Patient Navigation

1. Patient Navigation Jennifer Klemp, PhD, MPHAssistant Professor of Medicine, Division of Clinical OncologyAssociate Director, Breast Cancer Survivorship Center The University of Kansas Cancer Center

2. Navigation: Points of Intervention • Early Detection • Cancer Screening • Pap test • Mammogram • FOBT • Colonoscopy • PSA/DRE • Awareness of cancer risk, signs, symptoms • Informed decision making • Survivorship • Long-term follow-up/ surveillance • Manage Late-effects • Rehabilitation • Coping • Health Promotion • Secondary- Prevention • Diagnosis • Oncology/Surgery consultation • Tumor Staging • Patient counseling & decision making • Clinical Trials • Prevention • Diet/Exercise • Sun Exposure • Alcohol • Tobacco Control • Chemoprevention • Treatment • Chemotherapy • Surgery • Radiation • Symptom Management • Psychosocial care NCI Cancer Control Continuum 2005

3. Barriers Freeman HP, Reuben SH. Voices of a Broken System. Bethesda, Md: NIH, NCI; 2001.

4. What Is Patient Navigation? • Patient navigation: • Supports patients in need of assistance with one-on-one contact • Strives to ensure that all patients have: • Education, instruction, resolution, assist with transition, support, access to resources • Utilizes a patient navigator to move patients through the health care system • Works within the organization and through external services to address barriers to health care Freeman HP. Oncol Issues. September/October 2004;19:44-46.

5. The Evolution of Patient Navigation The patient navigator concept grew out of the 1989 American Cancer Society’s national hearings on cancer and the poor, highlights included: • Gaps in service • fragmentation of care • delayed and/or missed appointments • Substantial barriers to care: • Financial • Lack of social support • Financial—insurance • Lack of social support

6. Goal of a Patient Navigation Program • The main goal of patient navigation is to save lives from cancer by: • Providing outreach and education about cancer and cancer screening • Eliminating barriers to care • Ensuring timely delivery of services Freeman HP. Oncol Issues. September/October 2004;19:44-46.

7. Patient and Family Benefits of Patient Navigation Programs • Provide emotional support • Help prepare patients for the cancer journey • Ease the referral process with health care professionals • Help coordinate appointments • Assist with logistics in getting care • Help find resources (eg, transportation, medications, supplies) • Refer patients to community resources Cancer Patient Navigation―Evaluation Findings, Summary Report. March 2004. Cancer Care Nova Scotia; 2004.

8. Health Care System Benefits of Patient Navigation Programs • Better patient preparedness • Greater support for patients • Improved collaboration among the health care professionals • More efficient clinical involvement with patients • Identification of service gaps • Increased patient satisfaction • Enhanced relationships with the community Cancer Patient Navigation―Evaluation Findings, Summary Report. March 2004. Cancer Care Nova Scotia; 2004.

9. Patient Navigation’s Guiding Principles • The guiding principles of patient navigation are to ensure that quality, confidentiality, and professionalism are threaded throughout all aspects of care and programming. Inherent in the process is continuous quality care for patients from screening through diagnosis and treatment, based on the following tenets: • Culturally competent care • Confidentiality • Respect • Compassion • Patient safety Freeman HP. Oncol Issues. September/October 2004;19:44-46.

10. Patient Navigator Programs • A survey by the National Cancer Institute in 2003 found more than 200 cancer programs nationwide with some form of patient navigation • Healthcare navigators include trained social workers, nurses, nurse practitioners, lay persons, volunteers • Programs vary in approach: • Face to face meeting • Phone connection • Internet

11. Need for Patient Navigation • Today’s Cancer Experience • Patients/ families self-navigate through the complex health care system • Patients face the stigma of a cancer diagnosis, increased complexity of the community’s understanding of the disease, multifaceted treatment, and fear of dying • The good news: better treatment means more cures and quality of life but… • Care coordination is necessary to lead cancer patients through the complex decision-making process

12. Navigation Left Largely to the Patient

13. Role of Patient Navigators • Throughout the cancer care continuum, patient navigators: • Circumvent bureaucratic barriers • Act as proactive patient advocates • Remove obstacles to prompt diagnosis and treatment Freeman HP, et al. Cancer Pract.1995;3:19-30.

14. Patient Navigator Roles May Include: Guide patients through the health care system Coordinate services Assist with increasing patient’s access to care Facilitate appropriate insurance applications Assist with access to community and social support services Work with community groups to increase cancer health awareness and provide cancer health education

15. Patient Navigators: Multidisciplinary Services Roles • Assist with identifying, applying, and using appropriate social services • Help patients identify and obtain financial help • Help patients arrive on-time and are prepared for scheduled appointments • Provide education, counseling, and emotional support • Facilitate interaction among and communication with health care staff and providers

16. Multidisciplinary Service Roles Cont…. Connect patients with resources and support systems Streamline appointments and paperwork – track interventions and outcomes Answer and/or triage general cancer questions Interpret medical and insurance information Follows patient throughout the disease process Coordinate re-entry after treatment

17. Functions Patient Navigators Do NOT Perform • Direct patient care • Physical assessment, diagnosis, or treatment • Ordering of care, treatments, or medications • Physical, occupational, or speech therapy

18. Patient Navigator Involvement Because of their intricate involvement in so many aspects of the multidisciplinary care process, navigators are often seen as integral part of the cancer care team.

19. Patient Navigator Programs:Results to Date • Improved patient care • Increased patient and physician satisfaction • Decreased time to diagnosis and treatment • Decreased fragmentation of care • More efficient delivery of care

20. Results to Date cont: • With adequate emotional and informational support, patients are better prepared for treatment and survivorship • Improved patient self-efficacy • Reduced patient use of emergency resources and specialist’s time

21. Step 1:Assess need for implementation Step 2:Enlist internal support Step 3a:Evaluate potential obstacles toimplementation; brainstormfor solutions Step 3c:Collect baseline data for needsassessment and evaluation Step 3b:Determine program scope, cost, andimplementation strategy Step 4:Implement program and identifya patient navigator Task: Prepare documents (eg, posters, brochures, policies, procedures, forms) Task:Implement support systems,referral processes, outreachstrategies Task:Track responses, appointments,and other relevant data Step 5:Assess program effectiveness Implementing a Navigation Program Task:Coordinate program planningwith appropriate departments HANYS BCDP™. Breast Health Patient Navigator Resource Kit. Rensselaer, NY: HANYS; 2002.

22. Developing a Patient Navigator Program • Conduct a needs assessment: patients, staff, & providers • Develop a Navigation/Survivorship Working Group • Identify champions and collaborators • Identify collaborators involved in caring for patients • Define program goals, objectives, and time frame • Formulate a patient navigator role description

23. Developing a Patient Navigator Program Identify potential costs and working budget • Grant funding, philanthropy, internal support • Develop tools: • Intake form • Tracking system/follow-up log • Decision tree/algorithm • Brochures describing the program • Identify program evaluation methods/outcomes • Formulate outreach strategies

24. Where Can Navigation Be Implemented? • Organizations providing care within the cancer continuum • Hospitals • Clinics (Specialty Clinics too) • Screening centers • Community not-for-profits • Oncology and radiation therapy offices • Organizations with an underserved population • Organizations wishing to provide a premier cancer care center delivery model

25. Determining If Patient Navigation Is Appropriate for Your Organization • Patient demographics • Statistics concerning patient populations • Defined Outcomes • Percentage of patients who complete a plan to resolution • Screening or High Risk Populations • Recruitment & retention onto clinical trials • Survivorship (chronic care model) • Palliative Care/Hospice

26. Summary • Navigation can play a role in any clinical/research setting • Essential for today fragmented health care model • Requirement for national accreditation • Improves patient care!! Thank You For Your Time