Article

Using Navigators to Improve Care of Underserved Patients

Institute for Health Policy Studies and Department of Anthropology, History, and Social Medicine, University of California-San Francisco, CA 94118, USA.
Cancer (Impact Factor: 4.89). 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.

Full-text preview

Available from: patientnavigatortraining.org
  • Source
    • "Cancer patient navigation (PN) is a process that provides individualized assistance to cancer patients, families, and caregivers to help overcome health-care system barriers and facilitate timely access to quality health and psychosocial care from pre-diagnosis through all phases of the cancer experience[27]. Patient navigators (PNs) assist patients in overcoming barriers to cancer screening and treatment, offer peer counseling , provide linkages to financial and community resources, and provide culturally competent patient education, particularly among (but not limited to) the underserved282930. PNs are increasingly being considered an important component to cancer care, and as such, the Commission on Cancer (CoC) is requiring CoC-accredited hospitals to include PN programs[31]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Centers for Disease Control and Prevention's (CDC) National Comprehensive Cancer Control Program (NCCCP) funds states, the District of Columbia, tribal organizations, territories, and jurisdictions across the USA develop and implement jurisdiction-specific comprehensive cancer control (CCC) plans. The objective of this study was to analyze NCCCP action plan data for incorporation and appropriateness of cancer survivorship-specific goals and objectives. In August 2013, NCCCP action plans maintained within CDC's Chronic Disease Management Information System (CDMIS) from years 2010 to 2013 were reviewed to assess the inclusion of cancer survivorship objectives. We used the CDMIS search engine to identify "survivorship" within each plan and calculated the proportion of programs that incorporate cancer survivorship-related content during the study period and in each individual year. Cancer survivorship objectives were then categorized by compatibility with nationally accepted, recommended strategies from the report A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies (NAP). From 2010 to 2013, 94 % (n = 65) of NCCCP action plans contained survivorship content in at least 1 year during the time period and 38 % (n = 26) of all NCCCP action plans addressed cancer survivorship every year during the study period. Nearly 64 % (n = 44) of NCCCP action plans included cancer survivorship objectives recommended in NAP. Nearly all NCCCP action plans addressed cancer survivorship from 2010 to 2013, and most programs implemented recommended cancer survivorship efforts during the time period. NCCCP grantees can improve cancer survivorship support by incorporating recommended efforts within each year of their plans.
    Full-text · Article · Mar 2015 · Journal of Cancer Survivorship
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Nov 2013 · Journal of Psychosocial Oncology
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jun 2013 · International Journal on Advances in Life Sciences
Show more