclusion criteria were applied to retrieved articles; 15 articles documenting nine discrete studies were selected. This review suggests that the role of a navigator for the chronically ill older person is a relatively new one. It provides some evidence that integrated and coordinated care guided by a navigator, using a variety of interventions such as care plans and treatment goals, is beneficial for chronically ill older adults transitioning across care settings. There is a need to further clarify and standardise the definition of navigation, as well as a need for additional research to assess the effectiveness and cost of different approaches to the health system.
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Affiliation(s)
- Brooke Manderson
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON, Canada
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Hanson JD. Understanding prenatal health care for American Indian women in a Northern Plains tribe. J Transcult Nurs 2011; 23:29-37. [PMID: 22052090 DOI: 10.1177/1043659611423826] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Early and regular prenatal care appointments are imperative for the health of both the mother and baby to help prevent complications associated with pregnancy and birth. American Indian women are especially at risk for health disparities related to pregnancy and lack of prenatal health care. Previous research has outlined a basic understanding of the reasons for lack of prenatal care for women in general; however, little is known about care received by pregnant women at Indian Health Service hospitals. Qualitative interviews were carried out with 58 women to better understand the prenatal health experiences of American Indian women from one tribe in the Northern Plains. Several themes related to American Indian women's prenatal health care experiences were noted, including communication barriers with physicians, institutional barriers such as lack of continuity of care, and sociodemographic barriers. Solutions to these barriers, such as a nurse midwife program, are discussed.
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Affiliation(s)
- Jessica D Hanson
- Health Disparities Research Center, Sanford Research/USD, 2301 East 60th Street North, Sioux Falls, SD 57104, USA.
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Abstract
Although patient navigation was introduced 2 decades ago, there remains a lack of consensus regarding its definition, the necessary qualifications of patient navigators, and its impact on the continuum of cancer care. This review provides an update to the 2008 review by Wells et al on patient navigation. Since then, there has been a significant increase in the number of published studies dealing with cancer patient navigation. The authors of the current review conducted a search by using the keywords "navigation" or "navigator" and "cancer." Thirty-three articles published from November 2007 through July 2010 met the search criteria. Consistent with the prior review, there is building evidence of some degree of efficacy of patient navigation in terms of increasing cancer screening rates. However, there is less recent evidence concerning the benefit of patient navigation with regard to diagnostic follow-up and in the treatment setting, and a paucity of research focusing on patient navigation in cancer survivorship remains. Methodological limitations were noted in many studies, including small sample sizes and a lack of control groups. As patient navigation programs continue to develop across North America and beyond, further research will be required to determine the efficacy of cancer patient navigation across all aspects of the cancer care continuum.
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Affiliation(s)
- Electra D Paskett
- MarionDivisionComprehensive Cancer Center, The Ohio State University, Columbus, USA.
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Nguyen TUN, Tran JH, Kagawa-Singer M, Foo MA. A qualitative assessment of community-based breast health navigation services for Southeast Asian women in Southern California: recommendations for developing a navigator training curriculum. Am J Public Health 2010; 101:87-93. [PMID: 21088273 DOI: 10.2105/ajph.2009.176743] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We identified key elements required for a training curriculum for Southeast Asian community-based health navigators (CBHNs), who help low-income, immigrant Cambodian, Laotian, Thai, and Vietnamese women negotiate cultural and systemic barriers to breast cancer screening and care in the United States. METHODS We gathered the perspectives of 3 groups: CBHNs, community members, and their providers. We conducted 16 focus groups with 110 women representing different stages of the cancer care continuum and in-depth interviews with 15 providers and 10 navigators to identify the essential roles, skills, and interpersonal qualities that characterize successful CBHNs. RESULTS The most important areas identified for training CBHNs were information (e.g., knowing pertinent medical information and how to navigate resources), logistics (transportation, interpretation), and affective interpersonal skills (understanding the language and cultural beliefs of patients, communicating with providers, establishing trust). CONCLUSIONS CBHNs serve a crucial role in building trust and making screening practices culturally meaningful, accessible, usable, and acceptable. Future research should focus on developing training curricula, policies, resources, and funding to better maximize the expertise and services that CBHNs provide and to expand our findings to other underserved communities.
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Affiliation(s)
- Tu-Uyen N Nguyen
- Asian American Studies Program, College of Humanities and Social Sciences, California State University, Fullerton, CA 92834-6868, USA.
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Maxwell AE, Jo AM, Crespi CM, Sudan M, Bastani R. Peer navigation improves diagnostic follow-up after breast cancer screening among Korean American women: results of a randomized trial. Cancer Causes Control 2010; 21:1931-40. [PMID: 20676928 PMCID: PMC2959157 DOI: 10.1007/s10552-010-9621-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 07/19/2010] [Indexed: 12/05/2022]
Abstract
Objective To test an intervention to increase adherence to diagnostic follow-up tests among Asian American women. Methods Korean American women who were referred for a diagnostic follow-up test (mainly diagnostic mammograms) and who had missed their follow-up appointment were eligible to participate in the study. Women from two clinics (n = 176) were randomly allocated to a usual care control arm or a peer navigator intervention arm. A 20-min telephone survey was administered to women in both study arms six months after they were identified to assess demographic and socio-economic characteristics and the primary outcome, self-reported completion of the recommended follow-up exam. Results Among women who completed the survey at six-month follow-up, self-reported completion of follow-up procedures was 97% in the intervention arm and 67% in the control arm (p < 0.001). Based on an intent-to-treat analysis of all women who were randomized and an assumption of no completion of follow-up exam for women with missing outcome data, self-reported completion of follow-up was 61% in the intervention arm and 46% in the usual care control arm (p < 0.069). Conclusions Our results suggest that a peer navigator intervention to assist Korean American women to obtain follow-up diagnostic tests after an abnormal breast cancer screening test is efficacious.
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Affiliation(s)
- Annette E Maxwell
- School of Public Health, University of California, Los Angeles and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900, USA.
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Burhansstipanov L, Dignan MB, Schumacher A, Krebs LU, Alfonsi G, Apodaca CC. Breast screening navigator programs within three settings that assist underserved women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2010; 25:247-52. [PMID: 20300914 PMCID: PMC3544404 DOI: 10.1007/s13187-010-0071-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Medically underserved women in the Greater Denver Metropolitan Area had low rates of routine repeat mammograms in the latter 1990s. "Increasing Mammography Adherence among Medically Underserved Women" was designed to increase annual rescreening among medically underserved populations living in this area. Four community-based organizations collaborated to implement this 5-year study. A culturally modified navigator model including both face-to-face and telephone formats was used to facilitate mammography for African Americans, Latinas, Native Americans, and poor White women who had not been rescreened in more than 18 months. The navigator-implemented intervention was statistically significant at the 0.05 level for increasing rescreening.
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Affiliation(s)
- Linda Burhansstipanov
- Grants Office, Native American Cancer Research Corporation, 3022 South Nova Road, Pine, CO 80470-7830, USA.
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Masi CM, Gehlert S. Perceptions of breast cancer treatment among African-American women and men: implications for interventions. J Gen Intern Med 2009; 24:408-14. [PMID: 19101776 PMCID: PMC2642574 DOI: 10.1007/s11606-008-0868-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 10/27/2008] [Accepted: 11/18/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND While breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. Current strategies to reduce this disparity focus on logistical and information needs, but contextual factors, such as concerns about racism and treatment side effects, may also represent significant barriers to improved outcomes. OBJECTIVE To characterize perceptions of breast cancer treatment among African-American women and men. DESIGN A qualitative study of African-American adults using focus group interviews. PARTICIPANTS Two hundred eighty women and 165 men who live in one of 15 contiguous neighborhoods on Chicago's South Side. APPROACH Transcripts were systematically analyzed using qualitative techniques to identify emergent themes related to breast cancer treatment. RESULTS The concerns expressed most frequently were mistrust of the medical establishment and federal government, the effect of racism and lack of health insurance on quality of care, the impact of treatment on intimate relationships, and the negative effects of surgery, radiation therapy, and chemotherapy. CONCLUSIONS In addition to providing logistical and information support, strategies to reduce the breast cancer mortality gap should also address contextual factors important to quality of care. Specific interventions are discussed, including strategies to enhance trust, reduce race-related treatment differences, minimize the impact of treatment on intimate relationships, and reduce negative perceptions of breast cancer surgery, radiation therapy, and chemotherapy.
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Affiliation(s)
- Christopher M Masi
- Section of General Internal Medicine, University of Chicago, 5841 S. Maryland Avenue, M/C 2007, Chicago, IL 60637, USA.
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Lin CJ, Schwaderer KA, Morgenlander KH, Ricci EM, Hoffman L, Martz E, Cosgrove RH, Heron DE. Factors associated with patient navigators' time spent on reducing barriers to cancer treatment. J Natl Med Assoc 2008; 100:1290-7. [PMID: 19024225 DOI: 10.1016/s0027-9684(15)31507-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patient navigator programs were established to mitigate barriers to cancer care, especially among underserved populations in 3 community hospitals in western Pennsylvania. This study was designed to determine and compare the time spent to enroll patients recently diagnosed with any type of cancer, the characteristics of enrolled patients, the types of barriers to treatment and the time it took patient navigators to address barriers. At enrollment, 253 (85%) of 299 enrollees reported barriers, most frequently problems with insurance and out-of-pocket expenses (31.5%) and transportation (24.6%). Navigators spent an average of 2.5 hours per patient. They spent significantly more time helping uninsured than insured patients and helping patients at the inner-city site. The most time was spent on financial problems (169 minutes), transportation problems (74 minutes), end-of-life issues (65 minutes), arrangement for dependent care (60 minutes), scheduling of appointments (34 minutes) and assistance with activities of daily living (24 minutes). Overall, financial barriers were the most often reported and the most time consuming. Patient navigators assisting cancer patients, especially the poor and underserved, will require significant time to address patients' financial and other barriers to care. This information will be helpful in the allocation of staff time and case loads for future programs.
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Affiliation(s)
- Chyongchiou J Lin
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA 15232, USA.
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Calhoun EA, Whitley EM, Esparza A, Ness E, Greene A, Garcia R, Valverde PA. A national patient navigator training program. Health Promot Pract 2008; 11:205-15. [PMID: 19116415 DOI: 10.1177/1524839908323521] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient Navigation is an intervention aimed at addressing cancer health disparities by eliminating barriers to diagnosis, treatment, and services. Three major patient navigation (PN) programs (The National Cancer Institute, The American Cancer Society &The Center for Medicare and Medicaid Services) are underway to address the needs of medically underserved cancer patients. There has not been national training with a defined curriculum for patient navigators (PNs). Curriculum for training the PNs was created by experts from the three programs. The efficacy of training was evaluated using a pre- and posttest. The data show that overall the posttest scores improved from the pretest. In addition, having a high school education or greater or having more years of work experience were significantly related to improvements on the posttest. The first successful standardized national training program was attended by 116 PNs representing 85 cities with the goal to reduce health disparities for medically underserved.
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Wells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E, Mandelblatt JS, Paskett ED, Raich PC. Patient navigation: state of the art or is it science? Cancer 2008; 113:1999-2010. [PMID: 18780320 DOI: 10.1002/cncr.23815] [Citation(s) in RCA: 418] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
First implemented in 1990, patient navigation interventions are emerging today as an approach to reduce cancer disparities. However, there is lack of consensus about how patient navigation is defined, what patient navigators do, and what their qualifications should be. Little is known about the efficacy and cost-effectiveness of patient navigation. For this review, the authors conducted a qualitative synthesis of published literature on cancer patient navigation. By using the keywords 'navigator' or 'navigation' and 'cancer,' 45 articles were identified in the PubMed database and from reference searches that were published or in press through October 2007. Sixteen studies provided data on the efficacy of navigation in improving timeliness and receipt of cancer screening, diagnostic follow-up care, and treatment. Patient navigation services were defined and differentiated from other outreach services. Overall, there was evidence of some degree of efficacy for patient navigation in increasing participation in cancer screening and adherence to diagnostic follow-up care after the detection of an abnormality. The reported increases in screening ranged from 10.8% to 17.1%, and increases in adherence to diagnostic follow-up care ranged from 21% to 29.2% compared with control patients. There was less evidence regarding the efficacy of patient navigation in reducing either late-stage cancer diagnosis or delays in the initiation of cancer treatment or improving outcomes during cancer survivorship. There were methodological limitations in most studies, such as a lack of control groups, small sample sizes, and contamination with other interventions. Although cancer-related patient navigation interventions are being adopted increasingly across the United States and Canada, further research will be necessary to evaluate their efficacy and cost-effectiveness in improving cancer care.
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Affiliation(s)
- Kristen J Wells
- Department of Health Outcomes and Behavior, Division of Cancer Prevention and Control, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.
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Braun KL, Allison A, Tsark JU. Using community-based research methods to design cancer patient navigation training. Prog Community Health Partnersh 2008; 2:329-40. [PMID: 20208313 PMCID: PMC2862697 DOI: 10.1353/cpr.0.0037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cancer mortality continues to be higher in Native Hawaiians than whites, and research has identified numerous barriers to good cancer care. Cancer navigator programs provide individualized assistance to patients and family members to overcome barriers, promoting early diagnosis and timely and complete treatment. OBJECTIVES Our purpose was to design a training curriculum to provide community-based outreach workers serving Native Hawaiians with cancer patient navigator skills. METHODS The Ho'okele i ke Ola (Navigating to Health) curriculum was informed by data gathered from Native Hawaiian cancer patients and their family members, outreach workers in Native Hawaiian communities, and cancer care providers. Based on findings, the 48-hour curriculum focused on cancer knowledge, cancer resources, and cancer communications. Three versions were developed: (1) six days of training and on-site tours in urban Honolulu; (2) four days of training on a neighbor island, with 2 days of on-site tours in Honolulu; and (3) a 3-credit community college independent study course. Graduates were interviewed after each session and 3 months after graduation about application of navigation skills. RESULTS In 18 months, 62 health workers from community-based, clinical, and community college settings were trained -31 in Honolulu-based trainings, 29 in neighbor island trainings where earlier graduates served as co-faculty, and 2 through Maui Community College (MCC). Follow-up data suggest increased knowledge, skills, capacity, and feelings of competence among trainees. CONCLUSIONS All three versions of the Ho'okele i ke Ola curriculum, developed with community input, have proven successful in increasing cancer patient navigation skills of trainees.
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Affiliation(s)
- Kathryn L. Braun
- `Imi Hale Native Hawaiian Cancer Network, Papa Ola Lōkahi, Honolulu, HI
- Office of Public Health Studies, John A. Burns School of Medicine, University of Hawai`i at Mānoa, Honolulu, HI
| | - Amanda Allison
- `Imi Hale Native Hawaiian Cancer Network, Papa Ola Lōkahi, Honolulu, HI
| | - JoAnn U. Tsark
- `Imi Hale Native Hawaiian Cancer Network, Papa Ola Lōkahi, Honolulu, HI
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Masi CM, Blackman DJ, Peek ME. Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. Med Care Res Rev 2007; 64:195S-242S. [PMID: 17881627 PMCID: PMC2657605 DOI: 10.1177/1077558707305410] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors conduct a systematic review of the literature to identify interventions designed to enhance breast cancer screening, diagnosis, and treatment among minority women. Most trials in this area have focused on breast cancer screening, while relatively few have addressed diagnostic testing or breast cancer treatment. Among patient-targeted screening interventions, those that are culturally tailored or addressed financial or logistical barriers are generally more effective than reminder-based interventions, especially among women with fewer financial resources and those without previous mammography. Chart-based reminders increase physician adherence to mammography guidelines but are less effective at increasing clinical breast examination. Several trials demonstrate that case management is an effective strategy for expediting diagnostic testing after screening abnormalities have been found. Additional support for these and other proven health care organization-based interventions appears justified and may be necessary to eliminate racial and ethnic breast cancer disparities.
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Affiliation(s)
- Christopher M Masi
- The University of Chicago, Section of General Internal Medicine, Department of Medicine, Chicago, IL 60637, USA
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Bradford JB, Coleman S, Cunningham W. HIV System Navigation: an emerging model to improve HIV care access. AIDS Patient Care STDS 2007; 21 Suppl 1:S49-58. [PMID: 17563290 DOI: 10.1089/apc.2007.9987] [Citation(s) in RCA: 243] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Little is known about the effectiveness of outreach interventions to engage and retain underserved populations living with HIV in stable, primary medical care. This study provided an opportunity to adapt a patient navigation model first developed for cancer care to assess its effectiveness with HIV-infected disadvantaged populations. Four grantees from the Health Resources and Services Administration (HRSA)-funded Outreach Initiative developed and successfully implemented navigation-like interventions. We examined the effectiveness of these interventions in decreasing barriers to HIV primary medical care and improving health outcomes. The conceptual framework laid out in the 1993 Institute of Medicine report Access to Health Care in America provided a valuable heuristic for guiding the analysis, and we used the model to select measures for the study. A reduction in barriers, improvement in mediators, and improved health outcomes were observed over the 12-month intervention period. Structural barriers to HIV care and provider engagement were significantly associated with health outcomes. Based on study results, we propose that an adapted navigation approach referred to as "HIV System Navigation" has promise for improving access to HIV care and warrants further development.
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Affiliation(s)
- Judith B Bradford
- The Fenway Institute of Fenway Community Health, Boston, Massachusetts., Center of Public Policy, Virginia Commonwealth University, Richmond, Virginia 23284-3065, USA.
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