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Using navigators to improve care of underserved patients: Current practices and approaches

Institute for Health Policy Studies and Department of Anthropology, History, and Social Medicine, University of California-San Francisco, CA 94118, USA.
Cancer (Impact Factor: 4.9). 09/2005; 104(4):848-55. DOI: 10.1002/cncr.21214
Source: PubMed

ABSTRACT Logistic, cultural, educational, and other barriers can impede the delivery of high-quality cancer care to underserved patients. Patient navigation services represent one innovation for addressing perceived barriers to care encountered by disadvantaged patients. In this report, the authors have 1) defined patient navigation, distinguishing it from other cancer support services; 2) described how programs are organized; and 3) discussed the need for research on program effectiveness.
Information was examined on navigation programs published in the scientific literature and on line. Qualitative research also was conducted, consisting of direct observation of patient care in cancer clinics with and without navigators in northern California, in-person interviews with personnel and patients in the clinics observed, and telephone interviews with navigators at four sites across the United States.
The authors found that navigation services have been implemented at all stages of cancer care: prevention, screening, treatment, and survival. Navigators differ from other cancer support personnel in their orientation toward flexible problem solving to overcome perceived barriers to care rather than the provision of a predefined set of services. There are no rigorous demonstrations of the effects and effectiveness of navigation, although such studies are underway.
Currently, patient navigation is understudied, and literature documenting its effects and effectiveness is scant. Rigorous studies are needed of the navigator role and program costs and benefits. Such studies will facilitate an assessment of program effectiveness, feasibility across a range of health care settings, and performance relative to alternative approaches for addressing barriers to care among the underserved.

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    • "Three patient navigators were interviewed. These were M¯ aori and worked for M¯ aori organizations (a patient navigator is someone who assists the patients and their family surmount barriers while negotiating the health system) (Dohan & Schrag, 2005). Navigators are being trialed in a number of places in New Zealand (Walker, Signal, Russell , Smiler, & Tuhiwai-Ruru, 2008). "
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    ABSTRACT: In New Zealand, support services have been developed in response to patient need but are variable. The benefits of psycho-social-spiritual care in reducing distress and enhancing quality of life for people with cancer and their families are well established yet unmet needs continue to feature. This project aimed to examine how health care professionals assessed for psycho-social-spiritual distress and unmet need, decisions on appropriate support, and identification of barriers in the referral process. A mixed-methods approach was used for this research. The qualitative phase entailed semistructured interviews with health care professionals working in cancer care. The quantitative phase was an online survey of oncologists and nurses. Thematic analysis was carried out by performing a side-by-side analysis of both sets of data. Nurses were most likely to assess for psycho-social-spiritual need and to refer to support services. Despite a clear mandate to provide regular psycho-social-spiritual assessment, there is no consistency of assessment and referral across New Zealand. There are clearly unmet psycho-social-spiritual needs among people affected by cancer in New Zealand, with health care professionals in this study noting structural impediments to adequate supportive care. There is a mismatch between the importance placed on such care and the capacity that is currently available. The results of this study provide evidence that can be used to argue for improvements in the infrastructure, funding allocation and policy that would allow for better psycho-social-spiritual care within the challenging context of increasing numbers of those affected by cancer.
    Journal of Psychosocial Oncology 11/2013; 31(6):659-74. DOI:10.1080/07347332.2013.835017 · 1.04 Impact Factor
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    • "Individual level health advocacy is increasingly being delivered by formally trained care professionals, including health navigators, consumer advocates, patient educators, home health nurses, personal trainers, and social workers who can be assigned to work with specific consumers to help promote the best possible health outcomes for these consumers. Research has shown that these health advocates can dramatically enhance health consumer satisfaction, understanding, quality of care, and important health outcomes [10] [11]. Individual level health advocates provide invaluable support for health care consumers to insure these consumers receive the best care and advice to promote their health and well-being. "
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    ABSTRACT: Health advocacy can make significant contributions to promoting global health by shaping health promotion programs that are responsive to the needs of consumers. Health care consumers have a major stake in the health care system, yet have had difficulty influencing health policies and practices due to the limited power typically afforded them within the modern health care system. Strategic health advocacy communication can help to recalibrate the balance of power in health care and health promotion efforts, facilitating important influences on health policies and practices, Health advocates can help make health programs responsive and adaptive to consumer needs by communicating consumers’ perspectives in compelling ways to key audiences using a variety of key media. This article describes the communication demands of effective health advocacy, the need to help advocates develop strategic communication knowledge and competencies, and presents a case study of the Global Advocacy Leadership Academy (GALA) program designed to promote effective health advocacy.
    International Journal on Advances in Life Sciences 06/2013; 5(1):66-78. · 14.20 Impact Factor
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    • "Within the emerging field of Patient Navigation (Thompson et al.), numerous models and approaches have been described including clinical (often nurse navigators), non-clinical (other health professionals and/or community health workers) navigation and mixed models which include both approaches (Burstein, 2009; Dohan & Schrag, 2005; Wells et al., 2008). Often these different models are implemented based on where along the cancer continuum the PN services are focused. "
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    ABSTRACT: Cancer patients face a myriad of psychosocial and practical issues. Especially challenging is the time from an initial diagnosis to the onset of treatment and patient navigation services are important to guide patients, especially underserved populations, through this maze of uncertainty. Here we report on the Pennsylvania Patient Navigator Demonstration Project (PaPND) designed to evaluate the acceptability, feasibility, and impact of a culturally and linguistically appropriate non-clinical navigator program. The development of the project, based on behavioral theory and community-based participatory research principles, is described. Forty-four cancer patients from diverse backgrounds participated, which included a baseline assessment, navigation services, and a four week and twelve week follow-up assessment. On average, participants experienced 1.8 barriers with transportation and insurance issues the most common barriers. The majority (56%) of the barriers required more than an hour of the navigator's time to address, with insurance, transportation and caregiver/support issues requiring the most time. Overall patients were fairly satisfied with the navigation services. The findings showed improvement patient's stress-related thoughts, cognition (understanding of their disease), expectancies and beliefs or values/goals, as well as self-efficacy of managing cancer related issues from the baseline to follow-up assessments. The evaluation results suggest that providing and connecting cancer patients to appropriate information to improve their understanding of their diagnosis and recommended treatments needs to be addressed, and where the integration of non-clinical and clinical navigation is essential. In addition, more attention to the assessment of psychosocial issues, such as the patients' emotional worries, and more comprehensive training in these areas would enhance navigation programs.
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