A cancer diagnosis can be difficult to overcome at the best of times, but consider barriers related to language, insurance status, academic achievement, geographic location, income level, and more. , and the cancer journey – everything from prevention and screening to diagnosis. and processing – can become almost impossible to get through.
Enter the Patient Navigator – a specially trained health worker who provides one-on-one assistance to patients, families and caregivers negatively affected by health disparities to facilitate timely access to health and psychosocial care from quality.
Patient navigation is one of the few interventions that has been shown to increase access to and completion of cancer screening and treatment in populations affected by health care disparities, including racial and ethnic minority populations, immigrant and refugee populations, low-income populations. , and underserved rural populations.
Navigation Thought Leadership
In June, members and leaders of the University of Colorado Cancer Center and the Colorado School of Public Health (ColoradoSPH) were key contributors to a supplement to the American Cancer Society’s journal Cancer that described the impact of patient navigation and the critical role it plays in improving outcomes for cancer patients. The collection of 13 articles was published by the National Navigation Roundtable (NNRT), an organization chaired by Andrea Dwyer, director of the Colorado Cancer Screening Program (CCSP) at CU Cancer Center and senior professional research assistant at ColoradoSPH.
“Navigators can be in systems where treatment, prevention, early detection, and even survivorship care are deployed,” Dwyer says. “The articles talk about this continuum, but one of the things that’s at the heart of all the articles is, what do we know about how navigation is implemented? How are browsers funded? What population of patients serve?”
Dwyer is the lead author of the articles “Collective Pursuit for Equity in Cancer Care: The National Navigation Roundtable”, which describes the role of the NNRT and details recent advances in patient navigation, and “What Makes for Successful Patient Navigation Implementation in Cancer Prevention and Screening Programs Using an Evaluation and Sustainability Framework,” which explains the role of patient navigators in CCSP and the success of the program in increasing endoscopic screening in medically underserved populations.
“The best proof that navigation works is prevention and early detection,” says Dwyer. “Data is still emerging on the impact of navigation in the treatment domain and across the rest of the continuum.”
The effects of COVID-19
Patricia Valverde, PhD, MPH, Fellow of the CU Cancer Center, Clinical Assistant Professor of Community and Behavioral Health, and Acting Director of the Latino Policy and Research Center for ColoradoSPH, was lead author of the article “Flexibility, Adaptation, and Roles of Patient Navigators in Oncology during COVID-19,” which details findings from a nationwide survey conducted by NNRT to investigate the impact of COVID-19 on cancer care and patient navigation in the first six months. of the pandemic.
“Within our workforce, we were hearing stories of sailors losing their jobs, being furloughed, or not really being used at the very start of the pandemic,” says Valverde. “We thought it was crazy, because browsers should be on the front line. Their skills and knowledge should be used.
To learn more, NNRT created a survey that received over 200 responses from navigators whose duties had changed in the first half of 2020. Many moved away from cancer-related services and received new training on COVID -19 and telehealth. Always working within medically underserved communities, navigators addressed myths related to mask use, the spread of COVID-19, disbelief, risk, clinical changes, prevention of transmission , finance and politics.
“They all had new tasks related to the pandemic, which is great,” says Valverde. “That’s what we wanted. We wanted to see that navigators, because of their skills, could be flexible and adaptable and transition to talking to community members and patients about any type of situation.
Training and survival
Valverde is also director of the Patient Navigator Training Collaborative at the Center for Public Health Practice at Colorado SPH. One of the nation’s largest training centers for patient navigators, the center focuses on topics such as health promotion, motivational interviewing, professional boundaries, care coordination, and resource locating.
“Cancer treatment is so complicated, and the navigator guides the patient on what to expect next,” says Valverde. “It can help them understand test results or prepare for meetings with their doctors so they understand their treatment options. Navigators can also help with co-pay assistance or the cost of certain medications.
Survival has become a priority for sailors in recent years, says Valverde, as advances in treatment mean people with cancer are living longer.
“Survivorship services are needed to support people after their cancer treatment because there are permanent side effects,” she says. “There is a continued need for follow-up screening; many cancer survivors continue to take medication for many years after their initial treatment.
Survivorship services also help patients who relied on daily or weekly support throughout their treatment – and who face the loss of that support once their treatment is over.
“They still experience the side effects of the treatment, but they don’t have that interaction with the clinical team,” says Valverde. “That’s what survivor support is, it’s that ongoing feeling of ‘We’re always here for you, let us know when you’re in trouble, here’s what to expect.'”
A grant for infrastructure and coordination
The patient navigation program at CU Cancer Center and its clinical care partner, UCHealth, received a boost in June with a three-year, $300,000 grant from the American Cancer Society. Focused on infrastructure, the funds will help standardize the role of the patient navigator across multiple care sites, as well as develop training and improve reporting.
“We have a number of oncology patient navigators throughout the UCHealth system, but each program has grown organically and there is no synchronized workflow across the system,” says Stacy. Fischer, MD, co-lead of the cancer prevention and control program. at the CU Cancer Center. “The opportunity this grant gives us is to look at what navigators are doing in each location and create synchronicity to increase our impact, not just for our healthcare system, but for patients.
This includes creating job descriptions and synchronized metrics that can be used to track the effectiveness of patient navigators, including identifying barriers to treatment and tracking how those barriers are addressed. All are beginning to take steps to ensure Navigators are able to continue to help people from medically underserved populations access the care and services they need.
“The next step in realizing the value of patient navigation is being able to sustain navigation, paying patient navigators fair and equitable wages, consistent implementation of navigation, and enabling the entire nursing and medical team to work at the top of their license. The efforts of the University of Colorado Cancer Center and the Colorado School of Public Health go a long way to ensuring that navigation is a reality for the cancer patients who need it most,” says Dwyer.
This article was written by Greg Glasgow and was originally published in the University of Colorado Cancer Center Newsroom.
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