Defining the Roles of Patient Navigation Can Remove Barriers to Quality Care

VBCC - July 2012, Volume 3, No 5 - AVBCC Annual Conference
Caroline Helwick

Houston, TX—Patient navigation assures timely access to care for many patients, especially the medically underserved population, and it will soon become mandated for institutions accredited by the Commission on Cancer, reported Mandi Pratt-Chapman, MA, Associate Director of the Community Programs, Codirector of the Center for the Advancement of Cancer Survivorship, Navigation and Policy, George Washington Cancer Institute, Washington, DC, at the Second Annual Conference of the Association for Value-Based Cancer Care.

Patient navigation is a coordinated process that addresses barriers to quality care by providing individualized assistance to patients, survivors, and families, and facilitating timely access to services.

Patient navigation is a way to address healthcare disparities, and it serves as an antidote to the fragmented and complex healthcare system, Ms Pratt-Chapman maintained. The goal is to identify and eliminate barriers to care, and to provide culturally competent interventions based on specific population needs.

“We know that issues faced by patients with cancer can have devastating consequences, and the healthcare system at large is labyrinthine. Many patients must fight their way through this dysfunctional system, while trying to save their own lives,” she noted. “Navigation is not a cure-all, but it is an approach that helps.”

Evolution of Patient Navigation

Patient navigation was conceived in 1990 by Harold P. Freeman, MD, who observed socioeconomic and racial disparities for cancer care in Harlem. After access to screening and patient navigation, 5-year cancer survival rates improved from 39% to 70% (Freeman HP, et al. Cancer. 1989;63: 2562-2569). These positive results led to an expansion of the concept across the cancer continuum and to the inclusion of families and caregivers.

GWCI’s Framework for Longitudinal Patient Navigation.
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Navigators now include nurses, social workers, trained laypersons, and community health workers who serve in a variety of capacities at various points from screening into survivorship. The roles of navigators and the framework of the program at George Washington Cancer Institute are outlined in the Figure.

“Navigation suffers from lack of definition, but we are trying to anchor navigation in meeting each patient’s specific needs,” Ms Pratt-Chapman said. “We are not fixing the system. We are facing the reality of the system and helping patients navigate a system we know is broken.”

Navigators educate individuals about screening, diagnosis, and treatment; build partnerships in the community; facilitate access to clinical trials; coordinate appointments with providers; maintain communication between patients and providers; ensure that medical records are available for appointments; arrange for support services (ie, language, financial, transportation, child care, home healthcare); and help patients learn to navigate themselves.

Navigators, who are trained to recognize patients with special needs or barriers to care, answer different needs within the various clinical departments. At George Washington Cancer Institute, there are navigators in radiology, in the breast care center, in hematology, and one navigator that is shared by urology and radiation oncology. These individuals meet week ly to discuss cases that may overlap.

Ms Pratt-Chapman suggested that attendees at the session focus on barriers specific to their institutions and develop the appropriate navigation structure, with a clear scope of practice for the navigators. “Delineating these roles can be key to your success,” she said. “The determination of who should navigate should be determined by the skill level required.”

Current Impact, Future Trends More than 30 US sites have been evaluated by research programs funded by the National Cancer Institute, the Centers for Medicare & Medicaid Services, and the Health Resource and Services Administration. These projects showed that navigation significantly shortens the time to definitive diagnosis, reduces stress levels for patients, increases satisfaction, and improves care. There is some indication that time to treatment may be slightly prolonged, although “we believe this may reflect having second opinions and an improved understanding of treatment options,” Ms Pratt-Chapman suggested.

As for future trends, Ms Pratt- Chapman noted that institutions accredited through the Commission on Cancer must develop and institute a patient navigation process through a phased-in approach by 2015. “You will be asked to identify a patient navigation process using existing staff or new hires, but you will need to be responsive to the needs of your population, and be regularly evaluated,” she said. This requirement may “fill in gaps” because of the oncology workforce shortage, she added.

Policy papers are also in development that should raise awareness on the institutional and national levels, she added, and should provide an evidence basis for moving forward and to inform reimbursement practices.

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