Hospitals are offering a new service to cancer patients: navigators to help them steer through the often-overwhelming maze of decisions, doctor visits and treatments, today’s Informed Patient Column reports.
Researchers across the country have been studying patient navigator programs for several years in an attempt to determine how best they can help patients — and how exactly they should be designed and staffed. A new supplement to the journal Cancer is devoted to the issue.
The National Consortium of Breast Centers offers a certification program for patient navigators focusing on the unique challenges faced by breast cancer patients, who may see several types of specialists and face multiple decisions on surgery, radiation and follow-up care.
While many of the programs are dedicated to helping underserved and racial and ethic minorities with poor access to care, even the savviest patients who have medical insurance can often be daunted by the complexities of cancer care, and benefit from the help of a navigator, says Martha Hare, program director of the National Cancer Institute’s Center to Reduce Cancer Health Disparities. “Patients may be overwhelmed by family issues, job issues, and even questions about whether they can get an appointment at a reasonable time,” she says.
The NCI’s Patient Navigation Research Program is currently analyzing results of a five-year study of thousands of patients at nine centers around the country, comparing those who used patient navigators to those who did not. Preliminary results are “encouraging” about the benefits, according to Karen Freund, a Boston University physician and chair of the design and analysis committee.
Several studies, starting with a project in Harlem for minority women in the 1990s, have already shown that patient navigation services increase participation in cancer screening and adherence to follow-up care after detection of an abnormality in minority groups and economically disadvantaged patients.
While funding for such programs has largely come from government grants, private foundations and cancer advocacy groups, more hospitals are expected to add the services thanks to revised standards from the American College of Surgeons’ Commission on Cancer, which accredits more than 1,400 cancer centers in the U.S. caring for 71% of all newly diagnosed cancer patients. By 2015, centers accredited by the commission must offer patient navigation services as a condition of accreditation.
Stephen B. Edge, chair of the commission and an oncologist at the Roswell Park Cancer Institute, tells the Health Blog there are many interpretations of navigation. The commission is requiring “that each program do an assessment of their community and develop programs to address barriers to access and smooth cancer care,” he says. The group plans to provide assistance in developing the programs, including a repository of best practices so all programs can learn from each other, he adds.
While commission accreditation isn’t used for reimbursement, accreditation “will be increasingly a requirement for any organization holding itself out to the public as a quality cancer program,” he says.
Research shows show patient navigators can also be helpful in getting patients to be screened for cancer in the first place – such as getting that mammogram or colonoscopy that many avoid. A study published in May in the Archives of Internal Medicine found that black and non-English speaking patients working with navigators at Cambridge Health Alliance, a Boston-area public health-care system, were more likely to undergo colorectal cancer screening than control patients without navigators, more likely to be screened by colonoscopy, and more likely to have abnormalities detected.
Laureen Gray, program director of special projects at Cambridge, says the service is now being offered to all patients, many of whom are low-income and speak languages such as Portuguese or Spanish. Navigators “guide them through the whole process” of preparing for a colonoscopy, make sure the patients understand the preparatory instructions and then that they show up for the procedure.
At Presbyterian Healthcare Services in Albuquerque, where four nurses and a social worker comprise the navigation team, Dava Gerard, a breast surgeon and administrator in the cancer program says patient navigation services need to reflect the needs and concerns of the community, which can vary greatly.
Presbyterian is compiling data that shows the cost-benefit of professional navigators who can assess and adapt to a spectrum of needs. However, “a basic competence is for navigators to know their boundaries,” Gerard says, so a navigator without medical knowledge or medical social worker isn’t providing inaccurate or dated treatment information.
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