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Morenz AM, Bender J, Hairston B, Starks H, Jackson S. "Advocates for Each Other": The creation and evaluation of a pragmatic peer navigation program for black patients in primary care with uncontrolled hypertension. PATIENT EDUCATION AND COUNSELING 2024; 125:108315. [PMID: 38723337 PMCID: PMC11146043 DOI: 10.1016/j.pec.2024.108315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Black individuals in the U.S. and in our primary care clinic experience worse control of blood pressure compared to White individuals. OBJECTIVE To address this inequity, our objectives were to (1) elicit from patients and community members their ideas for barriers and facilitators to blood pressure control; and (2) use their input to design and pilot a navigator program for Black patients in our clinic to improve blood pressure management. PATIENT INVOLVEMENT We conducted three focus groups with 27 individuals and identified two main areas of need that informed the peer navigator program: (1) community-based services and (2) skill development for hypertension self-management. METHODS Peer navigators from the Black community called participants at least monthly for 6-12 months and connected them with medical and social services. Available blood pressure data was used as the primary outcome to measure change pre- to post-peer navigation program. RESULTS Among 499 eligible patients in the clinic, 53 (10.6%) enrolled in the peer navigation program. For those with baseline and follow-up blood pressure data, mean systolic blood pressure decreased from 155.9 to 142.4 mmHg after the program (change of -13.6, 95% CI -24.7 to -2.4) for the enrolled patients (N = 17) and from 139.1 to 137.1 mmHg (change of -2.5, -4.8 to 1.9) for unenrolled, comparison patients (N = 183). DISCUSSION This community-informed peer navigation program to support Black patients with uncontrolled hypertension led to a 11.1 mmHg greater decrease in average systolic blood pressure for enrolled patients compared to the comparison group. However, the enrolled group started with a significantly higher systolic blood pressure at baseline with more room for improvement. While this study was conducted during the pandemic years, low uptake of this program needs to be addressed in expansion efforts. PRACTICAL VALUE Clinic-based peer navigation for hypertension improved blood pressure control and was highly regarded by the subset of enrolled patients. Increasing uptake and sustainable funding for non-billable clinic roles remain areas of need. FUNDING Grant from the Pacific Hospital Preservation & Development Authority.
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Affiliation(s)
- Anna M Morenz
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Jessica Bender
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Helene Starks
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Sara Jackson
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Santos Salas A, LeGuerrier B, Horvath L, Bassah N, Adewale B, Bardales O, Duggleby W, Salami B, Watanabe SM. The impact of socioeconomic inequality on access to health care for patients with advanced cancer: A qualitative study. Asia Pac J Oncol Nurs 2024; 11:100520. [PMID: 39027088 PMCID: PMC11255108 DOI: 10.1016/j.apjon.2024.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/17/2024] [Indexed: 07/20/2024] Open
Abstract
Objective In Canada, populations experiencing socioeconomic inequality have lower rates of access to screening and diagnosis and higher mortality rates than people from higher-income areas. Limited evidence exists concerning their experiences when living with advanced cancer. We explored how socioeconomic inequality shapes the experiences of patients with advanced cancer. Methods We utilized a qualitative study design that combined tenets of hermeneutic phenomenological inquiry and critical theory. Four individuals with advanced cancer from low-income neighborhoods, three family members, and six cancer care providers were accrued through a tertiary cancer center in a western Canadian city. One-on-one interviews and brief notes were used for data collection. Data were analyzed through thematic analysis. Results Three interrelated themes were identified: 'Lack of access to socioeconomic supports,' 'Gaps in access to health care resources and services,' and 'Limited access to symptom relief.' Patients experienced inadequate finances, housing, and transportation. Most patients lived alone and had limited family and social support. Patients reported lack of knowledge of available resources and health system navigation issues, including communication problems with providers and among levels of care. Cancer care providers and patients described issues achieving symptom relief as well as challenges associated with extensive disease. Conclusions Study findings suggest that socioeconomic inequality interferes with the ability of persons with advanced cancer to access health care and contributes to less optimal cancer outcomes. Socioeconomic inequality may increase symptom severity. Findings call for the development of tailored interventions for populations with advanced cancer and socioeconomic inequality.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bronwen LeGuerrier
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lucas Horvath
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nahyeni Bassah
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bisi Adewale
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Olga Bardales
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Duggleby
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bukola Salami
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon M. Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Coronado-Vázquez MDV, Gómez-Trenado R, Benito-Sánchez B, Barrio-Cortes J, Gil-Salmerón A, Amengual-Pliego M, Grabovac I. Cancer prevention in people experiencing homelessness: ethical considerations and experiences from the CANCERLESS project. Front Public Health 2024; 12:1371505. [PMID: 38655508 PMCID: PMC11036339 DOI: 10.3389/fpubh.2024.1371505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
The incidence of cancer in Europe has been increasing in recent years. Despite this, cancer prevention has remained a low priority in health policies. Cancer is one of the main causes of mortality among people experiencing homelessness, who continue to have difficulties accessing prevention programs. A strategy that has been tested to favor cancer prevention is the health navigator figure. The objective of CANCERLESS project is to implement this model among populations experiencing homelessness in four European countries to foster the prevention and early detection of cancer. In this perspective, a presentation of CANCERLESS project is made, and its ethical aspects are discussed according to the ethics of public health, the ethics of care, solidarity, relational autonomy, and the social recognition of the virtue of just generosity. The ethical foundations of CANCERLESS project are rooted in social justice and in equity in access to health systems in general and cancer screening programs in particular. The ethics of public health guided by utilitarianism are insufficient in serving the interests of the most disadvantaged groups of the population. Hence, it is necessary to resort to relational bioethics that includes the ethics of care and solidarity and that recognizes the moral identity of socially excluded persons, reaffirming their position of equality in society. Relational autonomy therefore provides a broader conception by including the influence of living conditions in decisions. For this reason, the CANCERLESS project opts for a dialogue with those affected to incorporate their preferences and values into decisions about cancer prevention.
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Affiliation(s)
- María del Valle Coronado-Vázquez
- Healthcare Center Las Cortes, Gerencia 1 Healthcare Center Las Cortes, Gerencia Asistencial de Atención Primaria, Madrid, Spain
- Facultad de Medicina, Francisco de Vitoria University, Madrid, Spain
- B21-20R Group, Instituto Aragonés de Investigaciones Sanitarias, Universidad de Zaragoza, Zaragoza, Spain
| | - Rosa Gómez-Trenado
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain
- Health Work Department, Complutense University of Madrid, Madrid, Spain
| | - Beatriz Benito-Sánchez
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain
| | - Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain
- Faculty of Health, Camilo José Cela University, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain
| | - Alejandro Gil-Salmerón
- International Foundation for Integrated Care, Oxford, United Kingdom
- International University of Valencia, Valencia, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Miguel Amengual-Pliego
- B21-20R Group, Instituto Aragonés de Investigaciones Sanitarias, Universidad de Zaragoza, Zaragoza, Spain
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
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Santos Salas A, Watanabe SM, Sinnarajah A, Bassah N, Huang F, Turner J, Alcalde Castro J, O'Rourke HM, Camargo-Plazas P, Salami B, Santana M, Campbell K, Abdel-Rahman O, Wildeman T, Vaughn L, Judge H, Ahmed S, Adewale B, Iyiola I. Increasing access to palliative care for patients with advanced cancer of African and Latin American descent: a patient-oriented community-based study protocol. BMC Palliat Care 2023; 22:204. [PMID: 38115105 PMCID: PMC10731745 DOI: 10.1186/s12904-023-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Cancer disparities are a major public health concern in Canada, affecting racialized communities of Latin American and African descent, among others. This is evident in lower screening rates, lower access to curative, and palliative-intent treatments, higher rates of late cancer diagnoses and lower survival rates than the general Canadian population. We will develop an Access to Palliative Care Strategy informed by health equity and patient-oriented research principles to accelerate care improvements for patients with advanced cancer of African and Latin American descent. METHODS This is a community-based participatory research study that will take place in two Canadian provinces. Patients and community members representatives have been engaged as partners in the planning and design of the study. We have formed a patient advisory council (PAC) with patient partners to guide the development of the Access to Palliative Care Strategy for people of African and Latin American descent. We will engage100 participants consisting of advanced cancer patients, families, and community members of African and Latin American descent, and health care providers. We will conduct in-depth interviews to delineate participants' experiences of access to palliative care. We will explore the intersections of race, gender, socioeconomic status, language barriers, and other social categorizations to elucidate their role in diverse access experiences. These findings will inform the development of an action plan to increase access to palliative care that is tailored to our study population. We will then organize conversation series to examine together with community partners and healthcare providers the appropriateness, effectiveness, risks, requirements, and convenience of the strategy. At the end of the study, we will hold knowledge exchange gatherings to share findings with the community. DISCUSSION This study will improve our understanding of how patients with advanced cancer from racialized communities in Canada access palliative care. Elements to address gaps in access to palliative care and reduce inequities in these communities will be identified. Based on the study findings a strategy to increase access to palliative care for this population will be developed. This study will inform ways to improve access to palliative care for racialized communities in other parts of Canada and globally.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Sharon M Watanabe
- Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 11560 University Avenue Edmonton, Alberta, T6G 1Z2, Canada
| | - Aynharan Sinnarajah
- Department of Medicine, Queen's University, 34 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Nahyeni Bassah
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Fleur Huang
- Division of Radiation Oncology, Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Jill Turner
- Supportive Care Team Cross Cancer Institute and Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Jacqueline Alcalde Castro
- Department of Psychosocial Oncology and Supportive Care, Princess Margaret Cancer Centre , Department of Medicine, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Hannah M O'Rourke
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | | | - Bukola Salami
- Cumming School of Medicine, University of Calgary Foothills Campus, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - María Santana
- Cumming School of Medicine, University of Calgary Foothills Campus, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Patient Engagement Team, Alberta SPOR SUPPORT Unit, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Katy Campbell
- Department of Women and Gender Studies, Faculty of Arts, College of Social Sciences and Humanities, 3-51 Assiniboia Hall, Edmonton, AB, T6G 2E7, Canada
| | - Omar Abdel-Rahman
- Medical Oncology Cross Cancer Institute and Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Tracy Wildeman
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Lisa Vaughn
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Harkeert Judge
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Sadia Ahmed
- Patient Engagement Team, Alberta SPOR SUPPORT Unit, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Bisi Adewale
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Iqmat Iyiola
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Nguyen OT, McCormick R, Patel K, Reblin M, Kim L, Hume E, Powers B, Otto A, Alishahi Tabriz A, Islam J, Hong Y, Kirchhoff AC, Turner K. Health insurance literacy among head and neck cancer patients and their caregivers: A cross-sectional pilot study. Laryngoscope Investig Otolaryngol 2022; 7:1820-1829. [PMID: 36544972 PMCID: PMC9764792 DOI: 10.1002/lio2.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Health insurance literacy interventions may reduce financial burden and its effects on cancer patients and their caregivers. However, little is known about the health insurance literacy levels of head and neck cancer (HNC) patients and their caregivers. We assessed the feasibility of screening for health insurance literacy in a pilot study and described the health insurance literacy levels of HNC patients and their caregivers. Methods We administered a survey that assessed demographics and subjective and objective health insurance literacy to HNC patients and their caregivers. Subjective health insurance literacy was measured through the Health Insurance Literacy Measure (score range: 0-84). Objective health insurance literacy was measured through correct answers to a previously developed 10-question knowledge test. Due to a small sample size, inferential statistics were not used; we instead descriptively reported findings. Results The pilot included 48 HNC patients and 13 caregivers. About 44.4% of patients and 30.8% of caregivers demonstrated low health insurance literacy (HILM ≤60). On the 10-item knowledge test, patients had an average of 6.8 (SD: 2.3) correct responses and caregivers had 7.8 (SD: 1.1) correct responses. Calculating out-of-pocket costs for out-of-network services was challenging; only 9.5% of patients and 0% of caregivers answered correctly. Conclusion Additional outreach strategies may be needed to supplement screening for health insurance literacy. Areas of focus for interventions include improving understanding of how to calculate financial responsibility for health care services and filing an appeal for health insurance claim denial. Level of Evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | | | - Krupal Patel
- Department of Head and Neck OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Maija Reblin
- Department of Family MedicineUniversity of VermontBurlingtonVermontUSA,Cancer Control & Population Health Sciences ProgramUniversity of Vermont Cancer CenterBurlingtonVermontUSA
| | - Lindsay Kim
- College of Medicine, University of South FloridaTampaFloridaUSA
| | - Emma Hume
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Benjamin Powers
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Amy Otto
- Department of Public Health SciencesUniversity of MiamiCoral GablesFloridaUSA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
| | - Jessica Islam
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Young‐Rock Hong
- Department of Health Services Research and ManagementUniversity of Florida College of Public Health and Health ProfessionsGainesvilleFloridaUSA
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences Research Program Huntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA,Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Kea Turner
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
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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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Feasibility of Patient Navigation-Based Smoking Cessation Program in Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074034. [PMID: 35409717 PMCID: PMC8998497 DOI: 10.3390/ijerph19074034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/26/2022] [Indexed: 12/04/2022]
Abstract
Continued smoking after a cancer diagnosis is causally associated with increased risks of all-cause and cancer-specific mortality, and of smoking-related second primary cancers. Patient navigation provides individualized assistance to address barriers to smoking cessation treatment and represents a promising bridge to smoking cessation in persons with cancer who smoke cigarettes. We conducted a single-arm interventional cohort study of current smokers identified through prospective health record screening and recruited from Penn State Cancer Institute outpatient clinics. Consented participants received two telephone intervention sessions and gain-framed messaging-based smoking cessation educational materials designed for persons with cancer. The primary study outcome was the feasibility of the patient navigation-based intervention; the secondary outcome was the engagement in smoking cessation treatment at the two-month follow-up. Of 1168 unique screened Cancer Institute patients, 134 (11.5%) were identified as current cigarette smokers. Among 67 patients approached at outpatient clinics, 24 (35.8%) were interested in participating, 12 (17.9%) were enrolled, eight (11.9%) completed the intervention sessions and study assessments, and six engaged in smoking cessation treatment. The participants expressed satisfaction with the intervention sessions (median = 8.5, scale 0–10). The low recruitment rates preclude patient navigation as a feasible method for connecting cancer patients to smoking cessation treatment resources.
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Dixit N, Sarkar U, Trejo E, Couey P, Rivadeneira NA, Ciccarelli B, Burke N. Catalyzing Navigation for Breast Cancer Survivorship (CaNBCS) in Safety-Net Settings: A Mixed Methods Study. Cancer Control 2021; 28:10732748211038734. [PMID: 34657452 PMCID: PMC8521758 DOI: 10.1177/10732748211038734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The current number of breast cancer survivors (BCS) in the United States is approximately 3.8 million, and this number is further expected to increase with improvement in treatments. Survivorship care plans (SCPs) are patient-centered tools that are designed to meet cancer survivors' informational needs about their treatment history, recommended health care, and health maintenance. However, the data on SCP benefits remain uncertain, especially in low-income and racial and ethnic minority cancer survivors. Patient navigation is an effective intervention to improve patient adherence and experience of interdisciplinary breast cancer treatment. Objectives This study sought to understand the role of lay patient navigators (LPN) in survivorship care planning for BCS in safety-net settings. Methods This study is a mixed methods pilot randomized clinical trial to understand the role of patient navigation in cancer survivorship care planning in a public hospital. We invited BCS who had completed active breast cancer treatment within 5 years. LPNs discussed survivorship care planning and survivorship care-related issues with BCS in the intervention arm over a 6-month intervention period and accompanied patients to their primary care appointment. LPNs also encouraged survivors to discuss health care issues with oncology and primary care providers. The primary objective was to assess BCS’ health-related quality of life (HRQOL). The secondary objectives were self-efficacy and implementation. We assessed implementation with 45–60-min semi-structured interviews with 15 BCS recruited from the intervention arm and 60-min focus groups with the oncologists and separately with LPNs. Results We enrolled 40 patients, 20 randomized to usual care and 20 randomized to LPN navigation. We did not find a statistically significant difference between the two arms in HRQOL. There was also no difference in self-efficacy between the two arms. Qualitative analysis identified implementation barriers to intervention that may have contributed to less effective intervention. Implications for Cancer Survivors Future survivorship care planning interventions need to consider: Cancer survivors’ needs and preferences, the need for dedicated resources, and the role of electronic health records in survivorship care plan delivery.
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Affiliation(s)
- Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Evelin Trejo
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul Couey
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Natalie A Rivadeneira
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Barbara Ciccarelli
- Cancer Navigation Program, San Francisco Department of Public Health, San Francisco, California, USA
| | - Nancy Burke
- School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, California, USA
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Dillon EC, Kim P, Li M, Huang Q, Colocci N, Cantril C, Hung DY. Breast Cancer Navigation: Using Physician and Patient Surveys to Explore Nurse Navigator Program Experiences. Clin J Oncol Nurs 2021; 25:579-586. [PMID: 34533512 DOI: 10.1188/21.cjon.579-586] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient navigators can improve patient experiences of care and outcomes, but little is known about how navigation programs may affect physician workflows and experience. OBJECTIVES This study aimed to understand patient and physician experiences with a breast cancer navigation (BCN) program using Lean design principles. METHODS Surveys were developed and distributed from 2019 to 2020 to 255 patients diagnosed with breast cancer and 128 physicians in primary care and cancer-related specialties. Descriptive analyses were conducted. FINDINGS Eighty-three physicians and 94 patients completed the survey. A large majority of physicians reported that the BCN program "made their day easier" and improved flow, care coordination, and patient experience. A large majority of patients reported receiving the right level of support during diagnosis communication and high satisfaction in other domains measured.
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Affiliation(s)
- Ellis C Dillon
- Center for Health Systems Research at Sutter Health and the Palo Alto Medical Foundation Research Institute
| | | | - Martina Li
- Center for Health Systems Research at Sutter Health and Palo Alto Medical Foundation Research Institute
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Kano M, Chen L, Boyce T, Gomez R, Gundelach AC, Jaffe SA, Sussman AL, Dayao ZR, Lobo J, Pestak CR, Rutledge TL. Characterizing Low-Risk Breast and Gynecological Cancer Patients for Transition into an Oncology/Primary Care Coordinated Care Model: Findings from a Survey of Diverse Survivors in a Rural U.S. State. Cancers (Basel) 2021; 13:cancers13174428. [PMID: 34503237 PMCID: PMC8431122 DOI: 10.3390/cancers13174428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 02/01/2023] Open
Abstract
We conducted a survey to characterize the key attributes of racial/ethnic and geographically diverse low-risk breast and gynecologic cancer patients. We collected data regarding patients' access to primary care (PC); compliance with screening recommendations; treatment for comorbidities; logistical barriers to clinic visits; and receipt of survivorship care documentation (SCD). Survey findings informed the development of an oncology/Primary Care Provider (PCP) care coordination intervention to improve care. We distributed a cross-sectional survey among a convenience sample of 150 cancer survivors. Responses were calculated using descriptive statistics and compared based on the distance participants traveled to their appointments at the cancer center (≤30 vs. >30 miles). Of the 150 respondents, 35% traveled >30 miles for follow-up care and 78% reported having one or more comorbid condition(s). PC utilization was high: 88% reported having a PCP, and 91% indicated ≤1 yearly follow-up visit. Participants traveling >30 miles reported higher rates of logistical challenges associated with cancer center visits compared to those traveling ≤30 miles. Nearly half of respondents (46%) had not received SCD. In conclusion, survey studies such as these allow for the systematic assessment of survivor behaviors and care utilization patterns to inform the development of care coordination interventions for diverse, low-risk cancer patients.
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Affiliation(s)
- Miria Kano
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Correspondence: ; Tel.: +1-(505)-925-1115
| | - Lu Chen
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch; Albuquerque, NM 77555, USA;
| | - Tawny Boyce
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Ricardo Gomez
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Amy C. Gundelach
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Shoshana Adler Jaffe
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Andrew L. Sussman
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Zoneddy R. Dayao
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Jolene Lobo
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Claire R. Pestak
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Teresa L. Rutledge
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA
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11
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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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12
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Improving the Standard of Care for All-A Practical Guide to Developing a Center of Excellence. Healthcare (Basel) 2021; 9:healthcare9060777. [PMID: 34205635 PMCID: PMC8235374 DOI: 10.3390/healthcare9060777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/04/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Pancreatic surgery is one of the more challenging procedures performed by surgeons. The operations are technically complex and have historically been accompanied by a substantial risk for mortality and postoperative complications. Other pancreatic pathologies require advanced therapeutic procedures that are highly endoscopist-dependent, requiring specific, knowledge-based training for optimal outcomes. An increase in diagnosed pancreatic pathologies every year reinforces a critical need for experienced surgeons, gastroenterologists/endoscopists, hospitals, and support personnel in the management of complex pancreatic cases and thus, well-designed Centers of Excellence (CoE). In this paper, we outline the framework for a Pancreas CoE across three developmental domains: (1) establishing the foundation; (2) formalizing the program; (3) solidifying the CoE status. This framework can likely be translated to any disease or procedure-specific service-line and facilitate the development of a successful CoE.
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13
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Islam T, Musthaffa S, Hoong SM, Filza J, Jamaris S, Cheng ML, Harun F, Abdullah Din N, Abd Rahman Z, Mohamed KN, Ho GF, Kaur R, Taib NA. Development and evaluation of a sustainable video health education program for newly diagnosed breast cancer patients in Malaysia. Support Care Cancer 2021; 29:2631-2638. [PMID: 32968861 DOI: 10.1007/s00520-020-05776-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Wider breast cancer (BC) treatment options, short consultation time with physicians, lack of knowledge, and poor coping skills at the time of diagnosis may affect patients' decisions causing treatment delays and non-adherence. To address this gap, a breast care nurse video orientation program was started. Our aim was to evaluate the video on patients' knowledge, satisfaction, and treatment adherence. METHODS The video was developed using the BC delay explanatory model. A self-administered pre- and post-survey on 241 newly diagnosed BC patients in University Malaya Medical Center was performed. The Wilcoxon matched paired signed rank test was used to evaluate patients' pre and post perceived knowledge using a Likert scale 0 to 4 (0 = "no knowledge," 4 = "a great degree of knowledge"). Treatment adherence among participants were measured after 1-year follow-up. RESULTS Eighty percent of the patients reported that the video met or exceeded their expectations. In total 80.5% reported that the video was very effective and effective in improving their perspective on BC treatments. There was improvement in perceived knowledge for treatment options (mean scores; M = 0.93 versus M = 2.97) (p < 0.001) and also for perceived knowledge on types of operation, information on chemotherapy, radiotherapy, hormone therapy, healthy diet, physical activity after treatments, and care of the arm after operation(p < 0.001). In total 89.4%, 79.3%, and 85.9% adhered to surgical, chemotherapy, and radiotherapy recommended treatment, respectively. CONCLUSION The video improved patients' perceived knowledge and satisfaction. The program improved access not only to new BC patients but also the public and found sustainable using the YouTube platform.
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Affiliation(s)
- Tania Islam
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Suhaida Musthaffa
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - See Mee Hoong
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Jasmine Filza
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Suniza Jamaris
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mao Li Cheng
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Faizah Harun
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Noraizam Abdullah Din
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Zarinah Abd Rahman
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Kamar Noraini Mohamed
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Gwo Fuang Ho
- Department of Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ranjit Kaur
- Breast Cancer Welfare Association Malaysia (BCWA), Selangor, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- UM Cancer Research Institute (UMCRI), Kuala Lumpur, Malaysia.
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14
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Haase KR, Anderson J, Knox A, Skrutkowski M, Snow B, Moody L, Pool Z, Vimy K, Watson L. Élaboration d'un énoncé de position national sur la navigation des patients atteints de cancer au Canada. Can Oncol Nurs J 2020; 30:83-92. [PMID: 33119728 DOI: 10.5737/236880763028392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Au Canada, le paysage des soins du cancer évolue et les infirmières en oncologie sont appelées à jouer de nouveaux rôles afin d'améliorer l'expérience des patients et des familles et de répondre à leurs besoins toujours changeants. L'un de ces rôles, la navigation des patients atteints de cancer (NPC), vise principalement à coordonner les soins centrés sur la personne et à guider les patients dans le système de santé. Dans plusieurs provinces et territoires du Canada, la navigation est devenue essentielle pour offrir des soins de grande qualité aux patients cancéreux. Depuis 2016, des chefs de file des soins infirmiers oncologiques se réunissent au sein d'un groupe national pour synthétiser leur compréhension de la navigation des patients en contexte canadien afin d'élaborer un énoncé de position national sur la NPC. Dans le présent article, nous analyserons l'historique de l'élaboration de l'énoncé de position sur la NPC que publiera prochainement l'Association canadienne des infirmières en oncologie (ACIO/CANO). Nous analyserons également les commentaires des participants aux ateliers tenus dans le cadre des congrès de 2016, 2017 et 2018, de même que les comptes rendus des réunions du groupe de travail national qui ont eu lieu pendant cette même période. Le présent article se veut un sommaire historique concis de l'évolution de la NPC au Canada, ainsi qu'un modèle pour les autres groupes aspirant à rédiger un énoncé de position consensuel.
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15
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Haynes KK, Rosenthal HG. The Ever-Changing World of Limb Salvage Surgery for Malignant Bone Tumors. Nurs Clin North Am 2020; 55:251-266. [PMID: 32389258 DOI: 10.1016/j.cnur.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The treatment of malignant bone tumors, also called bone sarcomas, has changed dramatically over the past 50 years owing to the advances in chemotherapy, immunotherapy, targeted therapy, radiation, prosthetic technology, and surgical advances. There are 3 main primary bone cancers: osteosarcoma, Ewing's sarcoma (or Ewing's family of sarcoma), and chondrosarcoma. Before advances in limb preservation techniques and before the development of prosthetic replacement, the treatment for a malignant bone tumor of the extremity was amputation. This article discusses the progression of surgical treatment of malignant bone cancers.
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Affiliation(s)
- Kimberly K Haynes
- The University of Kansas Hospital Sarcoma Center, 10730 Nall Avenue, Suite 201, Overland Park, KS 66211, USA.
| | - Howard G Rosenthal
- The University of Kansas Hospital Sarcoma Center, 10730 Nall Avenue, Suite 201, Overland Park, KS 66211, USA
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16
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Haase KR, Anderson J, Knox A, Skrutkowski M, Snow B, Moody L, Pool Z, Vimy K, Watson L. Development of a national position statement on cancer patient navigation in Canada. Can Oncol Nurs J 2020; 30:73-82. [PMID: 33118981 DOI: 10.5737/236880763027382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
As the landscape of cancer care in Canada evolves, oncology nursing roles are developed to enhance the patient experience and address the changing needs of patients and families. Cancer Patient Navigation (CPN), an oncology nursing role focusing primarily on person-centred care coordination and system navigation, has become integral to providing high-quality cancer care in many Canadian jurisdictions. Since 2016, a national group of oncology nursing leaders have been engaged in convening and catalyzing our understanding of the role of patient navigation in the Canadian cancer context with the purpose of developing a national position statement on CPN. In this paper, we provide a historical analysis of the development of the forthcoming Canadian Association of Nurses in Oncology (CANO) position statement on CPN. We present an analysis of participant feedback from workshops at the 2016, 2017, and 2018 conferences, and meeting minutes from the National working group over this same time period. This paper serves as a concise historical summary of the evolution of CPN in Canada while providing a template for other groups looking to develop a consensus-based position statement.
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17
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Silander K, Torkki P, Peltokorpi A, Tarkkanen M, Lepäntalo A, Mattson J, Bono P, Kaila M. Comparing modular and personal service delivery in specialised outpatient care: A survey of haematology and oncology patient preferences. Health Serv Manage Res 2019; 32:209-217. [PMID: 31403337 DOI: 10.1177/0951484819868681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Oncology and haematology are shifting from inpatient to outpatient care, requiring new care delivery models. This study compares preferences of oncology patients treated by named nurses in a traditional specialty-focused day hospital and haematology patients treated without named nurses in a modularised day hospital. Methods Questionnaires to explore patient preferences on number of treating nurses and named nurses, and satisfaction in day hospital care were distributed to 300 haematology and 410 oncology patients. Binomial logistic regressions were performed to study how background variables influenced preferences for having (i) a named nurse or (ii) maximum three treating nurses in the day hospital. Results In 2016, 156 (52%) haematology and 289 (70%) oncology surveys were completed and returned. Both groups were satisfied with day hospital care. Haematology patients preferred named nurses less often than oncology patients (odds ratio (OR) = 0.09, p < 0.0005). Haematology patients were less likely to prefer a maximum of three treating nurses (OR = 0.12, p < 0.0005). Conclusion This study suggests that patients can be satisfied with outpatient care with or without named nurses. However, as several factors affect patient satisfaction and experience, more in-depth research is needed to understand how modularisation and patient preferences may be linked.
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Affiliation(s)
- Katariina Silander
- 1 Aalto University, Department of Industrial Engineering and Management, Espoo, Finland.,2 University of Helsinki, Helsinki, Finland
| | | | - Antti Peltokorpi
- 3 Aalto University, Department of Civil Engineering, Espoo, Finland
| | - Maija Tarkkanen
- 2 University of Helsinki, Helsinki, Finland.,4 Helsinki University Hospital, Helsinki, Finland
| | - Aino Lepäntalo
- 2 University of Helsinki, Helsinki, Finland.,4 Helsinki University Hospital, Helsinki, Finland
| | - Johanna Mattson
- 2 University of Helsinki, Helsinki, Finland.,4 Helsinki University Hospital, Helsinki, Finland
| | - Petri Bono
- 2 University of Helsinki, Helsinki, Finland.,4 Helsinki University Hospital, Helsinki, Finland
| | - Minna Kaila
- 2 University of Helsinki, Helsinki, Finland.,4 Helsinki University Hospital, Helsinki, Finland
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18
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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: 61] [Impact Index Per Article: 12.2] [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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Westman B, Ullgren H, Olofsson A, Sharp L. Patient-reported perceptions of care after the introduction of a new advanced cancer nursing role in Sweden. Eur J Oncol Nurs 2019; 41:41-48. [PMID: 31358256 DOI: 10.1016/j.ejon.2019.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/15/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Extensive research results show quality improvements associated with advanced cancer nursing roles. Despite this, these roles are not implemented in many countries. The aim of this cross-sectional, population-based study was to compare patients' perception of care, before and after the introduction of a new advanced nursing role, the coordination contact nurse (CCN), in a region in Sweden. METHOD All patients (with gynaecological, haematological, Head & Neck, upper gastrointestinal cancers) diagnosed in the region the year prior and one-year post introducing the new CCN role were identified from the Swedish Cancer Register. Data were collected using the European Organization of Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire (QLQ-C30 and QLQ-INFO25) and a study specific questionnaire. RESULT The results, based on baseline (n = 869) and follow-up data (n = 1003), show statistically significant patient-reported improvements after the introduction of the CCN role, regarding health-related patient information (EORTC QLQ- INFO25 global mean score increased from 41.23 to 44.16, p = 0.0006). We found statistically significant improvements related to availability of supportive care resources, e.g. increased reported access to contact nurse (from 53% to 66%, p ≤ 0.0001) and individual written care plans (from 40% to 54%, p < 0.0001). We also found some improvements related to patient involvement and care coordination, but also room for further developments. CONCLUSION The implementation of the new advanced cancer nursing role may have contributed to important improvements, but it has also identified areas in need of development. Further research with long-term evaluations of CCN roles in other contexts, are both needed and on-going.
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Affiliation(s)
- B Westman
- Regional Cancer Centre, Stockholm Gotland, 10239, Stockholm, Sweden.
| | - H Ullgren
- Regional Cancer Centre, Stockholm Gotland, 10239, Stockholm, Sweden; Karolinska University Hospital, Theme Cancer, Patient Area Airway, Lung and Skin Cancer, 17176, Stockholm, Sweden; Umeå University, Department of Nursing, 90187, Umeå, Sweden
| | - A Olofsson
- Regional Cancer Centre, Stockholm Gotland, 10239, Stockholm, Sweden
| | - L Sharp
- Regional Cancer Centre, Stockholm Gotland, 10239, Stockholm, Sweden; Karolinska Institutet, LIME, Division of Innovative Care Research, 17177, Stockholm, Sweden
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Singh-Carlson S, Wong F, Trevillion K, Reynolds G. Programme d’infirmière-coordonnatrice des soins du cancer du sein : effet sur le niveau de détresse des patientes. Can Oncol Nurs J 2019; 28:256-261. [PMID: 31148813 DOI: 10.5737/23688076284256261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Savitri Singh-Carlson
- San Diego State University, École de sciences infirmières, San Diego, CA, USA, 92182. Courriel :
| | - Frances Wong
- California State University, Long Beach, Health Care Administration, Graduate Program Director, Director, Center for Behavioral Research and Services
| | - Kris Trevillion
- California State University, Long Beach, Health Care Administration, Graduate Program Director, Director, Center for Behavioral Research and Services
| | - Grace Reynolds
- California State University, Long Beach, Health Care Administration, Graduate Program Director, Director, Center for Behavioral Research and Services
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21
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Singh-Carlson S, Wong F, Trevillion K, Reynolds G. Impact of a breast cancer care RN-coordinator program on patients' distress level. Can Oncol Nurs J 2019; 28:250-255. [PMID: 31148810 DOI: 10.5737/23688076284250255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to determine whether patients receiving navigation supportive care from a Breast Cancer Care Coordinator (BCCC), prior to initial oncology consultation at a British Columbia Cancer Agency, Abbotsford Centre (BCCA-AC), demonstrated different levels of anxiety and depression from those not receiving such support at the same BCCA centre. A retrospective review of the Psychological Screen for Cancer (PSSCAN) scores of new breast cancer patients seen for oncology consultation for the control cohort (receiving usual care) were compared to PSSCAN scores of those who had received care from a BCCC prior to the oncology consultation (the study cohort). A total of 91 PSSCANs were reviewed in the study, with 54 belonging to the treatment group and 37 to the control group. PSSCAN scores for anxiety and depression did not show significant differences between the two groups.
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Affiliation(s)
| | - Frances Wong
- California State University, Long Beach, Health Care Administration, Graduate Program Director, Director, Center for Behavioral Research and Services
| | - Kris Trevillion
- California State University, Long Beach, Health Care Administration, Graduate Program Director, Director, Center for Behavioral Research and Services
| | - Grace Reynolds
- California State University, Long Beach, Health Care Administration, Graduate Program Director, Director, Center for Behavioral Research and Services
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Panozzo S, Collins A, McLachlan SA, Lau R, Le B, Duffy M, Philip JA. Scope of Practice, Role Legitimacy, and Role Potential for Cancer Care Coordinators. Asia Pac J Oncol Nurs 2019; 6:356-362. [PMID: 31572755 PMCID: PMC6696811 DOI: 10.4103/apjon.apjon_29_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: The cancer care coordinator (CCC) role has become a priority in providing coordinated, patient-centered, supported care for patients, and their families experiencing cancer. The CCC role exists with heterogeneity across tumor streams, clinical disciplines, and institutions. This study explored CCCs perceptions and experiences of their role, scope of practice, and potential for future role development. Methods: This research used a mixed methods design. Focus groups and individual interviews were conducted with a purposive sample of 16 CCCs from two tertiary public teaching hospitals in Melbourne, Australia. A thematic analysis approach was used. A quantitative record of relative time spent on tasks was also collected. Results: Three major themes were identified: (1) Perceptions of role legitimacy, (2) Structure and funding of the role determines scope of practice, and (3) Reflections on the potential for the role. Variability was evident in predominant tasks undertaken, integration into the unit, level of patient contact, and regard from other professional colleagues. Variability appears to relate to employment time assigned to the role, and history and structure of the role. Conclusions: The findings underline the need when establishing and reviewing CCC roles for explicit attention to be given to the reporting, integration, structural, and collegiate support for the role as this will profoundly influence its success.
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Affiliation(s)
- Stacey Panozzo
- Department of Medicine, University of Melbourne, Australia.,Palliative Medicine Research Group, St. Vincent's Hospital Melbourne, Australia.,Peter MacCallum Cancer Centre, Australia
| | - Anna Collins
- Department of Medicine, University of Melbourne, Australia.,Palliative Medicine Research Group, St. Vincent's Hospital Melbourne, Australia
| | | | - Rosalind Lau
- Centre for Palliative Care, St. Vincent's Hospital Melbourne, Australia
| | - Brian Le
- Peter MacCallum Cancer Centre, Australia.,Palliative and Supportive Care Unit, Royal Melbourne Hospital, Australia
| | - Mary Duffy
- Peter MacCallum Cancer Centre, Australia
| | - Jennifer A Philip
- Department of Medicine, University of Melbourne, Australia.,Palliative Medicine Research Group, St. Vincent's Hospital Melbourne, Australia
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Fishman KN, Levitt AJ, Markoulakis R, Weingust S. Satisfaction with Mental Health Navigation Services: Piloting an Evaluation with a New Scale. Community Ment Health J 2018; 54:521-532. [PMID: 29147951 DOI: 10.1007/s10597-017-0201-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/04/2017] [Indexed: 11/24/2022]
Abstract
As mental health navigation services continue to be implemented, the need for valid and reliable tools to assess the quality of these services increases. While case managers target individuals with severe mental illness and aim to reduce burden and cost, and increase independence, navigation services target all individuals with a range of mental health and/or substance use issues, with the aim of reducing barriers to treatment and coordinating individualized care. The current study evaluated satisfaction with a navigation service using a new 22-item questionnaire, the Navigation Satisfaction Tool (NAVSAT). Forty clients completed a web-based version of the NAVSAT to evaluate satisfaction with a family mental health navigation service in Toronto, Canada. Descriptive statistics on the sample and range of treatments/services are provided. The NAVSAT has excellent reliability (Cronbach's alpha = 0.96) and face validity. Satisfaction with the following navigation-level factors were the best predictors of overall satisfaction with navigation; the navigator's ability to recommend the appropriate treatment (β = 0.116, p = .05), intake procedures (β = 0.364, p = .005), and the principal contact's satisfaction with his/her frequency of contact with the navigator (β = 0.602, p = .001). Satisfaction with the following provider-level factors were the best predictors of overall satisfaction with the referred service; the referred service's ability to improve the youth's well being (β = 0.684, p < .001), and the referred service's ability to listen and understand the family's concerns (β = 0.356, p = .001). The NAVSAT appears to be a reliable tool for measuring satisfaction in the current sample. If these findings are replicated in a larger population serving youth and young adults in transition, the NAVSAT may prove to be a helpful guide for program evaluation and development for navigation and treatment services for this population.
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Affiliation(s)
- Keera N Fishman
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue Room FG03, Toronto, ON, M4N 3M5, Canada. .,Department of Psychology, Faculty of Social Sciences, University of Ottawa, 136 Jean Jacques Lussier, VNR 3088, Ottawa, ON, K1N 6N5, Canada.
| | - Anthony J Levitt
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue Room FG03, Toronto, ON, M4N 3M5, Canada.,University of Toronto, Toronto, ON, Canada
| | - Roula Markoulakis
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue Room FG03, Toronto, ON, M4N 3M5, Canada
| | - Staci Weingust
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue Room FG03, Toronto, ON, M4N 3M5, Canada
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White J, Park J, Russell KB, Reynolds K, Madani A, Carlson LE, Giese-Davis J. Falling through the cracks. A thematic evaluation of unmet needs of adult survivors of childhood cancers. Psychooncology 2018; 27:1979-1986. [DOI: 10.1002/pon.4754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Jennifer White
- Department of Physiotherapy; Monash University; Melbourne Victoria Australia
| | - Joanne Park
- Department of Psychology; University of British Columbia; Vancouver British Columbia Canada
- Department of Oncology; University of Calgary; Calgary Alberta Canada
- Tom Baker Cancer Centre, Psychosocial Resources; Calgary Alberta Canada
| | - K. Brooke Russell
- Department of Oncology; University of Calgary; Calgary Alberta Canada
- Tom Baker Cancer Centre, Psychosocial Resources; Calgary Alberta Canada
| | | | - A. Madani
- Provincial Health Services Authority; Vancouver British Columbia Canada
| | - Linda E. Carlson
- Department of Oncology; University of Calgary; Calgary Alberta Canada
- Tom Baker Cancer Centre, Psychosocial Resources; Calgary Alberta Canada
| | - Janine Giese-Davis
- Department of Oncology; University of Calgary; Calgary Alberta Canada
- Tom Baker Cancer Centre, Psychosocial Resources; Calgary Alberta Canada
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Ranaghan C, Boyle K, Meehan M, Moustapha S, Fraser P, Concert C. Effectiveness of a patient navigator on patient satisfaction in adult patients in an ambulatory care setting: a systematic review. ACTA ACUST UNITED AC 2018; 14:172-218. [PMID: 27635752 DOI: 10.11124/jbisrir-2016-003049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND One approach to overcoming healthcare system barriers and facilitating timely access to quality care and patient satisfaction is with a patient navigator. A patient navigator is a trained person who individually assists patients, families and caregivers navigate the healthcare system barriers efficiently and effectively at any point along the care continuum, improving patient care at all levels of an organization. OBJECTIVES To synthesize the best available evidence on the effectiveness of a patient navigator on patient satisfaction in adult patients 18 years and older in ambulatory care settings. INCLUSION CRITERIA TYPES OF PARTICIPANTS This review considered studies that involved adults of any ethnicity, race or gender, aged 18 years or older, regardless of diagnoses, stage of illness, whether the illness is acute or chronic or previous treatment, who had been receiving care in an ambulatory care setting. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST This review considered studies on the use of a patient navigator as an additional intervention to usual care for promoting patient satisfaction for adult patients in an ambulatory care setting. Usual care without a patient navigator was considered as a comparator. TYPES OF STUDIES This review considered experimental and observational studies. OUTCOMES The outcome considered was patient satisfaction. SEARCH STRATEGY The literature search included published and unpublished studies in the English Language from 1990 through July 2015. A search of PubMed, CINAHL, Excerpta Medica Database (EMBASE), Academic Search Premier, Cochrane Library, PsycINFO and Health Source: Nursing/Academic Edition, Social Work Abstracts and Web of Science was conducted. A search for gray literature and electronic hand searching of relevant journals was also performed. METHODOLOGICAL QUALITY Two reviewers independently evaluated the included studies for methodological quality utilizing standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION Standardized data extraction tools from Joanna Briggs Institute were used by two independent reviewers for data extraction. DATA SYNTHESIS A statistical meta-analysis was not possible due to heterogeneity between the included studies. Results are presented in a narrative form. RESULTS Four studies were included in this review, two were randomized controlled trials (RCTs), one was a quasi-experimental pre-post-test design study and one was a cohort study. The four studies showed that a patient navigator had clinical benefit for patient satisfaction, care coordination and patient access to timely healthcare services. One RCT reported a mean satisfaction score of 4.3 for navigated patients and 2.9 for non-navigated patients; P < 0.001. A second RCT showed an odds ratio 1.29; 95% confidence interval 0.92-1.82 for navigated versus non-navigated patients. The quasi-experimental pre-test-post-test study showed navigated patient satisfaction with a mean = 11.45 (standard deviation [SD], 3.69) in comparison with the non-navigated patient (mean, 14.95; SD, 1.69) (F = 11.85; P = 0.000). The cohort study demonstrated a mean satisfaction score of 90.7 for navigated patients and 85.5 for non-navigated patients; P = 0.03. The four studies showed no clinically significant results; however, the patient navigator role may promote relationships among the healthcare team, reducing barriers for patient-centered care and enhanced patient satisfaction. CONCLUSION There is a paucity of evidence on the effectiveness of a patient navigator on patient satisfaction. In the four studies selected for inclusion, a patient navigator had a positive effect on patient satisfaction, although none of the studies demonstrated statistical significance with a patient navigator on patient satisfaction. The effect of a patient navigator remains questionable with differences in perceptions on the best individual for the role and the expected role perception and performance. A standardized approach to the role of the patient navigator may maximize health outcomes and positively affect the quality of life for all patients.
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Affiliation(s)
- Coleen Ranaghan
- The Northeast Institute of Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Centre of Excellence
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Effects of patient navigation on satisfaction with cancer care: a systematic review and meta-analysis. Support Care Cancer 2018; 26:1369-1382. [PMID: 29497815 DOI: 10.1007/s00520-018-4108-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/11/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Patient navigation (PN) is a model of healthcare coordination designed to reduce barriers to achieving optimal health outcomes. Systematic reviews evaluating whether PN is associated with higher patient satisfaction with cancer care are lacking. METHODS We conducted a systematic review to synthesize evidence of comparative studies evaluating the effectiveness of PN programs to improve satisfaction with cancer-related care. We included studies reported in English that: (1) evaluated a PN intervention designed to increase satisfaction with cancer care; and (2) involved a randomized controlled trial (RCT) or non-RCT approach. Standardized forms were used to abstract data from studies. These data were evaluated for methodological quality, summarized qualitatively, and synthesized under a random effects model. RESULTS The initial search yielded 831 citations. Nine met inclusion criteria. Five had adequate data (1 RCT and 4 non-RCTs) to include in the meta-analysis. Methodological quality of included studies ranged from weak to strong, with half rated as weak. Findings of the RCTs showed a statistically significant increase in satisfaction with cancer care involving PN (standardized mean difference (SMD) = 2.30; 95% confidence interval 1.79, 2.80, p < 0.001). Pooled results from non-RCTs showed no significant association between PN and satisfaction with cancer-related care (standardized mean difference = 0.39; 95% confidence interval - 0.02, 0.80, p = 0.06). CONCLUSIONS Although PN has been widely implemented to improve cancer care, high-quality studies are needed to characterize the relationship between PN and satisfaction with cancer-related care.
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Abstract
The objective of this article is to introduce the Clinical Framework for Quality Improvement of Cancer Cachexia (Cachexia Care Framework) as a tool to demonstrate the relevance of integrating the clinical components of cancer cachexia and the organizational strategies of a cancer institution on the quality of patient care and delivery of services throughout the cancer cachexia continuum. The data sources included peer-reviewed literature relevant to cancer cachexia and quality cancer care, and the authors’ expertise. The Cachexia Care Framework results from a combination of the international consensus definition of cancer cachexia, the Institute of Medicine report Ensuring Quality Cancer Care, and the authors’ experience with a cancer cachexia clinic. This framework is proposed as a guidance for oncology nurses and other healthcare providers to improve the quality of care of cancer cachexia patients. Specifically, the framework can be used by oncology nurses involved in the care of patients diagnosed with cancer cachexia either in direct patient care, administration, research, or education. Nurses can use the framework in clinical practice to identify specific assessments and interventions based on the cachexia stage of the patient; in nursing administration, the framework offers a wide view of potential errors that can happen and the opportunity to prevent them; in nursing research, the framework illustrates the several factors and processes that can impact patient outcomes; and in nursing education, the framework outlines the elements necessary to develop and implement a continuum education curriculum to educate the workforce of oncology nurses, and in the academic setting, an interprofessional curriculum to educate nurses and many other healthcare disciplines.
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Affiliation(s)
- Clara Granda-Cameron
- Undergraduate Program, College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary Pat Lynch
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, USA
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Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres. Injury 2018; 49:97-103. [PMID: 28988066 DOI: 10.1016/j.injury.2017.09.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/07/2017] [Accepted: 09/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. METHODS A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. RESULTS Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients. CONCLUSIONS The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients encounter complex barriers to quality discharge that likely require a comprehensive, multimodal intervention.
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Gordils-Perez J, Schneider S, Gabel M, Trotter K. Oncology Nurse Navigation: Development and Implementation of a Program at a Comprehensive Cancer Center. Clin J Oncol Nurs 2017; 21:581-588. [DOI: 10.1188/17.cjon.581-588] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bettle A, Latimer M, Fernandez C, Hughes J. Supporting Parents' Pain Care Involvement With Their Children With Acute Lymphoblastic Leukemia: A Qualitative Interpretive Description. J Pediatr Oncol Nurs 2017; 35:43-55. [PMID: 28849687 DOI: 10.1177/1043454217727518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Children with acute lymphoblastic leukemia experience pain from the disease, treatment, and procedures. Parents can be effective in managing their child's pain, but little is systematically known about how they do this. Appreciative inquiry was used to frame the study within a strengths-based lens and interpretive descriptive methods were used to describe pain sources, parents' pain care role, and key structures supporting parents pain care involvement. Eight paediatric oncology clinic nurses and 10 parents participated. Six key themes per group were identified. Parent themes included establishing therapeutic relationships, relearning how to care for my child, overcoming challenges and recognizing pain, learning parent specific strategies, empowering to take active pain care role, and maintaining relationships. Nurse themes included establishing therapeutic relationships, preparing parents to care for their child, facilitating pain assessment, teaching parents best pain care, empowering parents, and maintaining relationships. These findings can be used to guide clinical practice and future research.
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Affiliation(s)
| | - Margot Latimer
- 1 IWK Health Centre, Halifax, Nova Scotia, Canada.,2 Dalhousie University, Halifax, Nova Scotia, Canada
| | - Conrad Fernandez
- 1 IWK Health Centre, Halifax, Nova Scotia, Canada.,2 Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean Hughes
- 1 IWK Health Centre, Halifax, Nova Scotia, Canada.,2 Dalhousie University, Halifax, Nova Scotia, Canada
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Harding M. Effect of nurse navigation on patient care satisfaction and distress associated with breast biopsy. Clin J Oncol Nurs 2016; 19:E15-20. [PMID: 25689662 DOI: 10.1188/15.cjon.e15-e20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Navigation during the biopsy period is a superior approach to delivering care, with those patients receiving services experiencing less distress. Critical nurse navigator roles include providing information and facilitating access to the healthcare system, both of which are influential on distress. The information in this article supports the expansion of navigation programs to include women undergoing biopsy and aids in promoting a higher standard of care. OBJECTIVES To evaluate the effect of navigation on care satisfaction and distress in women undergoing breast biopsy. METHODS A descriptive, cross-sectional survey design from two outpatient radiology clinics in Appalachia was used. FINDINGS Navigated women had lower scores on every distress measure and were less likely to seek information from an outside source. Women who were more satisfied with their care reported decreased distress; the factors influencing distress varied depending on whether they were the recipient of navigation services. In the non-navigated population, general satisfaction with care and accessibility were more likely to influence distress.
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Affiliation(s)
- Mariann Harding
- School of Nursing, Kent State University at Tuscarawas, New Philadelphia, OH
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Abstract
BACKGROUND Nurse practitioners should become more active in patient navigation and its subcomponent, care coordination, because research has shown that these roles are influential in improving patient care at all levels of an organization. Well-defined process and outcome measures, as well as educational initiatives, are critical to these programs because they serve as the structure for program evaluation. OBJECTIVES This article aims to assess and define metrics that nurse practitioners in the oncology setting can use to evaluate navigation programs, which is essential for the evolution of research pertaining to the navigation field. METHODS The current article is a systematic review that describes oncology nurse practitioner navigation metrics using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) format for the systematic literature review process. These metrics are then compared to current standards of care. FINDINGS Seven studies met the criteria for this review. Research is emerging that shows benefit in using an oncology nurse practitioner navigator for ensuring timely care and patient and staff satisfaction. These metrics are in line with expert consensus recommendations. The need for more research identifying sound research tools that have been rigorously tested has been identified.
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Affiliation(s)
- Frances Johnson
- Michael E. DeBakey Veterans Affairs Medical Center in Houston, TX
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Yatim F, Cristofalo P, Ferrua M, Girault A, Lacaze M, Di Palma M, Minvielle E. Analysis of nurse navigators' activities for hospital discharge coordination: a mixed method study for the case of cancer patients. Support Care Cancer 2016; 25:863-868. [PMID: 27830394 PMCID: PMC5266768 DOI: 10.1007/s00520-016-3474-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/26/2016] [Indexed: 11/24/2022]
Abstract
Background Modern cancer care requires the development of clinical pathways to enhance coordination, but there are few descriptive studies about the content of coordination activities. More specifically, little is known about hospital discharge coordination, although this is seen as a sensitive phase of clinical pathway. Purpose The purpose of this study was to identify and quantify the categories of activities performed by nurse navigators for hospital discharge coordination. Methods Patients supported within the Coordinating Outpatient Care department (COC) at Gustave Roussy (Villejuif, France). Study conducted over two consecutive phases (Feb-September 2014): (1) a qualitative phase to identify the categories of coordination activities (interviews with patients plus, focus groups with nurse navigators—NNs); (2) a quantitative phase to quantify the relative share of each category. The calls received through the telephone platform of COC (made by both patients and primary care providers) were systematically reported (caller; reason for the call; procedure performed) and then analyzed. Results Qualitative phase: 17 interviews with patients, plus 2 focus groups with NNs. Quantitative phase: 543 calls analyzed. The callers were patients or their relatives (38 %), private nurses (35 %), medical device providers (20 %), and other primary care providers (e.g., pharmacists, family physicians) (7 %). Five categories of coordination activities identified: (F1) Patient monitoring (29 %); (F2) Helping to navigate (24 %); (F3) Managing technical problems (17 %); (F4) Explaining care protocols (16 %); (F5) Collecting and transmitting the patient medical record information (14 %). Conclusions The majority of requirements are related to organizational issues (e.g., navigation, lack of information, appointments). Nurse navigators’ training and qualification must therefore combine both clinical and managerial skills.
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Affiliation(s)
- Fatima Yatim
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France. .,EHESP School Public Health, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France.
| | - Paula Cristofalo
- EHESP School Public Health, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France
| | - Marie Ferrua
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France
| | - Anne Girault
- EHESP School Public Health, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France
| | - Marilene Lacaze
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France
| | - Mario Di Palma
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France
| | - Etienne Minvielle
- Gustave Roussy, 114, rue Edouard-Vaillant, 94 805, Villejuif, France.,EHESP School Public Health, 15 avenue du Professeur Léon-Bernard, 35043, Rennes, France
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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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Murphy J, Mollica M. All Hands on Deck: Nurses and Cancer Care Delivery in Women's Health. Front Oncol 2016; 6:174. [PMID: 27500124 PMCID: PMC4956645 DOI: 10.3389/fonc.2016.00174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/07/2016] [Indexed: 12/04/2022] Open
Affiliation(s)
- Jeanne Murphy
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Michelle Mollica
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
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Johnson F. The Process of Oncology Nurse Practitioner Patient Navigation: A Pilot Study. Clin J Oncol Nurs 2016; 20:207-10. [PMID: 26991716 DOI: 10.1188/16.cjon.207-210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oncology nurse practitioner (ONP) patient navigators may improve clinical outcomes. However, no standard measures of the process of oncology patient navigation or of related clinical outcomes exist, and research in this area is limited. The exploratory pilot study detailed in this article used grounded theory and interviews with three ONPs to define the processes employed by ONP patient navigators in caring for patients with cancer.
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Affiliation(s)
- Frances Johnson
- Michael E. DeBakey Veterans Affairs Medical Center in Houston, TX
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Foglino S, Bravi F, Carretta E, Fantini MP, Dobrow MJ, Brown AD. The relationship between integrated care and cancer patient experience: A scoping review of the evidence. Health Policy 2016; 120:55-63. [DOI: 10.1016/j.healthpol.2015.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/18/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022]
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Hong YS, Park JY, Kim SH, Kim SA, Kim YH. Effects of a Navigation Program for Patients with Newly Diagnosed Gastric Cancer: A Randomized Controlled Trial. ASIAN ONCOLOGY NURSING 2016. [DOI: 10.5388/aon.2016.16.3.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yeon Seo Hong
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Jeong Yun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| | - So Hee Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Sun A Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Yeon Hee Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
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Molina Y, Kim S, Berrios N, Calhoun EA. Medical mistrust and patient satisfaction with mammography: the mediating effects of perceived self-efficacy among navigated African American women. Health Expect 2015; 18:2941-50. [PMID: 25308749 PMCID: PMC4393336 DOI: 10.1111/hex.12278] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Medical mistrust is salient among African American women, given historic and contemporary racism within medical settings. Mistrust may influence satisfaction among navigated women by affecting women's perceptions of their health-care self-efficacy and their providers' roles in follow-up of abnormal test results. OBJECTIVES To (i) examine whether general medical mistrust and health-care self-efficacy predict satisfaction with mammography services and (ii) test the mediating effects of health-related self-efficacy. DESIGN The current study is a part of a randomized controlled patient navigation trial for medically underserved women who had received a physician referral to obtain a mammogram in three community hospitals in Chicago, IL. After consent, 671 African American women with no history of cancer completed questionnaires concerning medical mistrust and received navigation services. After their mammography appointment, women completed health-care self-efficacy and patient satisfaction questionnaires. RESULTS Women with lower medical mistrust and greater perceived self-efficacy reported greater satisfaction with care. Medical mistrust was directly and indirectly related to patient satisfaction through self-efficacy. CONCLUSIONS Preliminary findings suggest future programmes designed to increase health-care self-efficacy may improve patient satisfaction among African American women with high levels of medical mistrust. Our findings add to a growing body of literature indicating the importance of self-efficacy and active participation in health care, especially among the underserved.
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Affiliation(s)
- Yamile Molina
- School of Public HealthUniversity of WashingtonSeattleWAUSA
- Fred Hutchinson Cancer Research CenterSeattleWAUSA
- School of Public HealthUniversity of Illinois‐ChicagoChicagoILUSA
| | - Sage Kim
- School of Public HealthUniversity of Illinois‐ChicagoChicagoILUSA
| | - Nerida Berrios
- School of Public HealthUniversity of Illinois‐ChicagoChicagoILUSA
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Post DM, McAlearney AS, Young GS, Krok-Schoen JL, Plascak JJ, Paskett ED. Effects of Patient Navigation on Patient Satisfaction Outcomes. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:728-35. [PMID: 25510369 PMCID: PMC7217374 DOI: 10.1007/s13187-014-0772-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Patient navigation (PN) may reduce cancer health disparities. Few studies have investigated the effects of PN on patient-reported satisfaction with care or assessed patients' satisfaction with navigators. The objectives of this study are to test the effects of PN on patient satisfaction with cancer care, assess patients' satisfaction with navigators, and examine the impact of barriers to care on satisfaction for persons with abnormal cancer-related screening tests or symptoms. Study participants included women and men with abnormal breast, cervical, or colorectal cancer screening tests and/or symptoms receiving care at 18 clinics. Navigated (n=416) and non-navigated (n=292) patients completed baseline and end-of-study measures. There was no significant difference between navigated and non-navigated patients in change in patient satisfaction with cancer care from baseline to exit. African-American (p<0.001), single (p=0.03), low income (p<0.01), and uninsured patients (p<0.001) were significantly less likely to report high patient satisfaction at baseline. A significant effect was found for change in satisfaction over time by employment status (p=0.04), with full-time employment showing the most improvement. The interaction between satisfaction with navigators and satisfaction with care over time was marginally significant (p=0.08). Baseline satisfaction was lower for patients who reported a barrier to care (p=0.02). Patients reporting other-focused barriers (p=0.03), including transportation (p=0.02), had significantly lower increases in satisfaction over time. Overall, results suggested that assessing barriers to cancer care and tailoring navigation to barrier type could enhance patients' experiences with health care. PN may have positive effects for healthcare organizations struggling to enhance quality of care.
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Affiliation(s)
- Douglas M Post
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 N. High St., Columbus, OH, 43201, USA
- Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, OH, 43201, USA
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 N. High St., Columbus, OH, 43201, USA
- Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, OH, 43201, USA
| | - Gregory S Young
- Center for Biostatistics, The Ohio State University, 2012 Kenny Rd., Columbus, OH, 43221, USA
| | - Jessica L Krok-Schoen
- Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, OH, 43201, USA
| | - Jesse J Plascak
- Biobehavioral Cancer Prevention and Control Training Program, University of Washington, PO Box 359455, Seattle, WA, 98195, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, OH, 43201, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, 395 W. 12th Ave., Columbus, OH, 43210, USA.
- Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH, 43210, USA.
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Kim S, Molina Y, Glassgow AE, Berrios N, Guadamuz J, Calhoun E. The effects of navigation and types of neighborhoods on timely follow-up of abnormal mammogram among black women. ACTA ACUST UNITED AC 2015; 2015. [PMID: 26949738 DOI: 10.18103/mra.v0i3.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the availability of relatively simple and inexpensive screening tools, minority women are more often diagnosed at a late stage of breast cancer, in part due to delays in follow-up of abnormal screening result. One of the key factors for timely follow-up of abnormal mammogram may be neighborhood characteristics. Patient Navigation (PN) programs aim to diminish barriers, but its differential effects by neighborhood have not been fully examined. The current study examines the effect of types of neighborhoods on time to follow-up of abnormal mammogram, and the differential effects of PN by neighborhood characteristics. METHODS We examined data from a total of 1,696 randomized patients from a randomized controlled trial, "the Patient Navigation in Medically Underserved Areas" study that explored the effect of navigation on breast health outcomes. We categorized participants' neighborhoods into three categories and compared the effect of navigation between these neighborhood types. RESULTS Navigated women in mixed race neighborhoods had a shorter time to follow-up compared with non-navigated women in the neighborhoods. Black women living in mixed neighborhoods had a significant longer time to follow-up of abnormal mammogram, compared with black women living in middle class black neighborhoods. CONCLUSION Patient navigation interventions improve timely follow-up of abnormal mammogram. Patient navigation may be particularly beneficial for minority women who reside in racially heterogeneous neighborhoods which may be less likely to have access to affordable health clinics and social services. Health policies concerning breast cancer early detection for minority women need to pay further attention to those who might potentially be excluded from health services due to the characteristics of neighborhoods. Socioeconomic conditions of neighborhood may affect individual health through multiple interlinked mechanisms. Neighborhood characteristics, such as poverty, segregation, access to resources, and social cohesion, cannot be fully understood with simplistic measures of neighborhood disadvantage.
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Jolly SE, Navaneethan SD, Schold JD, Arrigain S, Konig V, Burrucker YK, Hyland J, Dann P, Tucky BH, Sharp JW, Nally JV. Development of a chronic kidney disease patient navigator program. BMC Nephrol 2015; 16:69. [PMID: 26024966 PMCID: PMC4459709 DOI: 10.1186/s12882-015-0060-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is a public health problem and there is a scarcity of type 2 CKD translational research that incorporates educational tools. Patient navigators have been shown to be effective at reducing disparities and improving outcomes in the oncology field. We describe the creation of a CKD Patient Navigator program designed to help coordinate care, address system-barriers, and educate/motivate patients. METHODS The conceptual framework for the CKD Patient Navigator Program is rooted in the Chronic Care Model that has a main goal of high-quality chronic disease management. Our established multidisciplinary CKD research team enlisted new members from information technology and data management to help create the program. It encompassed three phases: hiring, training, and implementation. For hiring, we wanted a non-medical or lay person with a college degree that possessed strong interpersonal skills and experience in a service-orientated field. For training, there were three key areas: general patient navigator training, CKD education, and electronic health record (EHR) training. For implementation, we defined barriers of care and created EHR templates for which pertinent study data could be extracted. RESULTS We have hired two CKD patient navigators who will be responsible for navigating CKD patients enrolled in a clinical trial. They have undergone training in general patient navigation, specific CKD education through directed readings and clinical shadowing, as well as EHR and other patient related privacy and research training. CONCLUSIONS The need for novel approaches like our CKD patient navigator program designed to impact CKD care is vital and should utilize team-based care and health information technology given the changing landscape of our health systems.
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Affiliation(s)
- Stacey E Jolly
- Department of General Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue- G10, Cleveland, OH, USA.
| | - Sankar D Navaneethan
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Jesse D Schold
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. .,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
| | - Susana Arrigain
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
| | - Victoria Konig
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
| | - Yvette K Burrucker
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Jennifer Hyland
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Priscilla Dann
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Barbara H Tucky
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - John W Sharp
- Health Informatics Program, Kent State University, Kent, OH, USA.
| | - Joseph V Nally
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Tan CHH, Wilson S, McConigley R. Experiences of cancer patients in a patient navigation program: a qualitative systematic review. ACTA ACUST UNITED AC 2015; 13:136-68. [DOI: 10.11124/jbisrir-2015-1588] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 10/31/2022]
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Gotlib Conn L, Hammond Mobilio M, Rotstein O, Blacker S. Cancer patient experience with navigation service in an urban hospital setting: a qualitative study. Eur J Cancer Care (Engl) 2014; 25:132-40. [DOI: 10.1111/ecc.12247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - O.D. Rotstein
- St. Michael's Hospital; Toronto Canada
- Department of Surgery; Faculty of Medicine; University of Toronto; Toronto Canada
- Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto Canada
| | - S. Blacker
- Cancer Services Planning and Performance; St. Michael's Hospital; Toronto Canada
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Gabitova G, Burke NJ. Improving healthcare empowerment through breast cancer patient navigation: a mixed methods evaluation in a safety-net setting. BMC Health Serv Res 2014; 14:407. [PMID: 25234963 PMCID: PMC4177686 DOI: 10.1186/1472-6963-14-407] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 09/15/2014] [Indexed: 12/02/2022] Open
Abstract
Background Breast cancer mortality rates in the U.S. remain relatively high, particularly among ethnic minorities and low-income populations. Unequal access to quality care, lower follow up rates, and poor treatment adherence contribute to rising disparities among these groups. Healthcare empowerment (HCE) is theorized to improve patient outcomes through collaboration with providers and improving understanding of and compliance with treatment. Patient navigation is a health care organizational intervention that essentially improves healthcare empowerment by providing informational, emotional, and psychosocial support. Patient navigators address barriers to care through multilingual coordination of treatment and incorporation of access to community services, support, and education into the continuum of cancer care. Methods Utilizing survey and qualitative methods, we evaluated the patient navigation program in a Northern California safety-net hospital Breast Clinic by assessing its impact on patients’ experiences with cancer care and providers’ perspectives on the program. We conducted qualitative interviews with 16 patients and 4 service providers, conducted approximately 66 hours of clinic observations, and received feedback through the self-administered survey from 66 patients. Results The role of the patient navigator at the Breast Clinic included providing administrative assistance, psychosocial support, improved knowledge, better understanding of treatment process, and ensuring better communication between patients and providers. As such, patient navigators facilitated improved collaboration between patients and providers and understanding of interdisciplinary care processes. The survey results suggested that the majority of patients across all ethnic backgrounds and age groups were highly satisfied with the program and had a positive perception of their navigator. Interviews with patients and providers highlighted the roles of a navigator in ensuring continuity of care, improving treatment completion rates, and reducing providers’ workload and waiting time. Uncertainty about the navigator’s role among the patients was a weakness of the program. Conclusions Patient navigation in the Breast Clinic had a positive impact on patients’ experiences with care and healthcare empowerment. Clarifying uncertainties about the navigators’ role would aid successful outcomes.
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Affiliation(s)
| | - Nancy J Burke
- Department of Anthropology, History, and Social Medicine and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
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Phillips SS, Tom LS, Bularzik C, Simon MA. Time and Motion Study of a Community Patient Navigator. AIMS Public Health 2014; 1:51-59. [PMID: 29546075 PMCID: PMC5689794 DOI: 10.3934/publichealth.2014.2.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/31/2014] [Indexed: 11/22/2022] Open
Abstract
Research on patient navigation has focused on validating the utility of navigators by defining their roles and analyzing their effects on patient outcomes, patient satisfaction, and cost effectiveness. Patient navigators are increasingly used outside the research context, and their roles without research responsibilities may look very different. This pilot study captured the activities of a community patient navigator for uninsured women with a positive screening test for breast cancer, using a time and motion approach over a period of three days. We followed the actions of this navigator minute by minute to assess the relative ratios of actions performed and to identify areas for time efficiency improvement to increase direct time with patients. This novel approach depicts the duties of a community patient navigator no longer fettered by navigation logs, research team meetings, surveys, and the consent process. We found that the community patient navigator was able to spend more time with patients in the clinical context relative to performing paperwork or logging communication with patients as a result of her lack of research responsibilities. By illuminating how community patient navigation functions as separate from the research setting, our results will inform future hiring and training of community patient navigators, system design and operations for improving the efficiency and efficacy of navigators, and our understanding of what community patient navigators do in the absence of research responsibilities.
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Affiliation(s)
- Sara S Phillips
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.,Rush Medical College, Chicago, IL, 60612, USA
| | - Laura S Tom
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Melissa A Simon
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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Bensink ME, Ramsey SD, Battaglia T, Fiscella K, Hurd TC, McKoy JM, Patierno SR, Raich PC, Seiber EE, Mears VW, Whitley E, Paskett ED, Mandelblatt JS. Costs and outcomes evaluation of patient navigation after abnormal cancer screening: evidence from the Patient Navigation Research Program. Cancer 2014; 120:570-8. [PMID: 24166217 PMCID: PMC3946403 DOI: 10.1002/cncr.28438] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/01/2013] [Accepted: 08/21/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Navigators can facilitate timely access to cancer services, but to the authors' knowledge there are little data available regarding their economic impact. METHODS The authors conducted a cost-consequence analysis of navigation versus usual care among 10,521 individuals with abnormal breast, cervical, colorectal, or prostate cancer screening results who enrolled in the Patient Navigation Research Program study from January 1, 2006 to March 31, 2010. Navigation costs included diagnostic evaluation, patient and staff time, materials, and overhead. Consequences or outcomes were time to diagnostic resolution and probability of resolution. Differences in costs and outcomes were evaluated using multilevel, mixed-effects regression modeling adjusting for age, race/ethnicity, language, marital status, insurance status, cancer, and site clustering. RESULTS The majority of individuals were members of a minority (70.7%) and uninsured or publically insured (72.7%). Diagnostic resolution was higher for navigation versus usual care at 180 days (56.2% vs 53.8%; P = .008) and 270 days (70.0% vs 68.2%; P < .001). Although there were no differences in the average number of days to resolution between the 2 groups (110 days vs 109 days; P = .63), the probability of ever having diagnostic resolution was higher for the navigation group versus the usual-care group (84.5% vs 79.6%; P < .001). The added cost of navigation versus usual care was $275 per patient (95% confidence interval, $260-$290; P < .001). There was no significant difference in stage distribution among the 12.4% of patients in the navigation group vs 11% of the usual-care patients diagnosed with cancer. CONCLUSIONS Navigation adds costs and modestly increases the probability of diagnostic resolution among patients with abnormal screening test results. Navigation is only likely to be cost-effective if improved resolution translates into an earlier cancer stage at the time of diagnosis.
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Affiliation(s)
- Mark E. Bensink
- Research and Economic Assessment in Cancer and Healthcare Group, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Scott D. Ramsey
- Research and Economic Assessment in Cancer and Healthcare Group, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tracy Battaglia
- Women’s Health Unit, Department of Medicine and Women’s Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Thelma C. Hurd
- School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - June M. McKoy
- Departments of Medicine and Preventative Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Steven R. Patierno
- George Washington University Cancer Institute, Washington, District of Columbia
| | | | - Eric E. Seiber
- College of Public Health, Ohio State University, Columbus, Ohio
| | - Victoria Warren Mears
- Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, Oregon
| | | | | | - Jeanne S. Mandelblatt
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
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Paediatric Patient-Centred Care: Evidence and Evolution. PAEDIATRIC PATIENT AND FAMILY-CENTRED CARE: ETHICAL AND LEGAL ISSUES 2014. [DOI: 10.1007/978-1-4939-0323-8_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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