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Rose J, Oliver Y, Sage P, Dong W, Koroukian SM, Koopman Gonzalez S. Factors affecting timely breast cancer treatment among black women in a high-risk urban community: a qualitative study. BMC Womens Health 2022; 22:354. [PMID: 35989341 PMCID: PMC9392989 DOI: 10.1186/s12905-022-01938-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 08/16/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Black women diagnosed with breast cancer in the U.S. tend to experience significantly longer waits to begin treatment than do their white counterparts, and such treatment delay has been associated with poorer survival. We sought to identify the factors driving or mitigating treatment delay among Black women in an urban community where treatment delay is common. METHODS Applying the SaTScan method to data from Ohio's state cancer registry, we identified the community within Cuyahoga County, Ohio (home to Cleveland) with the highest degree of breast cancer treatment delay from 2010 through 2015. We then recruited breast cancer survivors living in the target community, their family caregivers, and professionals serving breast cancer patients in this community. Participants completed semi-structured interviews focused on identifying barriers to and facilitators of timely breast cancer treatment initiation after diagnosis. RESULTS Factors reported to impact timely treatment fell into three primary themes: informational, intrapersonal, and logistical. Informational barriers included erroneous beliefs and lack of information about processes of care; intrapersonal barriers centered on mistrust, fear, and denial; while logistical barriers involved transportation and financial access, as well as patients' own caregiving obligations. An informational facilitator was the provision of objective and understandable disease information, and a common intrapersonal facilitator was faith. Logistical facilitators included financial counseling and mechanisms to assist with Medicaid enrollment. Crosscutting these themes, and mentioned frequently, was the centrality of both patient navigators and support networks (formal and, especially, informal) as critical lifelines for overcoming barriers and leveraging facilitating factors. CONCLUSIONS The present study describes the numerous hurdles to timely breast cancer treatment faced by Black women in a high-risk urban community. These hurdles, as well as corresponding facilitators, can be classified as informational, intrapersonal, and logistical. Observing similar results on a larger scale could inform the design of interventions and policies to reduce race-based disparities in processes of cancer care.
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Affiliation(s)
- Johnie Rose
- grid.67105.350000 0001 2164 3847Center for Community Health Integration, Case Western Reserve University, 11000 Cedar Ave., Ste. 402, Cleveland, OH 44106-7136 USA ,grid.67105.350000 0001 2164 3847Case Comprehensive Cancer Center, Cleveland, OH USA
| | - Yvonne Oliver
- grid.67105.350000 0001 2164 3847Case Comprehensive Cancer Center, Cleveland, OH USA ,Freelance Qualitative Researcher, Cleveland, OH, USA
| | - Paulette Sage
- Freelance Qualitative Researcher, Cleveland, OH, USA
| | - Weichuan Dong
- grid.67105.350000 0001 2164 3847Case Comprehensive Cancer Center, Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH USA
| | - Siran M. Koroukian
- grid.67105.350000 0001 2164 3847Case Comprehensive Cancer Center, Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH USA
| | - Sarah Koopman Gonzalez
- grid.67105.350000 0001 2164 3847Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH USA
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Coordination Models for Cancer Care in Low- and Middle-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137906. [PMID: 35805565 PMCID: PMC9265683 DOI: 10.3390/ijerph19137906] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
Background: The coordination of cancer care among multiple providers is vital to improve care quality and ensure desirable health outcomes across the cancer continuum, yet evidence is scarce of this being optimally achieved in low- and middle-income countries (LMICs). Objective: Through this scoping review, our objective was to understand the scope of cancer care coordination interventions and services employed in LMICs, in order to synthesise the existing evidence and identify key models and their elements used to manage and/or improve cancer care coordination in these settings. Methods: A detailed search strategy was conducted, aligned with the framework of Arksey and O’Malley. Articles were examined for evidence of coordination interventions used in cancer care in LMICs. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension Guidelines for Scoping Reviews, which included a checklist and explanation. The PRISMA flow diagram was utilised to report the screening of results. Data were extracted, categorised and coded to allow for a thematic analysis of the results. Results: Fourteen studies reported on coordination interventions in cancer care in LMICs. All studies reported a positive impact of cancer coordination interventions on the primary outcome measured. Most studies reported on a patient navigation model at different points along the cancer care continuum. Conclusions: An evidence-based and culturally sensitive plan of care that aims to promote coordinated and efficient multidisciplinary care for patients with suspicion or diagnosis of cancer in LMICs is feasible and might improve the quality of care and efficiency.
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Loo S, Mullikin K, Robbins C, Xiao V, Battaglia TA, Lemon SC, Gunn C. Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study. BMC Health Serv Res 2022; 22:683. [PMID: 35597947 PMCID: PMC9123866 DOI: 10.1186/s12913-022-08090-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In 2018 Translating Research Into Practice (TRIP), an evidence-based patient navigation intervention aimed at addressing breast cancer care disparities, was implemented across six Boston hospitals. This study assesses patient navigator team member perspectives regarding implementation barriers and facilitators one year post-study implementation. METHODS We conducted in-depth qualitative interviews at the six sites participating in the pragmatic TRIP trial from December 2019 to March 2021. Navigation team members involved with breast cancer care navigation processes at each site were interviewed at least 12 months after intervention implementation. Interview questions were designed to address domains of the Consolidated Framework for Implementation Research (CFIR), focusing on barriers and facilitators to implementing the intervention that included 1) rigorous 11-step guidelines for navigation, 2) a shared patient registry and 3) a social risk screening and referral program. Analysis was structured using deductive codes representing domains and constructs within CFIR. RESULTS Seventeen interviews were conducted with patient navigators, their supervisors, and designated clinical champions. Participants identified the following benefits provided by the TRIP intervention: 1) increased networking and connections for navigators across clinical sites (Cosmopolitanism), 2) formalization of the patient navigation process (Goals and Purpose, Access to Knowledge and Information, and Relative Advantage), and 3) flexibility within the TRIP intervention that allowed for diversity in implementation and use of TRIP components across sites (Adaptability). Barriers included those related to documentation requirements (Complexity) and the structured patient follow up guidelines that did not always align with the timeline of existing site navigation processes (Relative Priority). CONCLUSIONS Our analysis provides data using real-world experience from an intervention trial in progress, identifying barriers and facilitators to implementing an evidence-based patient navigation intervention for breast cancer care. We identified core processes that facilitated the navigators' patient-focused tasks and role on the clinical team. Barriers encountered reflect limitations of navigator funding models and high caseload. TRIAL REGISTRATION Clinical Trial Registration Number NCT03514433 , 5/2/2018.
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Affiliation(s)
- Stephanie Loo
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA.
| | - Katelyn Mullikin
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Charlotte Robbins
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Victoria Xiao
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | | | - Christine Gunn
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA.,Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.,The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
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4
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Fenton A, Downes N, Mendiola A, Cordova A, Lukity K, Imani J. Multidisciplinary Management of Breast Cancer and Role of the Patient Navigator. Obstet Gynecol Clin North Am 2022; 49:167-179. [DOI: 10.1016/j.ogc.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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LeClair AM, Battaglia TA, Casanova NL, Haas JS, Freund KM, Moy B, Parsons SK, Ko NY, Ross J, Ohrenberger E, Mullikin KR, Lemon SC. Assessment of patient navigation programs for breast cancer patients across the city of Boston. Support Care Cancer 2021; 30:2435-2443. [PMID: 34767089 DOI: 10.1007/s00520-021-06675-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Healthcare systems contribute to disparities in breast cancer outcomes. Patient navigation is a widely cited system-based approach to improve outcomes among populations at risk for delays in care. Patient navigation programs exist in all major Boston hospitals, yet disparities in outcomes persist. The objective of this study was to conduct a baseline assessment of navigation processes at six Boston hospitals that provide breast cancer care in preparation for an implementation trial of standardized navigation across the city. METHODS We conducted a mixed methods study in six hospitals that provide treatment to breast cancer patients in Boston. We administered a web-based survey to clinical champions (n = 7) across six sites to collect information about the structure of navigation programs. We then conducted in-person workflow assessments at each site using a semi-structured interview guide to understand site-specific implementation processes for patient navigation programs. The target population included administrators, supervisors, and patient navigators who provided breast cancer treatment-focused care. RESULTS All sites offered patient navigation services to their patients undergoing treatment for breast cancer. We identified wide heterogeneity in terms of how programs were funded/resourced, which patients were targeted for navigation, the type of services provided, and the continuity of those services relative to the patient's cancer treatment. CONCLUSIONS The operationalization of patient navigation varies widely across hospitals especially in relation to three core principles in patient navigation: providing patient support across the care continuum, targeting services to those patients most likely to experience delays in care, and systematically screening for and addressing patients' health-related social needs. Gaps in navigation across the care continuum present opportunities for intervention. TRIAL REGISTRATION Clinical Trial Registration Number NCT03514433, 5/2/2018.
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Affiliation(s)
- Amy M LeClair
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.,Department of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Nicole L Casanova
- Department of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen M Freund
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Beverly Moy
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan K Parsons
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Naomi Y Ko
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.,Department of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - JoEllen Ross
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Katelyn R Mullikin
- Department of General Internal Medicine, Boston Medical Center, Boston, MA, USA
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Kolla A, Lim S, Zanowiak J, Islam N. The Role of Health Informatics in Facilitating Communication Strategies for Community Health Workers in Clinical Settings: A Scoping Review. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:E107-E118. [PMID: 33512874 PMCID: PMC7994181 DOI: 10.1097/phh.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community health workers (CHWs) have been identified as effective members of health care teams in improving health outcomes and reducing health disparities, especially among racial and ethnic minorities. There is a growing interest in integrating CHWs into clinical settings using health informatics-based strategies to help provide coordinated patient care and foster health-promoting behaviors. OBJECTIVE In this scoping review, we outline health informatics-based strategies for CHW-provider communication that aim to improve integration of CHWs into clinical settings. DESIGN A scoping review was conducted. ELIGIBILITY CRITERIA US-based sources between 2013 and 2018 were eligible. STUDY SELECTION Literature was identified through PubMed and Google queries and hand searching key reference lists. Articles were screened by title, abstract, and then full-text. MAIN OUTCOME MEASURES Health informatics-based strategies for CHW-provider communication and their impacts on patient care were documented and analyzed. RESULTS Thirty-one articles discussed health informatics-based strategies for CHW-provider communication and/or integration of CHWs into clinical settings. These strategies include direct CHW documentation of patient encounters in electronic health records (EHRs) and other Web-based applications. The technologies were used to document patient encounters and patient barriers to health care providers but were additionally used for secure messaging and referral systems. These strategies were found to meet the needs of providers and CHWs while facilitating CHW-provider communication, CHW integration, and coordinated care. CONCLUSIONS Health informatics-based strategies for CHW-provider communication are important for facilitating CHW integration and potentially improving patient outcomes and improving disparities among minority populations. This integration can support the development of future disease prevention programs and health care policies in which CHWs are an established part of the public health workforce. However, further investigation must be done on overcoming implementation challenges (eg, lack of time or funding), especially in smaller resource-challenged community-based clinics that serve minority patients.
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Affiliation(s)
- Avani Kolla
- Department of Population Health, New York University School of Medicine, New York, New York
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Dixit N, Rugo H, Burke NJ. Navigating a Path to Equity in Cancer Care: The Role of Patient Navigation. Am Soc Clin Oncol Educ Book 2021; 41:1-8. [PMID: 33830828 DOI: 10.1200/edbk_100026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Notable barriers exist in the delivery of equitable care for all patients with cancers. Social determinants of health at distal, intermediate, and proximal levels impact cancer care. Patient navigation is a patient-centered intervention that functions across these overlapping determinants to increase access to cancer services throughout the cancer care continuum. There is a need to standardize patient navigation training while remaining responsive to local contexts of care and a need to implement patient navigation programs with a health equity lens to address cancer care inequities.
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Affiliation(s)
- Niharika Dixit
- University of California San Francisco/Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Hope Rugo
- The Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
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Bernstein A, Harrison KL, Dulaney S, Merrilees J, Bowhay A, Heunis J, Choi J, Feuer JE, Clark AM, Chiong W, Lee K, Braley TL, Bonasera SJ, Ritchie CS, Dohan D, Miller BL, Possin KL. The Role of Care Navigators Working with People with Dementia and Their Caregivers. J Alzheimers Dis 2020; 71:45-55. [PMID: 31322558 DOI: 10.3233/jad-180957] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Care navigation is an approach to personalized care management and care coordination that can help overcome barriers to care. Care navigation has not been extensively studied in dementia, where health care workforce innovations are needed as a result of increasing disease prevalence and resulting costs to the health care system. OBJECTIVE To identify facilitators and barriers to care navigation in dementia and to assess dementia caregiver satisfaction with care navigation. METHODS Methods include qualitative research (interviews, focus groups, observations) with "Care Team Navigators" (CTNs) who were part of a dementia care navigation program, the Care Ecosystem, and a quantitative survey with caregivers about their experiences with CTNs. Transcripts were analyzed to identify themes within the data. RESULTS CTNs identified the following facilitators to care navigation in dementia: working closely with caregivers; providing emotional support; tailoring education and resources; and coordinating with a clinical team around issues ranging from clinical questions to financial and legal decision-making. The barriers CTNS identified included burn-out, the progressive nature of the disease; coordinating with primary care providers; and identifying resources for dyads who are low-income, do not speak English, or live in rural areas. Caregivers across both sites highly rated CTNs, though satisfaction was higher among those in Nebraska and Iowa. CONCLUSIONS Innovative approaches to care delivery in dementia are crucial. Care navigation offers a feasible model to train unlicensed people to deliver care as a way to deliver larger-scale support for the growing population of adults living with dementia and their caregivers.
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Affiliation(s)
- Alissa Bernstein
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Krista L Harrison
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Dulaney
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Merrilees
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Angela Bowhay
- Department of Internal Medicine, Division of Geriatrics, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Julia Heunis
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jeff Choi
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Julie E Feuer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amy M Clark
- Department of Internal Medicine, Division of Geriatrics, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kirby Lee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Tamara L Braley
- Department of Internal Medicine, Division of Geriatrics, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Stephen J Bonasera
- Department of Internal Medicine, Division of Geriatrics, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Christine S Ritchie
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Dan Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine L Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Battaglia TA, Freund KM, Haas JS, Casanova N, Bak S, Cabral H, Freedman RA, White KB, Lemon SC. Translating research into practice: Protocol for a community-engaged, stepped wedge randomized trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative. Contemp Clin Trials 2020; 93:106007. [PMID: 32305457 PMCID: PMC7884078 DOI: 10.1016/j.cct.2020.106007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/10/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Racial and socioeconomic disparities in breast cancer mortality persist. In Boston, MA, Black, Non-Hispanic women and Medicaid-insured individuals are 2-3 times more likely to have delays in treatment compared to White or privately insured women. While evidence-based care coordination strategies for reducing delays exist, they are not systematically implemented across healthcare settings. METHODS Translating Research Into Practice (TRIP) utilizes community engaged research methods to address breast cancer care delivery disparities. Four Massachusetts Clinical and Translational Science Institute (CTSI) hubs collaborated with the Boston Breast Cancer Equity Coalition (The Coalition) to implement an evidence-based care coordination intervention for Boston residents at risk for delays in breast cancer care. The Coalition used a community-driven process to define the problem of care delivery disparities, identify the target population, and develop a rigorous pragmatic approach. We chose a cluster-randomized, stepped-wedge hybrid type I effectiveness-implementation study design. The intervention implements three evidence-based strategies: patient navigation services, a shared patient registry for use across academic medical centers, and a web-based social determinants of health platform to identify and address barriers to care. Primary clinical outcomes include time to first treatment and receipt of guideline-concordant treatment, which are captured through electronic health records abstraction. We will use mixed methods to collect the secondary implementation outcomes of acceptability, adoption/penetration, fidelity, sustainability and cost. CONCLUSION TRIP utilizes an innovative community-driven research strategy, focused on interdisciplinary collaborations, to design and implement a translational science study that aims to more efficiently integrate proven health services interventions into clinical practice.
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Affiliation(s)
- Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America.
| | - Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Internal Medicine and Primary Care, Department of Medicine, Tufts Medical Center, Boston, MA, United States of America; Tufts University School of Medicine, Boston, MA, United States of America
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nicole Casanova
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Sharon Bak
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America; Boston University School of Medicine, Boston, MA, United States of America
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Rachel A Freedman
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, United States of America
| | - Karen Burns White
- Initiative to Eliminate Cancer Disparities, Dana Farber/Harvard Cancer Center, Boston, MA, United States of America
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
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Freund KM, Haas JS, Lemon SC, Burns White K, Casanova N, Dominici LS, Erban JK, Freedman RA, James TA, Ko NY, LeClair AM, Moy B, Parsons SK, Battaglia TA. Standardized activities for lay patient navigators in breast cancer care: Recommendations from a citywide implementation study. Cancer 2019; 125:4532-4540. [PMID: 31449680 DOI: 10.1002/cncr.32432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/07/2019] [Accepted: 07/10/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is a need for guidelines on patient navigation activities to promote both the quality of patient navigation and the standards of reimbursement for these services because a lack of reimbursement is a major barrier to the implementation, maintenance, and sustainability of these programs. METHODS A broad community-based participatory research process was used to identify the needs of patients for navigation. A panel of stakeholders of clinical providers was convened to identify specific activities for navigators to address the needs of patients and providers with the explicit goal of reducing delays in the initiation of cancer treatment and improving adherence to the care plan. RESULTS Specific activities were identified that could be generalized to all patient navigation programs for care during active cancer management to address the needs of vulnerable communities. CONCLUSIONS Oncology programs that seek to implement lay patient navigation may benefit from the adoption of these activities for quality monitoring. Such activities are necessary as we consider reimbursement strategies for navigators without clinical training or licensure.
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Affiliation(s)
- Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Division of Internal Medicine and Primary Care, Department of Medicine, Tufts Medical Center, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karen Burns White
- Initiative to Eliminate Cancer Disparities, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Nicole Casanova
- Section of General Internal Medicine, Center of Excellence in Women's Health, Boston University School of Medicine, Boston, Massachusetts
| | - Laura S Dominici
- Dana-Farber/Brigham and Women's Cancer Center, Brigham and Women's Faulkner Hospital, Boston, Massachusetts
| | - John K Erban
- Cancer Center and Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ted A James
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Naomi Y Ko
- Section of Hematology and Oncology, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Amy M LeClair
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Beverly Moy
- Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Cancer Center and Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.,Reid R. Sacco AYA Cancer Program, Tufts University School of Medicine, Boston, Massachusetts
| | - Tracy A Battaglia
- Section of General Internal Medicine, Center of Excellence in Women's Health, Boston University School of Medicine, Boston, Massachusetts
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11
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Kelly KJ, Doucet S, Luke A. Exploring the roles, functions, and background of patient navigators and case managers: A scoping review. Int J Nurs Stud 2019; 98:27-47. [PMID: 31271977 DOI: 10.1016/j.ijnurstu.2019.05.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patient navigators and case managers are health care workers who aim to provide individualized assistance to patients facing significant health concerns. Although these roles emerged from distinct historical need, the terms are often used interchangeably in the literature and are described to have overlapping functions. Differences in the way that these roles are conceptualized across countries has led to a lack of clarity regarding the exact functions that each offer to patients, caregivers, and the health care system. OBJECTIVES To differentiate the functions and backgrounds of patient navigators and case managers across settings and disease contexts. DESIGN This review was guided based on the PRISMA extension for scoping reviews using a five-step review process: identify the research questions; search and identify relevant studies; select studies based on a priori criterion; chart the data; and collate, summarize and report the results. DATA SOURCES A search of the literature was undertaken in peer-reviewed databases (Medline, CINAHL, and PubMed) and the grey literature (Google and unpublished articles in online repositories). REVIEW METHODS Extracted data included information on patient navigators and/or case managers related to their reported background, training, and/or knowledge; roles and/or specific functions; clinical setting; and targeted condition or disease type. RESULTS The search strategy resulted in 10,523 articles. After applying the eligibility criteria during title and abstract evaluation, 468 full-text articles were reviewed, resulting in a total of 160 articles. Functions of patient navigators and case managers were organized into nine emerging categories: (1) advocacy; (2) care coordination; (3) case monitoring and patient needs assessment; (4) community engagement; (5) education; (6) administration and research activities; (7) psychosocial support; (8) navigation of services; and (9) reduction of barriers. The background and knowledge areas of each role were compared and contrasted, and three categories related to the practice context of each role were identified: (1) typical setting and care trajectory; (2) target patient population; and (3) mode of service delivery. CONCLUSIONS The current study identified important differences in the functions between patient navigators and case managers. However, there remains significant ambiguity between the functions of these two roles. Standardized definitions detailing scope of practice, and allowing for inherent flexibility across different settings, are needed to improve service delivery.
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Affiliation(s)
- K J Kelly
- University of New Brunswick Saint John, 100 Tucker Park Road, P.O. Box 5050, E2L 4L5, Saint John, New Brunswick, Canada.
| | - S Doucet
- University of New Brunswick Saint John, 100 Tucker Park Road, P.O. Box 5050, E2L 4L5, Saint John, New Brunswick, Canada.
| | - A Luke
- University of New Brunswick Saint John, 100 Tucker Park Road, P.O. Box 5050, E2L 4L5, Saint John, New Brunswick, Canada.
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12
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Desveaux L, McBrien K, Barnieh L, Ivers NM. Mapping variation in intervention design: a systematic review to develop a program theory for patient navigator programs. Syst Rev 2019; 8:8. [PMID: 30621796 PMCID: PMC6323765 DOI: 10.1186/s13643-018-0920-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/18/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is a great deal of variation in the design and delivery of patient navigator (PN) programs, making it difficult to design or adopt these interventions in new contexts. We (1) systematically reviewed the literature to generate a preliminary program theory to describe how patient navigator interventions are designed and delivered; and (2) describe how the resulting program theory was applied in context to inform a prototype for a patient navigator program. METHODS The current study includes a secondary review of a larger systematic review. We reviewed studies included in the primary review to identify those that designed and evaluated programs to assist patients in accessing and/or adhering to care. We conducted a content analysis of included publications to describe the barriers targeted by PN interventions and the navigator activities addressing those barriers. A program theory was constructed by mapping patient navigator activities to corresponding constructs within the capability-opportunity-motivation model of behavior change (COM-B) model of behavior change. The program theory was then presented to individuals with chronic disease, healthcare providers, and system stakeholders, and refined iteratively based on feedback. RESULTS Twenty one publications describing 19 patient navigator interventions were included. A total of 17 unique patient navigator activities were reported. The most common included providing education, facilitating referrals, providing social and emotional support, and supporting self-management. The majority of navigator activities targeted barriers to physical opportunity, including facilitating insurance claims, assistance with scheduling, and providing transportation. Across all interventions, navigator activities were designed to target a total of 20 patient barriers. Among interventions reporting positive effects, over two thirds targeted knowledge barriers, problems with scheduling, proactive re-scheduling following a missed appointment, and insurance. The final program design included a total of 13 navigator activities-10 informed by the original program theory and 3 unique activities informed by stakeholders. CONCLUSIONS There is considerable heterogeneity in intervention content across patient navigator interventions. Our results provide a schema from which to develop PN interventions and illustrate how an evidence-based model was used to develop a real-world PN intervention. Our findings also highlight a critical need to improve the reporting of intervention components to facilitate translation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013005857.
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Affiliation(s)
- Laura Desveaux
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave Toronto, Toronto, Ontario, M5S 1B2, Canada. .,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, Ontario, Canada.
| | - Kerry McBrien
- Department of Family Medicine, University of Calgary, G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4 N1, Canada.,Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta, T2N 2 T9, Canada
| | - Noah M Ivers
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave Toronto, Toronto, Ontario, M5S 1B2, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Women's College Hospital and University of Toronto, 76 Grenville Ave, Toronto, Ontario, Canada
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13
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Kashima K, Phillips S, Harvey A, Van Kirk Villalobos A, Pratt-Chapman M. Efficacy of the Competency-Based Oncology Patient Navigator Training. JOURNAL OF ONCOLOGY NAVIGATION & SURVIVORSHIP 2018; 9:519-524. [PMID: 31772830 PMCID: PMC6879008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Patient navigators play a critical role in working across interdisciplinary cancer teams and guiding patient care throughout the cancer continuum. Training for cancer patient navigators is needed to increase navigator capacity to improve health outcomes, especially given the current climate of provider shortages and high healthcare costs. OBJECTIVE The objective of the study was to evaluate the efficacy of the competency-based online Oncology Patient Navigator Training: The Fundamentals, designed by The George Washington University Cancer Center to increase confidence among participants in training learning objectives, which align with patient navigator competencies. METHODS We analyzed pre- and postlesson data from 671 learners who completed the training from 2015 to 2017 to assess changes in confidence across learning objectives. Questions were asked on a 5-point Likert scale (strongly disagree to strongly agree). We calculated summary statistics and compared pre- and postlesson scores using paired t tests. RESULTS Learners reported statistically significant (P <.001) improvements in confidence across all objectives, increasing from an average mean of 3.6 to 4.3. Learners who completed this training also reported high intention to implement new strategies/skills/information into practice (87.7%). DISCUSSION The Oncology Patient Navigator Training: The Fundamentals was found to be efficacious in improving participant confidence, and learners intended to apply their training in practice. Further research on how effectively the training prepares participants for certification and for ability to perform navigation duties in practice is warranted. CONCLUSION This fundamental training for patient navigators increased learners' confidence on competency-based learning objectives.
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Affiliation(s)
- Kanako Kashima
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
| | - Serena Phillips
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
| | - Allison Harvey
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
| | - Aubrey Van Kirk Villalobos
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC
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14
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Broder-Fingert S, Qin S, Goupil J, Rosenberg J, Augustyn M, Blum N, Bennett A, Weitzman C, Guevara JP, Fenick A, Silverstein M, Feinberg E. A mixed-methods process evaluation of Family Navigation implementation for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1288-1299. [PMID: 30404548 DOI: 10.1177/1362361318808460] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is growing interest in Family Navigation as an approach to improving access to care for children with autism spectrum disorder, yet little data exist on the implementation of Family Navigation. The aim of this study was to identify potential failures in implementing Family Navigation for children with autism spectrum disorder, using a failure modes and effects analysis. This mixed-methods study was set within a randomized controlled trial testing the effectiveness of Family Navigation in reducing the time from screening to diagnosis and treatment for autism spectrum disorder across three states. Using standard failure modes and effects analysis methodology, experts in Family Navigation for autism spectrum disorder (n = 9) rated potential failures in implementation on a 10-point scale in three categories: likelihood of the failure occurring, likelihood of not detecting the failure, and severity of failure. Ratings were then used to create a risk priority number for each failure. The failure modes and effects analysis detected five areas for potential "high priority" failures in implementation: (1) setting up community-based services, (2) initial family meeting, (3) training, (4) fidelity monitoring, and (5) attending testing appointments. Reasons for failure included families not receptive, scheduling, and insufficient training time. The process with the highest risk profile was "setting up community-based services." Failure in "attending testing appointment" was rated as the most severe potential failure. A number of potential failures in Family Navigation implementation-along with strategies for mitigation-were identified. These data can guide those working to implement Family Navigation for children with autism spectrum disorder.
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Affiliation(s)
| | - Sarah Qin
- 2 The Children's Hospital of Philadelphia, USA
| | | | | | | | | | | | | | | | | | | | - Emily Feinberg
- 1 Boston University School of Medicine, USA.,5 Boston University School of Public Health, USA
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15
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Karliner LS, Kaplan C, Livaudais-Toman J, Kerlikowske K. Mammography facilities serving vulnerable women have longer follow-up times. Health Serv Res 2018; 54 Suppl 1:226-233. [PMID: 30394526 PMCID: PMC6341204 DOI: 10.1111/1475-6773.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate mammography facilities’ follow‐up times, population vulnerability, system‐based processes, and association with cancer stage at diagnosis. Data Sources Prospectively collected from San Francisco Mammography Registry (SFMR) 2005‐2011, California Cancer Registry 2005‐2012, SFMR facility survey 2012. Study Design We examined time to biopsy for 17 750 abnormal mammogram results (BI‐RADS 4/5), categorizing eight facilities as short or long follow‐up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced‐stage (≥IIb) cancer diagnosis by facility follow‐up group. Data Extraction Methods Merged SFMR, Cancer Registry and facility survey data. Principal Findings Facilities (N = 4) with short follow‐up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow‐up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow‐up facilities. The long follow‐up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow‐up facility was associated with higher adjusted odds of advanced‐stage cancer (OR 1.45; 95% CI 1.10‐1.91). Conclusions Providing mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow‐up and cancer diagnosis stage.
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Affiliation(s)
- Leah S Karliner
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Celia Kaplan
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Jennifer Livaudais-Toman
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Karla Kerlikowske
- General Internal Medicine Section, San Francisco Veteran Affairs Medical Center, San Francisco, California.,Departments of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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16
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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: 12] [Impact Index Per Article: 2.0] [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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17
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Glassgow AE, Molina Y, Kim S, Campbell RT, Darnell J, Calhoun EA. A Comparison of Different Intensities of Patient Navigation After Abnormal Mammography. Health Promot Pract 2018; 20:914-921. [PMID: 29907079 DOI: 10.1177/1524839918782168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Patient navigation is a practice strategy to address barriers to timely diagnosis and treatment of cancer. The aim of this study was to examine the effectiveness of varying intensities of patient navigation and timely diagnostic resolution after abnormal mammography. Method. This is a secondary analysis of a subset of women with an abnormal screening or diagnostic mammogram who participated in the "patient navigation in medically underserved areas" 5-year randomized trial. We compared timely diagnostic resolution in women assigned to different intensities of patient navigation including, full navigation intervention, no contact with navigators, or limited contact with navigators. Results. The sample included 1,725 women with abnormal mammogram results. Women who interacted with patient navigators had significantly fewer days to diagnostic resolution after abnormal mammography compared with women who did not interact with patient navigators. Discussion. Results from our study suggest that even limited contact with navigators encourages women to seek more timely diagnostic resolution after an abnormal mammogram, which may offer a low-cost practice strategy to improve timely diagnosis for disadvantaged and underserved women.
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Affiliation(s)
| | | | - Sage Kim
- University of Illinois at Chicago, Chicago, IL, USA
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18
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Valverde PA, Calhoun E, Esparza A, Wells KJ, Risendal BC. The early dissemination of patient navigation interventions: results of a respondent-driven sample survey. Transl Behav Med 2018; 8:456-467. [PMID: 29800405 DOI: 10.1093/tbm/ibx080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Patient navigators (PNs) coordinate medical services and connect patients with resources to improve outcomes, satisfaction, and reduce costs. Little national information is available to inform workforce development. We analyzed 819 responses from an online PN survey conducted in 2009-2010. Study variables were mapped to the five Consolidated Framework for Implementation Research (CFIR) constructs to explore program variations by type of PN. Five logistic regression models compared each PN type to all others while adjusting for covariates. Thirty-five percent of respondents were nurse navigators, 28% lay navigators, 20% social work (SW)/counselor navigators, 7% allied health navigators, and 10% were "other" types of PNs. Most were non-Hispanic White (71%), female (94%), and at least college educated (70%). The primary differences were observed among: the core intervention tasks; position structure; work setting; health conditions navigated; navigator race/ethnicity; personal cancer experiences; navigation training; and patient populations served. Lay PNs had fewer odds of identifying as Hispanic, work in rural settings and assist underserved populations compared to others. Nurse navigators showed greater odds of clinical responsibilities, work in hospital or government settings and fewer odds of navigating minority populations compared to others. SW/counselor navigators also had additional duties, provided greater assistance to Medicare patient populations, and less odds of navigating underserved populations than others. In summary, our survey indicates that the type of PN utilized is an indicator of other substantial differences in program implementation. CFIR provides a robust method to compare differences and should incorporate care coordination outcomes in future PN research.
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Affiliation(s)
- Patricia A Valverde
- Department of Community and Behavioral Health, School of Public Health, Aurora, CO
| | - Elizabeth Calhoun
- University of Arizona, Office of the Senior Vice President for Health Sciences, Vice President for Population Health Sciences, Executive Director, Center for Population Science and Discovery, Roy P. Drachman Hall, Tucson, AZ
| | - Angelina Esparza
- Executive Staff Analyst/Chief Program Officer, Houston Department for Health and Human Services, Houston, TX
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO
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Abstract
OBJECTIVE Patient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred. SETTING AND PARTICIPANTS We used the Arksey and O'Malley scoping review method. Searches were conducted in MEDLINE, Embase, ProQuest Medical, other key databases and grey literature for studies reported in English from January 2000 to April 2016. We defined a patient navigator as a person or process creating a connection or link between a person needing primary care and a primary care provider. Our target population was people without a regular source of, affiliation or connection with primary care. Studies were included if they reported on participants who were connected to primary care by patient navigation and attended or made an appointment with a primary care provider. Data analysis involved descriptive numerical summaries and content analysis. RESULTS Twenty studies were included in the final scoping review. Most studies referred to 'patient navigator' or 'navigation' as the mechanism of connection to primary care. As such, we grouped the components according to Freeman's nine-principle framework of patient navigation. Seventeen studies included elements of patient-centred care: informed and involved patient, receptive and responsive health professionals and a coordinated, supportive healthcare environment. CONCLUSIONS Patient navigators may assist to connect people requiring primary care to appropriate providers and extend the concept of patient-centred care across different healthcare settings. Navigation requires further study to determine impact and cost-effectiveness and explore the experience of patients and their families.
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Affiliation(s)
- Annette Peart
- Southern Academic Primary Care Research Unit, Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Australia
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia
| | - Ted Brown
- Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Australia
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20
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Falk D. A Mixed Methods Review of Education and Patient Navigation Interventions to Increase Breast and Cervical Cancer Screening for Rural Women. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:173-186. [PMID: 29412063 DOI: 10.1080/19371918.2018.1434583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Reviews have assessed studies of breast and cervical cancer screening access and utilization for rural women, but none analyze interventions to increase screening rates. A mixed methods literature search identified studies of breast and/or cervical cancer prevention education and patient navigation interventions for rural women. Rural areas need greater implementation and evaluation of screening interventions as these services address the challenges of delivering patient-centered cancer care to un-/underserved communities. The lack of intervention studies on breast and cervical cancer education and patient navigation programs compared to urban studies highlights the need for validation of these programs among diverse, rural populations.
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Affiliation(s)
- Derek Falk
- a School of Social Work , The University of Texas at Austin , Austin , Texas USA
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21
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Duggleby W, Pesut B, Cottrell L, Friesen L, Sullivan K, Warner G. Development, Implementation, and Evaluation of a Curriculum to Prepare Volunteer Navigators to Support Older Persons Living With Serious Illness. Am J Hosp Palliat Care 2017; 35:780-787. [PMID: 29129107 DOI: 10.1177/1049909117740122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this article is to report the development, implementation, and evaluation of a curriculum designed to prepare volunteer navigators to support community-dwelling older persons with serious chronic illness. The role of the volunteer navigator was to facilitate independence and quality of life through building social connections, improving access to resources, and fostering engagement. A curriculum was constructed from evidence-based competencies, piloted and revised, and then implemented in 7 subsequent workshops. Workshop participants were 51 volunteers and health-care providers recruited through local hospice societies and health regions. Curriculum was evaluated through satisfaction and self-efficacy questionnaires completed at workshop conclusion. Postworkshop evaluation indicated a high degree of satisfaction with the training. One workshop cohort of 7 participants was followed for 1 year to provide longitudinal evaluation data. Participants followed longitudinally reported improved self-efficacy over 12 months and some challenges with role transition. Future improvements will include further structured learning opportunities offered by telephone postworkshop, focusing on advocacy, communication, and conflict management. Overall, volunteers were satisfied with the curriculum and reported good self-perceived efficacy in their new role as navigators.
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Affiliation(s)
- Wendy Duggleby
- 1 Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Barbara Pesut
- 2 Faculty of Health and Social Development, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Laura Cottrell
- 1 Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Lynnelle Friesen
- 3 School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Kelli Sullivan
- 3 School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Grace Warner
- 4 School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
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22
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Rocque GB, Williams CP, Jones MI, Kenzik KM, Williams GR, Azuero A, Jackson BE, Halilova KI, Meneses K, Taylor RA, Partridge E, Pisu M, Kvale EA. Healthcare utilization, Medicare spending, and sources of patient distress identified during implementation of a lay navigation program for older patients with breast cancer. Breast Cancer Res Treat 2017; 167:215-223. [DOI: 10.1007/s10549-017-4498-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/01/2017] [Indexed: 01/06/2023]
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Vanderpool RC, Nichols H, Hoffler EF, Swanberg JE. Cancer and Employment Issues: Perspectives from Cancer Patient Navigators. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:460-466. [PMID: 26627904 PMCID: PMC4889558 DOI: 10.1007/s13187-015-0956-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Among individuals diagnosed with cancer, 40 % are working-age adults who will face numerous challenges in returning to work, yet oncology providers report limited guidance and uncoordinated communication processes in addressing patients' work-related issues. Cancer patient navigators are uniquely positioned to fill this care and communication gap due to their focus on both practical matters and clinical care. This cross-sectional study utilized survey methodology to collect quantitative and qualitative data from 58 cancer patient navigators to (1) identify patients' cancer and employment issues that commonly challenge navigators and (2) identify the necessary training navigators felt would allow them to more effectively help patients deal with cancer and employment issues. Participants from the southeast USA were invited to complete a paper survey while in attendance at a statewide cancer patient navigator conference or online via the state comprehensive cancer coalition's cancer patient navigator listserv. Results suggest financial burdens, work and treatment conflicts, taking unpaid leave for cancer care, and working through treatment were common concerns among their patients. Navigators also identified employment, legal, government programs, and financial resources as important training and education topics that would help them address their clients' employment and cancer conflicts. Given the fact that employment issues remain one of the most common unmet need of survivors and the increasing presence of navigators across the USA, it is important to address the role of navigators in meeting patients' needs regarding cancer and employment and ensure they are provide with adequate training and resources.
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Affiliation(s)
- Robin C Vanderpool
- Department of Health Behavior, University of Kentucky College of Public Health, 2365 Harrodsburg Road, Suite A230, Lexington, KY, 40504, USA.
| | - Helen Nichols
- University of Maryland School of Social Work, Baltimore, MD, USA
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Creating a Novel Online Digital Badge-Awarding Program in Patient Navigation to Address Healthcare Access. J Nurses Prof Dev 2017; 33:106-112. [PMID: 28471991 DOI: 10.1097/nnd.0000000000000357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A novel, sustainable digital badge-awarding online course was developed to prepare learners with familiarity of patient navigation. Learners offered favorable endorsement of essentially all elements of the program, especially the utility of the Blackboard learning management software program. Quality Matters standards provided a rigorous framework for the challenges of designing, implementing, and evaluating online curricula. Online education is an effective method for meeting the professional development needs of those seeking careers in care coordination/patient navigation.
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Gunn CM, Parker VA, Bak SM, Ko N, Nelson KP, Battaglia TA. Social Network Structures of Breast Cancer Patients and the Contributing Role of Patient Navigators. Oncologist 2017; 22:918-924. [PMID: 28559408 DOI: 10.1634/theoncologist.2016-0440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/13/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Minority women in the U.S. continue to experience inferior breast cancer outcomes compared with white women, in part due to delays in care delivery. Emerging cancer care delivery models like patient navigation focus on social barriers, but evidence demonstrating how these models increase social capital is lacking. This pilot study describes the social networks of newly diagnosed breast cancer patients and explores the contributing role of patient navigators. MATERIALS AND METHODS Twenty-five women completed a one hour interview about their social networks related to cancer care support. Network metrics identified important structural attributes and influential individuals. Bivariate associations between network metrics, type of network, and whether the network included a navigator were measured. Secondary analyses explored associations between network structures and clinical outcomes. RESULTS We identified three types of networks: kin-based, role and/or affect-based, or heterogeneous. Network metrics did not vary significantly by network type. There was a low prevalence of navigators included in the support networks (25%). Network density scores were significantly higher in those networks without a navigator. Network metrics were not predictive of clinical outcomes in multivariate models. CONCLUSION Patient navigators were not frequently included in support networks, but provided distinctive types of support. If navigators can identify patients with poorly integrated (less dense) social networks, or who have unmet tangible support needs, the intensity of navigation services could be tailored. Services and systems that address gaps and variations in patient social networks should be explored for their potential to reduce cancer health disparities. IMPLICATIONS FOR PRACTICE This study used a new method to identify the breadth and strength of social support following a diagnosis of breast cancer, especially examining the role of patient navigators in providing support. While navigators were only included in one quarter of patient support networks, they did provide essential supports to some individuals. Health care providers and systems need to better understand the contributions of social supports both within and outside of health care to design and tailor interventions that seek to reduce health care disparities and improve cancer outcomes.
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Affiliation(s)
- Christine M Gunn
- Evans Department of Medicine, Women's Health Unit, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Victoria A Parker
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sharon M Bak
- Women's Health Unit Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Naomi Ko
- Department of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts, USA
| | - Kerrie P Nelson
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Tracy A Battaglia
- Department of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts, USA
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Abstract
BACKGROUND Patient navigation refers to a direct patient care role that links patients with clinical providers and their support system and provides individualized support during cancer care, ensuring that patients have access to the knowledge and resources necessary to complete recommended treatment. While most reports have studied the role of patient navigators during the cancer screening or diagnostic process, emerging evidence indicates the benefits of patient navigation during active cancer treatment. DISCUSSION Reports in the literature are conflicting on the impact of patient navigation during cancer care and on the benefits to timely or quality care in all populations. Recent sub-analyses of the Patient Navigation Research Program data demonstrated specifically the benefits of targeting patient navigation to the most vulnerable populations, including those with low educational attainment, low income and unstable housing, less social support, multiple comorbidities, and minority race/ethnicity. CONCLUSION The implications of the Patient Navigation Research Program are that this resource is best utilized when directed to support the care of patients at locations with known challenges to timely care and for specific patients with risk factors for delays in care, including comorbidities, low educational attainment and low income. Implementation of patient navigation programs requires the following processes: needs assessment, selection of a navigator to meet the community and care needs, supervision and integration of the navigator into clinical processes, and systems support to facilitate the identification and tracking of those patients requiring patient navigation. There is a need for ongoing research on methods to fund and sustain patient navigation programs.
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Affiliation(s)
- Karen M Freund
- a Institute of Clinical Research and Health Policy Studies, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine , Boston , Massachusetts , USA
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Rohan EA, Slotman B, DeGroff A, Morrissey KG, Murillo J, Schroy P. Refining the Patient Navigation Role in a Colorectal Cancer Screening Program: Results From an Intervention Study. J Natl Compr Canc Netw 2016; 14:1371-1378. [PMID: 27799508 DOI: 10.6004/jnccn.2016.0147] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/13/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Oncology patient navigators help individuals overcome barriers to increase access to cancer screening, diagnosis, and timely treatment. This study, part of a randomized intervention trial investigating the efficacy of patient navigation in increasing colonoscopy completion, examined navigators' activities to ameliorate barriers to colonoscopy screening in a medically disadvantaged population. METHODS This study was conducted from 2012 through 2014 at Boston Medical Center. We analyzed navigator service delivery and survey data collected on 420 participants who were navigated for colonoscopy screening after randomization to this intervention. Key variables under investigation included barriers to colonoscopy, activities navigators undertook to reduce barriers, time navigators spent on each activity and per contact, and patient satisfaction with navigation services. Descriptive analysis assessed how navigators spent their time and examined what aspects of patient navigation were most valued by patients. RESULTS Navigators spent the most time assessing patient barriers/needs; facilitating appointment scheduling; reminding patients of appointments; educating patients about colorectal cancer, the importance of screening, and the colonoscopy preparation and procedures; and arranging transportation. Navigators spent an average of 44 minutes per patient. Patients valued the navigators, especially for providing emotional/peer support and explaining screening procedures and bowel preparation clearly. CONCLUSIONS Our findings help clarify the role of the navigator in colonoscopy screening within a medically disadvantaged community. These findings may help further refine the navigator role in cancer screening and treatment programs as facilities strive to effectively and efficiently integrate navigation into their services.
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Affiliation(s)
- Elizabeth A Rohan
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Beth Slotman
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Amy DeGroff
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Kerry Grace Morrissey
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Jennifer Murillo
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Paul Schroy
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
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Simon MA, Samaras AT, Nonzee NJ, Hajjar N, Frankovich C, Bularzik C, Murphy K, Endress R, Tom LS, Dong X. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:27-33. [PMID: 27594792 PMCID: PMC5001622 DOI: 10.4137/cmwh.s39136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 12/02/2022]
Abstract
Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented.
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Affiliation(s)
- Melissa A Simon
- Associate Professor, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Athena T Samaras
- Research Assistant, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Narissa J Nonzee
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.; Clinical Research Associate, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nadia Hajjar
- Patient Navigator, DuPage Navigation Project, Access DuPage, Carol Stream, IL, USA
| | - Carmi Frankovich
- Patient Navigator, DuPage Navigation Project, Access DuPage, Carol Stream, IL, USA
| | - Charito Bularzik
- Patient Navigator, DuPage Navigation Project, Access DuPage, Carol Stream, IL, USA
| | - Kara Murphy
- Executive Director, Access DuPage, Carol Stream, IL, USA
| | - Richard Endress
- President, DuPage Health Coalition, Access DuPage, Carol Stream, IL, USA
| | - Laura S Tom
- Clinical Research Associate, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - XinQi Dong
- Professor, Department of Medicine, Rush Institute for Healthy Aging, Rush University, Chicago, IL, USA
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Mutchler MG, McDavitt B, Ghani MA, Nogg K, Winder TJ, Soto JK. Getting PrEPared for HIV Prevention Navigation: Young Black Gay Men Talk About HIV Prevention in the Biomedical Era. AIDS Patient Care STDS 2015; 29:490-502. [PMID: 26121564 DOI: 10.1089/apc.2015.0002] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), represent new opportunities to reduce critically high HIV infection rates among young black men who have sex with men (YBMSM). We report results of 24 dyadic qualitative interviews (N=48), conducted in Los Angeles, CA, exploring how YBMSM and their friends view PrEP and PEP. Interviews were analyzed using a grounded theory approach. Participants had widely divergent levels of knowledge about these prevention methods. Misconceptions and mistrust regarding PrEP were common, and concerns were expressed about PrEP-related stigma and the potential for gossip among peers who might assume a person on PrEP was HIV-positive. Yet participants also framed PrEP and PEP as valuable new options within an expanded "tool kit" of HIV prevention strategies that created possibilities for preventing new HIV infections, dating men with a different HIV status, and decreased anxiety about exposure to HIV. We organized themes around four main areas: (1) information and misinformation about biomedical HIV prevention; (2) expectations about PrEP, sexual behavior, and stigma; (3) gossip, disclosure, and "spreading the word" about PrEP and PEP; and (4) the roles of PrEP and PEP in an expanded HIV prevention tool kit. The findings suggest a need for guidance in navigating the increasingly complex array of HIV-prevention options available to YBMSM. Such "prevention navigation" could counter misconceptions and address barriers, such as stigma and mistrust, while helping YBMSM make informed selections from among expanded HIV prevention options.
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Affiliation(s)
- Matt G. Mutchler
- Department of Sociology, California State University, Dominguez Hills, Carson, California
- AIDS Project Los Angeles, Community Based Research Program, Los Angeles, California
| | - Bryce McDavitt
- Department of Sociology, California State University, Dominguez Hills, Carson, California
- AIDS Project Los Angeles, Community Based Research Program, Los Angeles, California
| | - Mansur A. Ghani
- AIDS Project Los Angeles, Community Based Research Program, Los Angeles, California
| | - Kelsey Nogg
- AIDS Project Los Angeles, Community Based Research Program, Los Angeles, California
| | - Terrell J.A. Winder
- Department of Sociology, University of California Los Angeles, Los Angeles, California
| | - Juliana K. Soto
- Department of Sociology, California State University, Dominguez Hills, Carson, California
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