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Dignan M, Dwyer S, Cromo M, Geertz M, Bardhan R, Stockton E. Development and Evaluation of Patient Navigation Training for Rural and Appalachian Populations. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1077-1083. [PMID: 36396832 DOI: 10.1007/s13187-022-02234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 06/02/2023]
Abstract
The Appalachian region of the USA includes 423 counties in 13 states positioned along the spine of the Appalachian Mountains stretching from New York to Mississippi. Approximately 42% of Appalachia is rural, and while the economy of Appalachia has diversified over the past two decades from reliance on agriculture and coal mining, 176 (41.6%) of the 423 counties are classified as economically distressed or at-risk. Patient navigation (PN) has been shown to be effective as an approach to address multiple barriers and enhance access to healthcare services, and yet there are no known PN programs focusing on the Appalachian population. This project was designed to develop, implement, and evaluate a curriculum and training program for PN for cancer prevention and control in Appalachia. The training program was developed through formative evaluation and offered daylong workshops that provided instruction in 60-90-min modules. Workshop topics included an introduction to PN, Appalachian culture, community needs assessment, communication, financial navigation, and navigation for screening and diagnostic follow-up for breast, cervical, and colorectal cancers. A total of 20 workshops were conducted with 334 attendees. The workshops were evaluated using a mixed-method approach using pre- and posttests and participant evaluations. The overall mean posttest scores increased by 4% from pretest (p < 0.05). Evaluation also showed that attendees valued the focus on Appalachian culture and judged the content relevant and useful. Attendees also expressed interest in additional opportunities for similar workshops that expanded upon current topics and allowed for exploration of Appalachian health-related issues.
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Affiliation(s)
- Mark Dignan
- College of Medicine, Prevention Research Center, University of Kentucky, 760 Press Avenue, Room 335, Lexington, KY, 40536-0679, USA.
| | - Sharon Dwyer
- College of Medicine, Prevention Research Center, University of Kentucky, 760 Press Avenue, Room 335, Lexington, KY, 40536-0679, USA
| | - Mark Cromo
- College of Medicine, Prevention Research Center, University of Kentucky, 760 Press Avenue, Room 335, Lexington, KY, 40536-0679, USA
| | - Margaret Geertz
- Kentucky College of Osteopathic Medicine, Pikeville, KY, USA
| | | | - Eric Stockton
- Grantmakers in Health, (Formerly Appalachian Regional Commission, Washington, DC, USA), Washington, DC, USA
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Palmer NR, Smith AN, Campbell BA, Andemeskel G, Tahir P, Felder TM, Cicerelli B. Navigation programs relevant for African American men with prostate cancer: a scoping review protocol. Syst Rev 2022; 11:122. [PMID: 35701771 PMCID: PMC9195379 DOI: 10.1186/s13643-022-01993-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The excess incidence and mortality due to prostate cancer that impacts African American men constitutes the largest of all cancer disparities. Patient navigation is a patient-centered healthcare system intervention to eliminate barriers to timely, high-quality care across the cancer continuum and improves health outcomes among vulnerable patients. However, little is known regarding the extent to which navigation programs include cultural humility to address prostate cancer disparities among African American men. We present a scoping review protocol of an in-depth examination of navigation programs in prostate cancer care-including navigation activities/procedures, training, and management-with a special focus on cultural context and humility for African American men to achieve health equity. METHODS We will conduct comprehensive searches of the literature in PubMed, Embase, Web of Science, and CINAHL Complete, using keywords and index terms (Mesh and Emtree) within the three main themes: prostate cancer, patient navigation, and African American men. We will also conduct a search of the gray literature, hand-searching, and reviewing references of included papers and conference abstracts. In a two-phase approach, two authors will independently screen titles and abstracts, and full-text based on inclusion/exclusion criteria. All study designs will be included that present detailed data about the elements of navigation programs, including intervention content, navigator training, and/or management. Data will be extracted from included studies, and review findings will be synthesized and summarized. DISCUSSION A scoping review focused on cultural humility in patient navigation within the context of eliminating disparities in PCa care among African American men does not yet exist. This review will synthesize existing evidence of patient navigation programs for African American prostate cancer patients and the inclusion of cultural humility. Results will inform the development and implementation of future programs to meet the unique needs of vulnerable prostate cancer patients in safety net settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2021 CRD42021221412.
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Affiliation(s)
- Nynikka R. Palmer
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, UCSF mailbox 1364, San Francisco, CA 94143 USA
| | - Ashley Nicole Smith
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, UCSF mailbox 1364, San Francisco, CA 94143 USA
| | - Brittany A. Campbell
- University of California San Francisco, 1450 3rd Street, San Francisco, CA 94143 USA
| | | | - Peggy Tahir
- UCSF Library, University of California San Francisco, 530 Parnassus Ave, San Francisco, CA 94143 USA
| | - Tisha M. Felder
- College of Nursing, University of South Carolina, 1601 Greene Street, Room 620, Columbia, SC 29208 USA
| | - Barbara Cicerelli
- Zuckerberg San Francisco General Hospital, 995 Potrero Ave, Building 80, Room 8000N Lower Level, San Francisco, CA 94110 USA
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Kokorelias KM, Shiers-Hanley JE, Rios J, Knoepfli A, Hitzig SL. Factors Influencing the Implementation of Patient Navigation Programs for Adults with Complex Needs: A Scoping Review of the Literature. Health Serv Insights 2021; 14:11786329211033267. [PMID: 34349519 PMCID: PMC8287353 DOI: 10.1177/11786329211033267] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Patient navigation is a model of care that aims to improve access to care by reducing the complexity of navigating health, education, and social services across the continuum of care and care settings. Little is known about the processes that facilitate or impede the implementation of patient navigation programs (PNPs). We conducted a scoping review to identify and summarize the current state of knowledge regarding the implementation and outcomes of existing implemented PNPs. We employed a 6-stage scoping review framework to identify and review eligible articles. Sixty-articles met the inclusion criteria (58 peer-reviewed and 2 grey literature). The Consolidated Framework for Implementation Research served as the theoretical framework during analysis to help extract factors relevant to implementation of navigator programs. Results of the scoping review are reported thematically. Influences on implementation were identified: (a) planning to ensure alignment with organizational need (b) funding (c) multidisciplinary engagement (d) establishing workflow (e) mechanisms for communication (f) stakeholders to encourage buy-in (g) appropriate caseload (h) in kind resources. PNPs improve the experiences of patients and families. The findings of this scoping review provides implementation considerations of PNPs across global care settings. Strategies for overcoming pragmatic and logistical issues must be developed for optimal implementation.
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Affiliation(s)
- Kristina M Kokorelias
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Jessica E Shiers-Hanley
- Hazel McCallion Academic Learning
Centre, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
| | - Jorge Rios
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Amanda Knoepfli
- Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
- SPRINT Senior Care, Toronto, ON,
Canada
| | - Sander L Hitzig
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
- Rehabilitation Sciences Institute,
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Pannell SC, Laviana AA, Huen KH, Shelton JB, Kwan L, Bennett CJ, Lorenz KA, Bergman J. Advance Care Planning and Patient Preferences in a Feasibility Pilot Study to Improve End-of-Life Communication among Men with Metastatic Urological Malignancies. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Stephanie C. Pannell
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Aaron A. Laviana
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kathy H.Y. Huen
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeremy B. Shelton
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Carol J. Bennett
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Karl A. Lorenz
- Stanford University School of Medicine, Palo Alto, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Olive View-UCLA Medical Center, Sylmar, California
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Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions. J Addict Med 2018; 12:262-272. [DOI: 10.1097/adm.0000000000000410] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cobran EK, Merino Y, Roach B, Bigelow SM, Godley PA. The Independent Specialty Medical Advocate Model of Patient Navigation and Intermediate Health Outcomes in Newly Diagnosed Cancer Patients. JOURNAL OF ONCOLOGY NAVIGATION & SURVIVORSHIP 2017; 8:454-462. [PMID: 29796340 PMCID: PMC5963700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Navigation programs are generally characterized as providing patient-centered support and guidance intended to help patients and family members overcome barriers such as timely diagnosis resolution, patient satisfaction, coping with primary and adjuvant treatment, management of side effects, and patient engagement in the healthcare process. The aim of this study was to examine the associations between the Independent Specialty Medical Advocate (ISMA) model of patient navigation and intermediate patient health outcomes for newly diagnosed cancer patients. METHODS A pre-post intervention study was conducted in 26 newly diagnosed cancer patients recruited from a national partnership between the LIVESTRONG Cancer Navigation Service Program and the NavigateCancer Foundation between April 2013 and December 2015. Participants received a 1-hour initial telephone consultation, and then a navigation care plan was developed for the 6-week study period. A paired t test was conducted to assess changes in intermediate health outcomes at baseline and 6 weeks after study intervention. RESULTS The majority of study participants were males (62%), married (50%), and Caucasian (69%). Overall, there was a statistically significant reduction in anxiety at 6 weeks postintervention (mean, 2.48; SD, 0.62; P <.05) compared with baseline (mean, 2.92; SD, 0.82) and in depression at 6 weeks postintervention (mean, 2.00; SD, 0.81; P <.05) compared with baseline (mean, 2.45; SD, 0.19). CONCLUSION The ISMA model of patient navigation appears to be associated with significant reduction in anxiety and depression. Further studies are needed to evaluate the ISMA model of patient navigation on long-term patient outcomes.
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Affiliation(s)
- Ewan K Cobran
- University of Georgia, College of Pharmacy, Department of Pharmaceutical Health Services, Outcomes, and Policy, Athens, GA
| | - Yesenia Merino
- University of North Carolina at Chapel Hill, Gillings School of Public Health, Department of Health Behavior, Chapel Hill, NC
| | | | | | - Paul A Godley
- Lineberger Comprehensive Cancer Center and the Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Henry JA, Thielman EJ, Zaugg TL, Kaelin C, Schmidt CJ, Griest S, McMillan GP, Myers P, Rivera I, Baldwin R, Carlson K. Randomized Controlled Trial in Clinical Settings to Evaluate Effectiveness of Coping Skills Education Used With Progressive Tinnitus Management. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1378-1397. [PMID: 28418492 DOI: 10.1044/2016_jslhr-h-16-0126] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/07/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE This randomized controlled trial evaluated, within clinical settings, the effectiveness of coping skills education that is provided with progressive tinnitus management (PTM). METHOD At 2 Veterans Affairs medical centers, N = 300 veterans were randomized to either PTM intervention or 6-month wait-list control. The PTM intervention involved 5 group workshops: 2 led by an audiologist (teaching how to use sound as therapy) and 3 by a psychologist (teaching coping skills derived from cognitive behavioral therapy). It was hypothesized that PTM would be more effective than wait-list control in reducing functional effects of tinnitus and that there would be no differences in effectiveness between sites. RESULTS At both sites, a statistically significant improvement in mean Tinnitus Functional Index scores was seen at 6 months for the PTM group. Combined data across sites revealed a statistically significant improvement in Tinnitus Functional Index relative to wait-list control. The effect size for PTM using the Tinnitus Functional Index was 0.36 (small). CONCLUSIONS Results suggest that PTM is effective at reducing tinnitus-related functional distress in clinical settings. Although effect sizes were small, they provide evidence of clinical effectiveness of PTM in the absence of stringent research-related inclusion criteria and with a relatively small number of sessions of cognitive behavioral therapy.
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Affiliation(s)
- James A Henry
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, ORDepartment of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Emily J Thielman
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
| | - Tara L Zaugg
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
| | - Christine Kaelin
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
| | - Caroline J Schmidt
- Psychology Service and Audiology Service, Veterans Affairs Connecticut Healthcare System, West HavenDepartment of Psychiatry, Yale University, New Haven, CT
| | - Susan Griest
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, ORDepartment of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Garnett P McMillan
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
| | - Paula Myers
- Department of Audiology, James A. Haley Veterans Hospital, Tampa, FL
| | - Izel Rivera
- Harry S. Truman Memorial Veterans' Hospital, Columbia, MO
| | | | - Kathleen Carlson
- Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, ORVeterans Affairs Health Services Research and Development Center of Innovation, Veterans Affairs Portland Health Care System, ORSchool of Public Health, Oregon Health & Science University, Portland
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Nix AT, Huber JT, Shapiro RM, Pfeifle A. Examining care navigation: librarian participation in a team-based approach? J Med Libr Assoc 2017; 104:131-7. [PMID: 27076800 DOI: 10.3163/1536-5050.104.2.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study investigated responsibilities, skill sets, degrees, and certifications required of health care navigators in order to identify areas of potential overlap with health sciences librarianship. METHOD The authors conducted a content analysis of health care navigator position announcements and developed and assigned forty-eight category terms to represent the sample's responsibilities and skill sets. RESULTS Coordination of patient care and a bachelor's degree were the most common responsibility and degree requirements, respectively. Results also suggest that managing and providing health information resources is an area of overlap between health care navigators and health sciences librarians, and that librarians are well suited to serve on navigation teams. CONCLUSION Such overlap may provide an avenue for collaboration between navigators and health sciences librarians.
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de la Riva EE, Hajjar N, Tom LS, Phillips S, Dong X, Simon MA. Providers' Views on a Community-Wide Patient Navigation Program: Implications for Dissemination and Future Implementation. Health Promot Pract 2016; 17:382-90. [PMID: 27009130 PMCID: PMC5600160 DOI: 10.1177/1524839916628865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The DuPage Patient Navigation Collaborative (DPNC) adapted and scaled the Patient Navigation Research Program's intervention model to navigate uninsured suburban DuPage County women with an abnormal breast or cervical cancer screening result. Recent findings reveal the effectiveness of the DPNC in addressing patient risk factors for delayed follow-up, but gaps remain as patient measures may not adequately capture navigator impact. Using semistructured interviews with 19 DPNC providers (representing the county health department, clinics, advocacy organizations, and academic partners), this study explores the critical roles of the DPNC in strengthening community partnerships and enhancing clinical services. Findings from these provider interviews revealed that a wide range of resources existed within DuPage but were often underused. Providers indicated that the DPNC was instrumental in fostering community partnerships and that navigators enhanced the referral processes, communications, and service delivery among clinical teams. Providers also recommended expanding navigation to mental health, women's health, and for a variety of chronic conditions. Considering that many in the United States have recently gained access to the health care system, clinical teams might benefit by incorporating navigators who serve a dual working purpose embedded in the community and clinics to enhance the service delivery for vulnerable populations.
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Affiliation(s)
| | | | - Laura S Tom
- Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Sara Phillips
- Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - XinQi Dong
- Rush University Medical Center, Chicago, IL, USA
| | - Melissa A Simon
- Northwestern University-Feinberg School of Medicine, Chicago, IL, USA Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
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Pockett R, Dzidowska M, Hobbs K. Social Work Intervention Research With Adult Cancer Patients: A Literature Review and Reflection on Knowledge-Building for Practice. SOCIAL WORK IN HEALTH CARE 2015; 54:582-614. [PMID: 26317763 DOI: 10.1080/00981389.2015.1046577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The results of a literature review of social work intervention research with adult cancer patients found only a small number of studies conducted by social work researchers. The findings of the review are presented followed by a reflective discussion on the nature of knowledge-building and research knowledge for practice. Knowledge building is considered as a continuous, negotiated process within communities of practice focused on psychosocial perspectives that draw on a range of knowledge sources. Epistemology, worldviews and research orientations are considered along with the values and stance of social work, all of which create the domain of the practice-researcher.
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Affiliation(s)
- Rosalie Pockett
- a Social Work & Policy Studies, Faculty of Education and Social Work , University of Sydney , Sydney , NSW , Australia
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Bergman J, Ballon-Landa E, Lorenz KA, Saucedo J, Saigal CS, Bennett CJ, Litwin MS. Community-Partnered Collaboration to Build an Integrated Palliative Care Clinic. Am J Hosp Palliat Care 2014; 33:164-70. [DOI: 10.1177/1049909114555156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: We partnered with patients, families, and palliative care clinicians to develop an integrated urology–palliative care clinic for patients with metastatic cancer. We assessed clinician satisfaction with a multidisciplinary palliative care clinic model. Methods: We conducted semi-structured interviews with 18 clinicians who practice in our integrated clinic. We analyzed transcripts using a multistage, cutting-and-sorting technique in an inductive approach based on grounded theory analysis. Finally, we administered a validated physician job satisfaction survey. Results: Clinicians found that referring a patient to palliative care in the urology clinic was feasible and appropriate. Patients were receptive to supportive care, and clinicians perceived that quality of care improved following the intervention. Conclusion: An integrated, patient-centered model for individuals with advanced urologic malignancies is feasible and well received by practitioners.
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Affiliation(s)
- Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Eric Ballon-Landa
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- UC Irvine School of Medicine, Irvine, CA, USA
| | - Karl A. Lorenz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Josemanuel Saucedo
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christopher S. Saigal
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Carol J. Bennett
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Mark S. Litwin
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Simon MA, Nonzee NJ, McKoy JM, Liu D, Luu TH, Byer P, Eklund EA, Richey EA, Wu Z, Dong X, Rademaker AW. Navigating veterans with an abnormal prostate cancer screening test: a quasi-experimental study. BMC Health Serv Res 2013; 13:314. [PMID: 23947435 PMCID: PMC3844412 DOI: 10.1186/1472-6963-13-314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/03/2013] [Indexed: 12/12/2022] Open
Abstract
Background Prostate cancer disproportionately affects low-income and minority men. This study evaluates the impact of a patient navigation intervention on timeliness of diagnostic resolution and treatment initiation among veterans with an abnormal prostate cancer screen. Methods Participants were enrolled between 2006 and 2010. The intervention involved a social worker and lay health worker navigation team that assisted patients in overcoming barriers to care. For navigated (n = 245) versus control (n = 245) participants, we evaluated rates of diagnostic resolution and treatment and adjusted for race, age, and Gleason score. Results Of 490 participants, 68% were African American, 47% were ≥ 65 years old, and 35% had cancer. Among those with an abnormal screen, navigation did not have a significant effect on time to diagnostic resolution compared to controls (median days of 97 versus 111; adj. HR 1.17, 95% CI, 0.96-1.43, p = 0.12). On analysis of the period beyond 80 days, navigated men reached resolution faster than controls (median of 151 days versus 190 days; adj. HR 1.41, 95% CI, 1.07-1.86, p = 0.01). Among those with cancer, navigation did not have a significant effect on time to treatment initiation compared to controls (median of 93 days versus 87 days; adj. HR 1.15, 95% CI, 0.82-1.62, p = 0.41). Conclusion Our navigation program did not significantly impact the overall time to resolution or treatment for men with prostate cancer compared to controls. The utility of navigation programs may extend beyond targeted navigation times, however, and future studies focusing on other outcomes measures are therefore needed.
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Affiliation(s)
- Melissa A Simon
- Robert H, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
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Andrews CM, Darnell JS, McBride TD, Gehlert S. Social work and implementation of the Affordable Care Act. HEALTH & SOCIAL WORK 2013; 38:67-71. [PMID: 23865284 DOI: 10.1093/hsw/hlt002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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