Understanding Patient Navigation in Oncology: Key Concepts and Competencies
Providing an overview of patient navigation in oncology, this educational material covers social determinants of health, patient navigation history, core competencies, and models in the field. Supported by the CDC, it discusses disparities in healthcare access and the impact on medically underserved populations, particularly in cancer care.
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An Overview of Patient Navigation and Competencies Oncology Patient Navigator Training: The Fundamentals
Acknowledgments This work was supported by the Cooperative Agreement #1U38DP004972-02 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. We would also like to thank: The Colorado Coalition for the Medically Underserved for giving us permission to use their video. The American Association for Cancer Research for giving us permission to use their video.
Learning Objectives Describe social determinants of health and health disparities Define patient navigation Discuss the history and evolution of patient navigation Explain models of patient navigation Discuss the process for developing the Core Competencies for Patient Navigators
Social Determinants of Health & Health Disparities Let s start our discussion of patient navigation by talking about social determinants of health and health disparities.
Social Determinants of Health BORN LIVE Health LEARN Functioning WORK Quality of Life PLAY WORSHIP AGE
Social Determinants of Health Source: Department of Health and Human Services, n.d.
Social Determinants of Health Video Click here to watch the video Source: Center for Health Progress, 2013
Medically Underserved Populations Underinsured or uninsured Low levels of education Rural and inner-city Low Unemployed LGBTQ socioeconomic status (SES) Source: Haynes & Smedley, 1999.
Cancer Health Disparities Adverse differences in cancer incidence (new cases), cancer prevalence (all existing cases), morbidity (cancer-related health complications), cancer mortality (deaths), cancer survivorship and burden of cancer or related health conditions that exist among specific population groups in the United States. Source: National Cancer Institute, 2015.
Cancer Health Disparities Video Click here to watch the video Source: American Association for Cancer Research, 2011
Factors that Contribute to Cancer Health Disparities Lack of medical coverage Barriers to early detection and screening Unequal access to improvements in treatment Socioeconomic status Stigma Source: National Cancer Institute, 2015
Health Equity The absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically. Source: World Health Organization, n.d.
Patient Navigation Now let s talk about the definition of patient navigation, some key milestones and models of patient navigation.
Patient Navigation Patient Navigation is an intervention that addresses barriers to quality standard care by providing individualized assistance to patients, survivors and families.
The First Patient Navigation Program 5-Year Survival Late Stage Diagnosis 80% 60% 70% 70% 49% 50% 60% 40% 50% 39% 40% 30% 21% 30% 20% 20% 10% 10% 0% 0% Before After Before After Source: Freeman et al., 2011.
The First Patient Navigation Program: A Summary A Summary of the American Cancer Society Report to the Nation: Cancer in the Poor
The First Patient Navigation Program Barrier Addressed By Access to screenings Providing free and low cost exams and mammograms Access to timely care Hiring patient navigators Source: Freeman et al., 2011
Milestones in Patient Navigation: 1971-1999 1999: 1989: 1971: National Cancer Act- declares War on Cancer The Unequal Burden of Cancer (IOM/NAM) Cancer in the Poor: A Report to the Nation (ACS) 1986: 1990: Special Report on Cancer in the Economically Disadvantaged (ACS) Dr. Freeman launches patient navigation program in Harlem, NY Source: Blaseg et al., 2014
Milestones in Patient Navigation: 2000-2009 Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (IOM/NAM) 2003: 2000: Assessing the Past, Chartering the Future (President s Cancer Panel) 2009: AONN+ launched 2001: Voices of a Broken System: Real People, Real Problems (President s Cancer Panel) 2005: Patient Navigator Outreach and Chronic Disease Act; NCI launches Patient Navigation Research Program Source: Blaseg et al., 2014
Milestones in Patient Navigation: 2010-2014 2010: Release of Joint Position on the Role of Oncology Nursing and Oncology Social Work in Patient Navigation; Affordable Care Act passed 2013: Oncology Nursing Society publishes Oncology Nurse Navigator Core Competencies 2012: 2014: New patient navigation standards from American College of Surgeons Commission on Cancer The George Washington Caner Center publishes Core Competencies for Non- Clinically Licensed Patient Navigators Source: Blaseg et al., 2014
Models of Patient Navigation Type of Organization Cancer program Community organization Hybrid Number of Navigators Continuum of Care Cancer Type Patient Type One More than one Across continuum of care Points in continuum of care Screening Treatment Survivorship Recurrence End of Life One/a few Many/ any type All patients High-need patients
Background of Navigators Social Work Nurse Non- Clinically Licensed Volunteer
Patient Navigation Competencies Now that you know more about the history and evolution of patient navigation, let s talk about patient navigation competencies.
Why Competencies? Creates professional standards Provides framework for training Clarifies function and importance to: Grantors Organizations Payors Policymakers
Competency and Training Development Identify roles & responsibilities Write Create training competencies
Competency and Training Development Academy of Oncology Nurse & Patient Navigators National Association of Social Workers Oncology Nursing Society Association of Oncology Social Workers Association of Community Cancer Centers Patient navigators and CHWs
Identify Roles and Responsibilities Patient navigation training curricula Journal articles on roles/responsibilities/ competencies/ tasks/ activities for CHWs, patient navigators, nurse/social worker navigators CHW, nurse navigator competencies
Functional Domains Professional Roles/ Responsibilities Patient Empowerment Cultural competency Communication Ethics & Professional Conduct Education, Prevention & Health Promotion Psychosocial Support Services / Assessment Barriers to Care / Health Disparities Community Resources Outreach Care Coordination Advocacy
Asking Patient Navigators Advocacy Barriers Basic skills Care coordination Communication Cultural sensitivity Ethics Evaluation Patient assessment Patient education Program development Resources Role delineation
Write Competencies Team wrote them Experts reviewed them > 500 professionals who work in cancer patient navigation gave feedback on them
Competencies Domains Patient Care (6) Knowledge for Practice (6) Practice-Based Learning (7) Interpersonal and Communication Skills (8) Professionalism (8) Systems-Based Practice (3) Interprofessional Collaboration (3) Personal and Professional Development (4)
Create Competency-Based Training Free 7 modules, 19 lessons Interactive Comprehensive Reviewed by experts
Acknowledgments The Pfizer Global Health Partnerships Program funded our original live trainings. The Avon Foundation for Women partially supported the development of our functional domains and competencies. Steering Committee Competency Reviewers Training Reviewers
Conclusion Describe social determinants of health and health disparities Define patient navigation Discuss the history and evolution of patient navigation Explain models of patient navigation Discuss the process for developing the Core Competencies for Patient Navigators
References American Association for Cancer Research. (2011). Cancer health disparities: Challenges and opportunities. [YouTube]. https://www.youtube.com/watch?v=0C5KEoydluc Blaseg, K. D., Daugherty, P., & Gamblin, K. A. (2014). Oncology nurse navigation: Delivering patient centered care across the continuum. Pittsburg (PA): Oncology Nursing Society. ISBN 10:1935864351. Center for Health Progress. (2013). Social determinants of health. [YouTube]. https://www.youtube.com/watch?v=I7iSYi3ziTI&index=3&list=PLAO0U2GXUBQFyPdyzgZ1h4cljJp7c aG8h Colorado Coalition for the Medically Underserved. [CCMU]. (2003). Social determinants of health [Video file]. https://www.youtube.com/watch?v=I7iSYi3ziTI&index=3&list=PLAO0U2GXUBQFyPdyzgZ1h4cljJp7c aG8h. Department of Health and Human Services. (n.d.). Social determinants of health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health Freeman, H. P., & Rodriguez, R. L. (2011). History and principles of patient navigation. Cancer, 117(15 Suppl):3539 3542. doi: 10.1002/cncr.26262.
References (cont.) Institute of Medicine (US) Committee on Cancer Research Among Minorities and the Medically Underserved. (1999). The burden of cancer among ethnic minorities and medically underserved populations. In Haynes MA, Smedley BD (Eds.). The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. Washington (DC): National Academies Press (US). ISBN 10: 0 309 07154 2. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK1788/. National Cancer Institute. (2015). Cancer health disparities definitions. http://www.cancer.gov/aboutnci/organization/crchd/about health disparities/definitions. National Cancer Institute. (2008). Cancer health disparities. http://www.cancer.gov/cancertopics/factsheet/disparities/cancer health disparities. National Cancer Institutes. (2015). Cancer health disparities. https://www.cancer.gov/about- nci/organization/crchd/about-health-disparities/definitions National Cancer Institute. (2015). Patient navigation research program (PNRP). http://www.cancer.gov/aboutnci/organization/crchd/disparities research/pnrp. World Health Organization. (n.d.a.) Equity. http://www.who.int/healthsystems/topics/equity/en/
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