Developing a provincial cancer patient navigation program utilizing a quality improvement approach Part two: Developing a Navigation Education Framework

The impact of socioeconomic inequality on access to health care for patients with advanced cancer: A qualitative study

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.

Cancer Patient Navigation in Canada: Directions From the North

OBJECTIVES

Cancer is a complex disease that is experienced by those affected by cancer and their loved ones differently. The importance of cancer patient navigation is quintessential to support those affected through the healthcare system and to supportive resources. Canadian cancer statistics advise of the continued increase of cancer and impacts on health care. With Canada being a large geographical area, large portions of the population live in rural and remote areas with decreased access to health services. In Canada, cancer navigation is different across the country; each province's or territory's health authority creates their own cancer navigation program based on the needs of their patients. This report aims to provide an overview of cancer in Canada, along with the different navigation programs available nationally. Additionally, it will review the role the Canadian Association of Nurses in Oncology/Association canadienne des infirmières en oncologie (CANO/ACIO) plays in creating a community of practice to support cancer patient navigators across the country.

METHODS

The information on various provincial and territorial navigation programs was obtained through discussion with the CANO/ACIO Navigation Special Interest Group (SIG). All provinces and territories were interviewed with the exception of Quebec, Prince Edward Island, Nunavut, and Yukon.

RESULTS

While the vast majority of navigation has a similar core intent, there are many differences between the provinces and territories in the navigation programs. These differences are based on geographical need and the individual health authorities.

CONCLUSIONS

The Canadian Association of Nurses in Oncology/Association canadienne des infirmières en oncologie (CANO/ACIO) provides a community for cancer navigators to connect through a Special Interest Group (SIG), meeting virtually monthly to support each other across Canada to collaborate, identify issues, trends, and challenges.

IMPLICATIONS FOR NURSING PRACTICE

Cancer patient navigation is a valuable resource for all individuals with cancer and their loved ones, particularly when faced with difficulties accessing care in rural and remote areas. Cancer patient navigators' scope is similar in intent, despite potential differences in programs. By connecting with other navigators through the CANO/ACIO navigation SIG, navigators across the country can provide a connection to discuss program similarities and barriers and opportunities for cancer navigation programs to work together to support each other and evolve their programs to meet the needs of their provincial and territorial residents.

An integrative review on the oncology nurse navigator role in the Canadian context

Several Canadian provincial cancer agencies have adopted a nurse-led model of patient navigation to decrease care fragmentation in the system. The scope of competencies of the oncology nurse navigator (ONN) in Canada has evolved over the years in response to emerging cancer care challenges. This integrative review aimed to outline the scope of competencies of the ONN role in Canada. Three databases were searched since its inception to identify Canadian studies or theoretical papers on the role of ONNs. The search yielded 62 articles of which 39 were included in the review. Three interdependent role domains were identified. The first domain of care coordinator highlighted the ONN as a coordinator of health and practical needs along the care journey. The second framed the ONN as a change agent, through increasing patients' health literacy, creating partnerships, and trusting relationships. ONNs were also described as a supporter of wellbeing, or a champion of emotional, multidimensional needs, and a transformer of the context of care. All domains were central to the navigator's success in addressing inequities in care and improving patient outcomes across care settings.

Revue intégrative sur le rôle de l’infirmière pivot en oncologie dans le contexte canadien

Plusieurs organismes provinciaux canadiens de lutte contre le cancer ont adopté un modèle de navigation des patients dirigé par des infirmières afin de réduire la fragmentation des soins dans le système. Au Canada, le champ de compétences de l’infirmière pivot en oncologie (IPO) a évolué en fonction des nouveaux défis liés aux soins. La présente revue intégrative vise à définir le champ de compétences de l’IPO au Canada. Trois bases de données ont été consultées dès le début afin de recenser les études et les articles théoriques sur le rôle de l’IPO au Canada. Cette recherche a produit 62 articles, dont 39 ont été retenus, permettant de dégager trois fonctions principales interdépendantes. La première concerne la coordination des soins et met en évidence le rôle de l’IPO en tant que coordonnatrice des besoins médicaux et pratiques des patients tout au long de leur parcours de soins. La deuxième fait de l’IPO une agente de changement ayant pour mission d’améliorer les connaissances médicales des patients, de créer des partenariats et d’instaurer des relations de confiance. Les IPO sont également perçues comme des garantes du bien-être, toujours soucieuses des besoins émotionnels et multidimensionnels, et comme des vecteurs de transformation des milieux de soins. Toutes ces fonctions jouent un rôle important pour que l’infirmière pivot parvienne à réduire les inégalités de soins et à améliorer le devenir des patients dans tous les milieux de soins.

Création d’un programme provincial de navigation santé pour les patients atteints de cancer à l’aide d’une approche d’amélioration de la qualité Troisième partie – Évaluation du programme et analyse des résultats

En 2012, l’agence provinciale du cancer de l’Alberta lançait un projet d’amélioration de la qualité dans le but de créer, de mettre en oeuvre et d’évaluer un programme provincial de navigation pour patients cancéreux englobant 15 établissements répartis sur plus de 600 000 kilomètres carrés. Ce projet a été sélectionné pour recevoir un financement de deux ans (d’avril 2012 à mars 2014) de l’Alberta Cancer Foundation (ACF) accordé à la suite d’un processus de subvention pour améliorer les soins (Enhanced Care Grant). Une série d’articles a été rédigée pour capturer l’essence de ce projet d’amélioration de la qualité des processus amorcés, des normes élaborées, du cadre éducatif déterminant l’orientation du nouveau personnel navigateur et des résultats mesurés. Le premier article de la série portait sur la base de connaissances ayant guidé l’élaboration du programme provincial de navigation et sur la méthodologie employée pour mettre le programme en oeuvre dans 15 centres de soins du cancer situés en région rurale ou en milieu urbain isolé (Anderson et al., 2016 ). Le deuxième article a approfondi le cadre éducatif conçu pour guider l’acquisition des compétences et le processus d’orientation des infirmières (et infirmiers) autorisées engagées pour remplir le rôle d’intervenant pivot auprès des patients cancéreux. Il a également exposé comment le cadre a évolué pour aider à ce que les navigateurs passent du statut de novice à celui d’expert. Le présent article, troisième et dernier de la série, explore les résultats obtenus grâce à ce projet d’amélioration de la qualité et se terminera par une section de discussion mettant en lumière les principales leçons retenues, les mesures d’adaptation mises en place, ainsi que les prochaines étapes en cours pour étendre la portée et les effets du programme provincial de navigation.