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Cancer Navigation: A Discussion on Barriers and Obstacles All Clinical Navigators Face

Cancer Navigation: A Discussion on Barriers and Obstacles All Clinical Navigators Face. Sharon Gentry RN, MSN, AOCN, CBCN Breast Nurse Navigator Derrick L Davis Forsyth Regional Cancer Center. Objectives. Identify common types of barriers that healthcare clinical navigators may face.

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Cancer Navigation: A Discussion on Barriers and Obstacles All Clinical Navigators Face

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  1. Cancer Navigation: A Discussion on Barriers and Obstacles All Clinical Navigators Face Sharon Gentry RN, MSN, AOCN, CBCN Breast Nurse Navigator Derrick L Davis Forsyth Regional Cancer Center

  2. Objectives • Identify common types of barriers that healthcare clinical navigators may face. • Explore solutions to address the barriers • Share experiences among navigators on overcoming healthcare barriers

  3. Defining barriers Barriers to health care are obstacles within our health care system that prevent vulnerable patient populations from getting needed health care, or that cause them to get inferior health care compared to advantaged patient populations. American Medical Student Association Foundation by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Medicine and Dentistry. http://www.amsa.org/programs/barriers/intro.html

  4. Potential Barriers toReceiving Timely Health Care Barrier Examples Freeman HP, Reuben SH. Voices of a Broken System. Bethesda, Md: NIH, NCI; 2001.

  5. Types of Barriers • Geographic/Cultural • Socioeconomic • Organizational/Systemic ***Combination of above factors are likely to increase disparities of care • Navigator role specific

  6. Geographic/Cultural

  7. Geographic/Cultural • Rural, suburban, inner-city….. • Veterans, Baby boomers, generations X, Y & Z • health beliefs and behaviors • Patient beliefs as well as practitioner beliefs

  8. Geographic/Cultural Language Bias Fears Care Information

  9. Health Literacy • “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” US Dept of Health and Human Sciences Teach back method http://minorityhealth.hhs.gov/templates http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf

  10. Examples

  11. Following directions

  12. Methods Commonly Used In U.S. Hospitals To Provide Language ServicesSource: Health Research and Educational Trust, 2006Robert Wood Foundation

  13. One solution

  14. Implicit Bias in Healthcare Unconscious (Implicit) Bias and Health Disparities: Where Do We Go from Here? Perm J. 2011 Spring; 15(2): 71–78. https://implicit.harvard.edu

  15. Socioeconomic barriers“drivers of healthcare disparities” • lack of health insurance • inability to pay out of pocket – transportation, child care • Inadequate education • Employment issues • Psychosocial concerns

  16. What is the socioeconomic status of the navigated population? • Who are the people? • Community profile 2015 Commission on Cancer requirement • Komen report • Census data • EMPLOYMENT STATUS COMMUTING TO WORK OCCUPATION INDUSTRY CLASS OF WORKER INCOME AND BENEFITS • HEALTH INSURANCE COVERAGE • BELOW THE POVERTY LEVEL http://factfinder2.census.gov/faces/tableservices/

  17. Psychosocial Concerns • Fear • Mistrust • Emotions • Distress – *Distress monitoring for Commission on Cancer by 2015

  18. Organizational/Systemic

  19. Organizational/Systemic Accessibility – • How accessible is your care ? Can the patient find it? • Physical barriers Accessible toilet and dressing rooms http://www.cdc.gov/ncbddd/disabilityandhealth/accessibility.html • Timely access for all

  20. Organizational/Systemic Communication • “Removing Barriers to Health Care A Guide for Health Professionals” http://projects.fpg.unc.edu/~ncodh/rbar/ • Insufficient cultural sensitive information Drop-out – give up in misunderstanding or frustration

  21. Organizational/Systemic • Unspoken rules • Chain of command • Guarded reactions

  22. Navigation as a Solution • Being there…trust • Negative research (clinical trial) experiences

  23. Unspoken Rules • Family members are usually expected to keep problems a secret...

  24. Navigator role specific • Role definition • Acceptance by leaders and peers • Job sustainability

  25. Barrier Solution • Cancer Patient Navigation Programs are designed to help patients receive the best care possible. And they help the team that serves patients provide better care. Cancer Patient Navigation is not the cure for the disease, but it can be the lifesaver for the patient.

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