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Ver Hoeve ES, Calhoun E, Hernandez M, High E, Armin JS, Ali-Akbarian L, Frithsen M, Andrews W, Hamann HA. Evaluating implementation of a community-focused patient navigation intervention at an NCI-designated cancer center using RE-AIM. BMC Health Serv Res 2024; 24:550. [PMID: 38685006 PMCID: PMC11059763 DOI: 10.1186/s12913-024-10919-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patient navigation is an evidence-based intervention that reduces cancer health disparities by directly addressing the barriers to care for underserved patients with cancer. Variability in design and integration of patient navigation programs within cancer care settings has limited this intervention's utility. The implementation science evaluation framework, RE-AIM, allows quantitative and qualitative examination of effective implementation of patient navigation programs into cancer care settings. METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation of a community-focused patient navigation intervention at an NCI-designated cancer center between June 2018 and October 2021. Using a 3-month longitudinal, non-comparative measurement period, univariate and bivariate analyses were conducted to examine associations between participant-level demographics and primary (i.e., barrier reduction) and secondary (i.e., patient-reported outcomes) effectiveness outcomes. Mixed methods analyses were used to examine adoption and delivery of the intervention into the cancer center setting. Process-level analyses were used to evaluate maintenance of the intervention. RESULTS Participants (n = 311) represented a largely underserved population, as defined by the National Cancer Institute, with the majority identifying as Hispanic/Latino, having a household income of $35,000 or less, and being enrolled in Medicaid. Participants were diagnosed with a variety of cancer types and most had advanced staged cancers. Pre-post-intervention analyses indicated significant reduction from pre-intervention assessments in the average number of reported barriers, F(1, 207) = 117.62, p < .001, as well as significant increases in patient-reported physical health, t(205) = - 6.004, p < .001, mental health, t(205) = - 3.810, p < .001, self-efficacy, t(205) = - 5.321, p < .001, and satisfaction with medical team communication, t(206) = - 2.03, p = .029. Referral patterns and qualitative data supported increased adoption and integration of the intervention into the target setting, and consistent intervention delivery metrics suggested high fidelity to intervention delivery over time. Process-level data outlined a successful transition from a grant-funded community-focused patient navigation intervention to an institution-funded program. CONCLUSIONS This study utilized the implementation science evaluation framework, RE-AIM, to evaluate implementation of a community-focused patient navigation program. Our analyses indicate successful implementation within a cancer care setting and provide a potential guide for other oncology settings who may be interested in implementing community-focused patient navigation programs.
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Affiliation(s)
| | | | | | | | | | | | - Michael Frithsen
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Wendy Andrews
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
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Okado I, Liu M, Elhajj C, Wilkens L, Holcombe RF. Patient reports of cancer care coordination in rural Hawaii. J Rural Health 2024. [PMID: 38225683 DOI: 10.1111/jrh.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Rural residents experience disproportionate burdens of cancer, and poorer cancer health outcomes in rural populations are partly attributed to care delivery challenges. Cancer patients in rural areas often experience unique challenges with care coordination. In this study, we explored patient reports of care coordination among rural Hawaii patients with cancer and compared rural and urban patients' perceptions of cancer care coordination. METHODS 80 patients receiving active treatment for cancer from rural Hawaii participated in a care coordination study in 2020-2021. Participants completed the Care Coordination Instrument, a validated oncology patient questionnaire. FINDINGS Mean age of rural cancer patients was 63.0 (SD = 12.1), and 57.7% were female. The most common cancer types were breast and GI. Overall, rural and urban patients' perceptions of care coordination were comparable (p > 0.05). There were statistically significant differences between rural and urban patients' perceptions in communication and navigation aspects of care coordination (p = 0.02 and 0.04, respectively). Specific differences included a second opinion consultation, clinical trial considerations, and after-hours care. 43% of rural patients reported traveling by air for part or all of their cancer treatment. CONCLUSIONS Findings suggest that while overall perceptions of care coordination were similar between rural and urban patients, differential perceptions of specific care coordination areas between rural and urban patients may reflect limited access to care for rural patients. Improving access to cancer care may be a potential strategy to enhance care coordination for rural patients and ultimately address rural-urban cancer health disparities.
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Affiliation(s)
- Izumi Okado
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Michelle Liu
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Carry Elhajj
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Lynne Wilkens
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Randall F Holcombe
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
- University of Vermont Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of Vermont, Burlington, Vermont, USA
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Griesemer I, Gottfredson NC, Thatcher K, Rini C, Birken SA, Kothari A, John R, Guerrab F, Clodfelter T, Lightfoot AF. Intervening in the Cancer Care System: An Analysis of Equity-Focused Nurse Navigation and Patient-Reported Outcomes. Health Promot Pract 2023:15248399231213042. [PMID: 38050901 DOI: 10.1177/15248399231213042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Nurse navigation can improve quality of cancer care and reduce racial disparities in care outcomes. Addressing persistent structurally-rooted disparities requires research on strategies that support patients by prompting structural changes to systems of care. We applied a novel conceptualization of social support to an analysis of racial equity-focused navigation and patient-reported outcomes. METHOD We applied an antiracism lens to create a theory-informed definition of system-facing social support: intervening in a care system on a patient's behalf. Participants were adults with early-stage breast or lung cancer, who racially identified as Black or White, and received specialized nurse navigation (n = 155). We coded navigators' clinical notes (n = 3,251) to identify instances of system-facing support. We then estimated models to examine system-facing support in relation to race, perceived racism in health care settings, and mental health. RESULTS Twelve percent of navigators' clinical notes documented system-facing support. Black participants received more system-facing support than White participants, on average (b = 0.78, 95% confidence interval [CI]: [0.25, 1.31]). The interaction of race*system-facing support was significant in a model predicting perceived racism in health care settings at the end of the study controlling for baseline scores (b = 0.05, 95% CI [0.01, 0.09]). Trends in simple slopes indicated that among Black participants, more system-facing support was associated with slightly more perceived racism; no association among White participants. DISCUSSION The term system-facing support highlights navigators' role in advocating for patients within the care system. More research is needed to validate the construct system-facing support and examine its utility in interventions to advance health care equity.
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Affiliation(s)
- Ida Griesemer
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | | | - Kari Thatcher
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | | | - Sarah A Birken
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Aneri Kothari
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Fatima Guerrab
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- People's Action Institute, Washington, DC, USA
| | | | - Alexandra F Lightfoot
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Matthews AK, Steffen AD, Burke LA, Donenberg G, Duangchan C, Akufo J, Opuada H, Oyaluade D, Vilona BH, Diaz H, Dodd D. The Use of Navigators to Increase Patient Portal Enrollment among Patients in a Federally Qualified Health Care System. Ethn Dis 2023; DECIPHeR:117-125. [PMID: 38846728 PMCID: PMC11099523 DOI: 10.18865/ed.decipher.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Purpose To describe the training, preliminary results, and lessons learned from using patient navigators to increase the enrollment of low-income patients in a health system-supported and electronic health record-linked patient portal. Methods Patient navigators (n=4) were trained to assist patients in a federally qualified health center to enroll in and use patient portals. Patient navigators were stationed at 3 clinic locations. Data from the electronic health record system (Epic) were used to compare MyChart patient portal activation rates and use among patients for the 8 months before and after patient navigation services were offered. Results Navigators offered 83% of eligible patients with activation assistance. Sixty-four percent of the patients (n=1062) offered MyChart enrollment assistance accepted help. Seventy-four percent of assisted patients with no prior MyChart enrollment activated their accounts during that clinic visit. The primary reason for declining MyChart assistance was a lack of access to or comfort with technology. Patient portal activation increased during the 8 months when navigators were at the clinics (51%) compared to the previous 8 months (44%). Most new users viewed lab results and read a message [χ2(1)=49.3, p<.001], with significant increases evident for African Americans [44% before, 49% during; χ2(1)=40.4, p<.001] and Latinx patients [52% before, 60% during; χ2(1)=6.15, p=.013]. Conclusion Study results suggest that using patient navigators is feasible and beneficial for increasing patient enrollment in the Federally Qualified Health Centers context. However, patient-, clinic-, and system-level factors were identified as barriers and should be addressed in future research studies.
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Affiliation(s)
| | | | - Larisa A. Burke
- College of Nursing, University of Illinois Chicago, Chicago, IL
| | - Geri Donenberg
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | | | - Jennifer Akufo
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | - Hope Opuada
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | - Damilola Oyaluade
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | | | - Hilda Diaz
- College of Medicine, The University of Illinois Chicago, Chicago, IL
| | - Darcy Dodd
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
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Iezadi S, Ebrahimi N, Ghamari SH, Esfahani Z, Rezaei N, Ghasemi E, Moghaddam SS, Azadnajafabad S, Abdi Z, Varniab ZS, Golestani A, Langroudi AP, Dilmaghani-Marand A, Farzi Y, Pourasghari H. Global and regional quality of care index (QCI) by gender and age in oesophageal cancer: A systematic analysis of the Global Burden of Disease Study 1990-2019. PLoS One 2023; 18:e0292348. [PMID: 37788249 PMCID: PMC10547202 DOI: 10.1371/journal.pone.0292348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The aim of this study was to examine the quality of care by age and gender in oesophageal cancer using Global Burden of Disease (GBD) database. METHODS Patients aged 20 and over with oesophageal cancer were included in this longitudinal study using GBD 1990-2019 data. We used the Socio-Demographic Index (SDI) to classify the regions. We used Principal Component Analysis (PCA) method to calculate the Quality of Care Index (QCI). The QCI was rescaled into a 0-100 single index, demonstrating that the higher the score, the better the QC. RESULTS The age-standardized QCI for oesophageal cancer dramatically increased from 23.5 in 1990 to 41.1 in 2019 for both sexes, globally. The high SDI regions showed higher QCI than the rest of the regions (45.1 in 1990 and 65.7 in 2019) whereas the low SDI regions had the lowest QCI, which showed a 4.5% decrease through the years (from 13.3 in 1990 to 12.7 in 2019). Globally, in 2019, the QCI showed the highest scores for patients aged 80-84, reported 48.2, and the lowest score for patients aged 25-29 reported 31.5, for both sexes. Globally, in 2019, age-standardized Gender Disparity Ratio (GDR) was 1.2, showing higher QCI in females than males. CONCLUSION There were fundamental differences in the QCI both globally and regionally between different age groups as well as between males and females. To achieve the goal of providing high-quality services equally to people in need in all over the world, health systems need to invest in effective diagnostic services, treatments, facilities, and equipment and to plan for screening and surveillance of high-risk individuals.
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Affiliation(s)
- Shabnam Iezadi
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Zahra Shokri Varniab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Golestani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashkan Pourabhari Langroudi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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The integration of accompanying patients into clinical teams in oncology: Perceptions of accompanying patients and nurses. Eur J Oncol Nurs 2023; 62:102256. [PMID: 36634593 DOI: 10.1016/j.ejon.2022.102256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/30/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES In Canada, two out of five people will be diagnosed with cancer which will affect their lives on a physical, psychological, and social levels. To help people affected by cancer (PAC) cope with the disease, support is provided by oncology nurses (ONs), including oncology pivot nurses (OPNs), as well as by accompanying patients (APs), i.e. people who have already had to deal with a cancer problem. APs are still a recent addition to the services offered in oncology, and as of yet no study has explored how the support provided by APs is being integrated into usual care, especially ONs care. This study explores the perceptions of APs and ONs on APs' integration into clinical teams. METHOD An exploratory qualitative study was carried out with six ONs and six APs through semi-structured interviews conducted from 2020 to 2021. Data were analyzed using a qualitative content analysis. RESULTS Participants perceived the AP's integration into the teams and during care as variable and in flux. They also identified factors that influence APs' integration into clinical teams (e.g.:the clinical teams' dynamics, the understanding of the AP's role, APs and patients' characteristics). Lastly, participants made recommendations to improve APs integration into clinical teams. CONCLUSION This study highlights how integrating APs into clinical teams has not yet become part of ONs' routines. ONs can play a key role in their integration through their collaborative and teamwork skills. Furthermore, there is a recognition that these two approaches can play complementary roles in supporting PACs.
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Ball GDC, O’Neill MG, Noor R, Alberga A, Azar R, Buchholz A, Enright M, Geller J, Ho J, Holt NL, Lebel T, Rosychuk RJ, Tarride JE, Zenlea I. A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol. Pilot Feasibility Stud 2023; 9:14. [PMID: 36691103 PMCID: PMC9868519 DOI: 10.1186/s40814-023-01246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families' access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children's and caregivers' acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. METHODS In our 2.5-year study, 108 6-17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families' barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. DISCUSSION Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. TRIAL REGISTRATION This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).
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Affiliation(s)
- Geoff D. C. Ball
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Marcus G. O’Neill
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Rafat Noor
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Angela Alberga
- grid.410319.e0000 0004 1936 8630Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC Canada
| | - Rima Azar
- grid.260288.60000 0001 2169 3908Psychobiology of Stress & Health Lab, Department of Psychology, Mount Allison University, Sackville, NB Canada
| | - Annick Buchholz
- grid.34428.390000 0004 1936 893XDepartment of Psychology, Carleton University, Ottawa, ON Canada
| | | | - Josie Geller
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Josephine Ho
- grid.22072.350000 0004 1936 7697Department of Paediatrics, University of Calgary, Calgary, AB Canada
| | - Nicholas L. Holt
- grid.17089.370000 0001 2190 316XFaculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB Canada
| | - Tracy Lebel
- Patient and Family Partner, Edmonton, AB Canada
| | - Rhonda J. Rosychuk
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Jean-Eric Tarride
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Ian Zenlea
- grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto, Toronto, ON Canada
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Cadel L, Kuluski K, Everall AC, Guilcher SJT. Recommendations made by patients, caregivers, providers, and decision-makers to improve transitions in care for older adults with hip fracture: a qualitative study in Ontario, Canada. BMC Geriatr 2022; 22:291. [PMID: 35392830 PMCID: PMC8988316 DOI: 10.1186/s12877-022-02943-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Older adults frequently experience fall-related injuries, including hip fractures. Following a hip fracture, patients receive care across a number of settings and from multiple different providers. Transitions between providers and across settings have been noted as a vulnerable time, with potentially negative impacts. Currently, there is limited research on how to improve experiences with transitions in care following a hip fracture for older adults from the perspectives of those with lived experienced. The purpose of this study was to explore service recommendations made by patients, caregivers, healthcare providers, and decision-makers for improving transitions in care for older adults with hip fracture. Methods This descriptive qualitative study was part of a larger longitudinal qualitative multiple case study. Participants included older adults with hip fracture, caregivers supporting an individual with hip fracture, healthcare providers, and decision-makers. In-depth, semi-structured interviews were conducted with all participants, with patients and caregivers having the opportunity to participate in follow-up interviews as they transitioned out of hospital. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Results A total of 47 participants took part in 65 interviews. We identified three main categories of recommendations: (1) hospital-based recommendations; (2) community-based recommendations; and (3) cross-sectoral based recommendations. Hospital-based recommendations focused on treating patients and families with respect, improving the consistency, frequency, and comprehensiveness of communication between hospital providers and between providers and families, and increasing staffing levels. Community-based recommendations included the early identification of at-risk individuals and providing preventative and educational programs. Cross-sectoral based recommendations were grounded in enhanced system navigation through communication and care navigators, particularly within primary and community care settings. Conclusions Our findings highlighted the central role primary care can play in providing targeted, integrated services for older adults with hip fracture. The recommendations outlined have the potential to improve experiences with care transitions for older adults with hip fracture, and thus, addressing and acting on them should be a priority.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. .,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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Edney LC, Roseleur J, Gray J, Koczwara B, Karnon J. Mapping a decade of interventions to address the supportive care needs of individuals living with or beyond cancer: a scoping review of reviews. Support Care Cancer 2022; 30:3793-3804. [PMID: 35029770 DOI: 10.1007/s00520-021-06713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Individuals diagnosed with cancer have a range of supportive care needs that are often unmet despite substantial evidence supporting interventions to address them. Addressing this knowledge-translation gap represents a significant opportunity to improve health outcomes. A scoping review of reviews was conducted to map the breadth of evidence for interventions, highlighting those with an existing evidence base, as well as those requiring further research. METHODS Systematic or meta-analytic reviews that examined interventions targeting supportive care needs of adults and children with cancer published between 2009 and 2019 were identified via searches in Medline, PsycINFO, CINAHL, Scopus and Cochrane. RESULTS Five hundred fifty-one systematic reviews, including 250 meta-analyses, of interventions addressing supportive care needs, were included. Most reviews focused on interventions to address the physical and psychosocial needs of individuals with few reviews identified to address practical needs. Interventions using mental health therapies and physical activity were most commonly used to address all supportive care needs, followed by the use of pharmaceutical and medical devices, complementary and alternative therapies, information and education resources, dietary information and specific spirituality and return-to-work interventions. CONCLUSION This scoping review of reviews presents the first broad overview of the literature addressing the supportive care needs of people living with or beyond cancer. It provides a database that health service providers can search to identify appropriate interventions. Results highlight specific research gaps, particularly for practical needs, where reviews are needed. It highlights where a substantial evidence base exists that researchers and policy-makers can consider when implementing interventions.
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Affiliation(s)
- Laura Catherine Edney
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Jacqueline Roseleur
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
| | - Jodi Gray
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.,Flinders Medical Centre, Adelaide, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
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Addressing a critical need for caregiver support in neuro-oncology: development of a caregiver navigation intervention using eSNAP social resource visualization. Support Care Cancer 2022; 30:5361-5370. [PMID: 35290512 PMCID: PMC8922391 DOI: 10.1007/s00520-022-06977-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
Informal caregivers are key to oncology care, but often have unmet needs, leading to poor psychological and physical health outcomes. Comprehensive, proactive caregiver support programs are needed. We describe the development of a support intervention for caregivers of persons with brain tumors. The intervention uses a caregiver navigator to help participants identify and capitalize on existing social support resources captured using a web-based tool (eSNAP) and connects participants to existing formal services. We describe the iterative development process of the manualized intervention with particular focus on the caregiver navigator sessions. The process included review of the literature and published patient navigation programs, expert and stakeholder review, and study team member review. Quantitative and qualitative data were captured from the first 15 participants randomized to receive the intervention, enrolled from February 2020 to December 2020. Four participants dropped from the study, 9 completed at least 7 modules, and 8 participants completed all 8. Quantitative and qualitative data were collected primarily from those who completed the intervention; data suggest caregivers were satisfied with the intervention and found it helpful. Our intervention is one of the first theory-based caregiver support interventions to include caregiver navigation in neuro-oncology. We use best-practice guidelines for design, including extensive stakeholder feedback. COVID-19 may have impacted recruitment and participation, but some preliminary data suggest that those able to engage with the intervention find it helpful. Data collection is ongoing in a larger trial. If effective, caregiver navigation could be a model for future interventions to ensure caregiver support.
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11
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Tang KL, Kelly J, Sharma N, Ghali WA. Patient navigation programs in Alberta, Canada: an environmental scan. CMAJ Open 2021; 9:E841-E847. [PMID: 34493550 PMCID: PMC8428899 DOI: 10.9778/cmajo.20210004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patient navigation is a complex intervention that has garnered substantial interest and investment across Canada. We conducted an environmental scan to understand the landscape of patient navigation programs within the health care system in Alberta, Canada. METHODS We included patient navigation programs within Alberta Health Services (AHS) and Alberta's Primary Care Networks (PCNs). Key informants were asked in October 2016 to identify existing programs and their corresponding program contacts. These program contacts were invited to complete a telephone-based survey from October 2016 to July 2017, to provide program descriptions and eligibility criteria, and to identify gaps in navigation. Programs were included if they engaged patients on an individual basis, and either facilitated continuity of care or promoted patient and family empowerment. We tabulated results and calculated summary statistics for program characteristics. RESULTS Ninety-five potentially eligible programs were identified by key informants. The response rate to the study survey was 73% (n = 69). After excluding programs not meeting inclusion criteria, we included a total of 58 programs in the study: 43 AHS programs and 15 PCN programs. Nearly all programs (93%, n = 54) delivered navigation via an individual acting as a navigator. A minority of programs also included nonnavigator components, such as Web-based resources (7%, n = 4) and process or structural changes to facilitate navigation (22%, n = 13). Certain patient subgroups were particularly well-served by patient navigation; these included patients with cancer, substance use disorders or mental health concerns, and pediatric patients. Gaps identified in navigation fell under 4 domains: awareness, resources, geographic distribution and integration. INTERPRETATION Patient navigation programs are common and have extended beyond cancer care, from which the construct originated; however, gaps include a lack of awareness and inequitable access to the programs. These findings will be of interest to those developing and implementing patient navigation interventions in Alberta and other jurisdictions.
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Affiliation(s)
- Karen L Tang
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta.
| | - Jenny Kelly
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta
| | - Nishan Sharma
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta
| | - William A Ghali
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta
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12
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Miller SD, Urquhart R, Kephart G, Asada Y, Younis T. Nurse Navigators' Views on Patient and System Factors Associated with Navigation Needs among Women with Breast Cancer. Curr Oncol 2021; 28:2107-2114. [PMID: 34198915 PMCID: PMC8293054 DOI: 10.3390/curroncol28030195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/19/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
Coordinating breast cancer treatment is a complex task that can overwhelm patients and their support networks. Though the Cancer Patient Navigator (CPN) program in Nova Scotia (NS) provides professional assistance to patients, certain groups of patients may still face barriers to accessing its services. Employing interviews and a modified Delphi approach with CPN participants, this study sought to identify factors associated with the need for navigation to help better target CPN program referrals among breast cancer patients. Six CPNs were recruited directly through the CPN program manager for interviews and surveys. The CPNs identified 27 different factors, which were divided into 4 categories: sociodemographic, psychological, clinical and health systems. While these patient factors (particularly sociodemographic) are not directly modifiable, awareness of their association with the need for navigation could be used to better target patients with a high need for navigation for referral to CPN services.
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Affiliation(s)
- Sally D. Miller
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (S.D.M.); (G.K.); (Y.A.)
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (S.D.M.); (G.K.); (Y.A.)
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (S.D.M.); (G.K.); (Y.A.)
| | - Yukiko Asada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (S.D.M.); (G.K.); (Y.A.)
| | - Tallal Younis
- Department of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada;
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13
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Bigelow SM, Hart E, Shaban T, Rao P, Khan AA, Baskaron M, Baker P, Schwartz TA, Mayer DK. A new proactive virtual resource center navigation model identifies patient risk factors to reduce barriers to cancer care during the COVID-19 pandemic. Support Care Cancer 2021; 29:6069-6077. [PMID: 33788005 PMCID: PMC8009761 DOI: 10.1007/s00520-021-06147-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
Purpose The COVID-19 pandemic has exacerbated cancer treatment disparities, including accessibility to resources. We describe the process and outcomes of a new proactive, virtual nurse-led, resource center navigation model enhanced by using volunteer patient navigators. Using known patient risk factors, this model provides interventions to reduce barriers to care, with an emphasis on non-English-speaking populations. Methods Patients were included if they (1) were in active cancer treatment and (2) had one or more known risk factors: distance from cancer hospital, needing complex care, 65 years or older, malignant hematological diagnosis, new treatment start, lives alone, non-English speaker, or a new hospital discharge. Nurse navigators triaged referrals to appropriate team members who identified and addressed barriers to care. Results The program engaged with 586 adult cancer patients over 1459 encounters. The most common risk factors included distance (59.7%), complex care (48.8%), and new treatment start (43.5%). The most common interventions were core education (69.4%), emotional support (61.2%), and education (35.7%). Statistical differences were found between Spanish-speaking (n = 118) and non-Spanish-speaking patients (n = 468). While Spanish-speaking patients had fewer risk factors (1.95 vs. 2.80, p ≤ .0001), they had nearly double the number of visits (4.27 vs. 2.04, p ≤ .0001) and 69% more interventions (8.26 vs. 4.90, p ≤ .0001). Many patients (42.7%) required follow-up visits. Conclusion We successfully established a new navigation model for the resource center during the pandemic that identified and reduced barriers to care, particularly in the Spanish-speaking population. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06147-3.
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Affiliation(s)
- Sharon M Bigelow
- Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, NC, USA.
| | - Elizabeth Hart
- Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, NC, USA
| | - Tina Shaban
- Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, NC, USA
| | - Preeyanka Rao
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ali Ahmad Khan
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marianne Baskaron
- Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, NC, USA
| | - Pamela Baker
- Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, NC, USA
| | - Todd A Schwartz
- Department of Biostatistics, Gillings School of Global Public Health, Chapel Hill, NC, USA.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah K Mayer
- Lineberger Comprehensive Cancer Center, North Carolina Cancer Hospital, Chapel Hill, NC, USA.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Perspectives of multisectoral community stakeholders on Arab American cancer patients' needs and suggested interventions. Support Care Cancer 2021; 29:5915-5925. [PMID: 33763724 DOI: 10.1007/s00520-021-06169-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/18/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Multilevel barriers can arise after a cancer diagnosis, especially in underserved racial/ethnic minority patient populations, raising the need for diverse and contextually adapted interventions. However, limited data exists on Arab American (ArA) cancer patients' needs, partly due to their racial/ethnic misclassification as Whites. This study leveraged the perspectives of cancer survivors and community stakeholders (i.e., healthcare and community leaders) to identify ArA cancer patients' needs, as well as their preferred intervention strategies to address them. METHODS Using a hybrid inductive-deductive content analysis approach, we analyzed qualitative data from interviews with 18 ArA community stakeholders recruited through community partners in Chicago. RESULTS Participants associated cancer stigma to ArA patients' concealment of their diagnosis and aversion to cancer support groups. Economic and language barriers to treatment were emphasized. A lack of resources for ArA cancer patients was also noted and was partly attributed to their misclassification as White. In response to these needs, participants suggested peer mentorship programs to overcome privacy concerns, hospital-based patient navigation to address language and economic barriers in healthcare, diversification of the healthcare workforce to overcome language barriers, and community coalitions to recognize ArA as an ethnic group and increase cancer support resources. Such advocacy will be essential to accurately characterize patients' cancer burden and obtain funding to support community programs and resources. CONCLUSION Our findings suggest that multilevel interventions at the patient, healthcare, and community levels are needed to address ArA cancer patients' needs.
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15
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Arditi C, Walther D, Gilles I, Lesage S, Griesser AC, Bienvenu C, Eicher M, Peytremann-Bridevaux I. Computer-assisted textual analysis of free-text comments in the Swiss Cancer Patient Experiences (SCAPE) survey. BMC Health Serv Res 2020; 20:1029. [PMID: 33172451 PMCID: PMC7654064 DOI: 10.1186/s12913-020-05873-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 10/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Patient experience surveys are increasingly conducted in cancer care as they provide important results to consider in future development of cancer care and health policymaking. These surveys usually include closed-ended questions (patient-reported experience measures (PREMs)) and space for free-text comments, but published results are mostly based on PREMs. We aimed to identify the underlying themes of patients’ experiences as shared in their own words in the Swiss Cancer Patient Experiences (SCAPE) survey and compare these themes with those assessed with PREMs to investigate how the textual analysis of free-text comments contributes to the understanding of patients’ experiences of care. Methods SCAPE is a multicenter cross-sectional survey that was conducted between October 2018 and March 2019 in French-speaking parts of Switzerland. Patients were invited to rate their care in 65 closed-ended questions (PREMs) and to add free-text comments regarding their cancer-related experiences at the end of the survey. We conducted computer-assisted textual analysis using the IRaMuTeQ software on the comments provided by 31% (n = 844) of SCAPE survey respondents (n = 2755). Results We identified five main thematic classes, two of which consisting of a detailed description of ‘cancer care pathways’. The remaining three classes were related to ‘medical care’, ‘gratitude and praise’, and the way patients lived with cancer (‘cancer and me’). Further analysis of this last class showed that patients’ comments related to the following themes: ‘initial shock’, ‘loneliness’, ‘understanding and acceptance’, ‘cancer repercussions’, and ‘information and communication’. While closed-ended questions related mainly to factual aspects of experiences of care, free-text comments related primarily to the personal and emotional experiences and consequences of having cancer and receiving care. Conclusions A computer-assisted textual analysis of free-text in our patient survey allowed a time-efficient classification of free-text data that provided insights on the personal experience of living with cancer and additional information on patient experiences that had not been collected with the closed-ended questions, underlining the importance of offering space for comments. Such results can be useful to inform questionnaire development, provide feedback to professional teams, and guide patient-centered initiatives to improve the quality and safety of cancer care.
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Affiliation(s)
- Chantal Arditi
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Diana Walther
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Ingrid Gilles
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Saphir Lesage
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Anne-Claude Griesser
- Medical Directorate, Lausanne University Hospital CHUV, rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Christine Bienvenu
- Department of Policlinics, Center for Primary Care and Public Health (Unisanté), Rue du Bugnon 44, 1011, Lausanne, Switzerland.,Swiss Cancer Patient Experiences (SCAPE) survey steering committee, Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Route de la Corniche 10, 1010, Lausanne, Switzerland.,Department of Oncology, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
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16
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Ramirez AG, Muñoz E, Long Parma D, Perez A, Santillan A. Quality of life outcomes from a randomized controlled trial of patient navigation in Latina breast cancer survivors. Cancer Med 2020; 9:7837-7848. [PMID: 32979042 PMCID: PMC7643682 DOI: 10.1002/cam4.3272] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Breast cancer survivorship is a life-long process involving challenges to health-care communities and individuals, especially Latinas. Patient Navigation has shown some success in meeting these challenges. The purpose of this study was to compare the effects of an enhanced Patient Navigation program (Intervention; PN+) vs Control (PN) over time on general cancer and breast cancer-specific quality of life (QoL) in Latina breast cancer survivors (BCS). METHODS We conducted a 2-year, two-arm randomized controlled trial of the "Staying Healthy" program among Latina BCS. The design compared PN+ vs PN over time. We recruited 60 patients into each study arm and randomized them by sequential numerical assignment. PN+ participants received culturally tailored educational materials and active, personalized Patient Navigation services, including phone calls, transportation, and care coordination. PN participants were navigated only upon request. Primary outcomes included general cancer (Functional Assessments of Cancer Therapy [FACTS]-G) and breast cancer-specific (FACT-B) QoL. RESULTS PN+ participants had significantly improved QoL measures compared to PN at 6-month follow-up on all subscales (P-values .007-.04) except physical well-being (PWB; P = .11). Intervention effect size coefficient (standard error) for FACT-G overall was 7.9 (3.1); P = .01. For FACT-B, it was 10.9 (3.9); P = .006. Again, all subscales showed significant effects [range 1.7-3.1 (0.8-1.2); P-values .006-.04], except for PWB [1.5 (1.0); P = .16] and social/family well-being (SWB) [2.1 (1.1); P = .06]. There were no differences between groups at baseline. DISCUSSION Multiple cultural, psychosocial, and socioeconomic variables contributing to these intervention effects will be addressed in future studies. As the national BCS population continues to increase, more Patient Navigation-focused partnerships among patients, health-care professionals, research groups, and community organizations are needed to improve BCS experiences. The Staying Healthy program has the potential to serve as a national survivorship care model for improving Latina BCS QoL.
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Affiliation(s)
- Amelie G. Ramirez
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
- The Mays Cancer CenterUT Health San Antonio MD Anderson Cancer CenterSan AntonioTXUSA
| | - Edgar Muñoz
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
| | - Dorothy Long Parma
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
- The Mays Cancer CenterUT Health San Antonio MD Anderson Cancer CenterSan AntonioTXUSA
| | - Arely Perez
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
| | - Alfredo Santillan
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
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17
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Dessources K, Hari A, Pineda E, Amneus MW, Sinno AK, Holschneider CH. Socially determined cervical cancer care navigation: An effective step toward health care equity and care optimization. Cancer 2020; 126:5060-5068. [DOI: 10.1002/cncr.33124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Kimberly Dessources
- Department of Surgery Memorial Sloan Kettering Cancer Center New York New York
| | - Anjali Hari
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Elizabeth Pineda
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Malaika W. Amneus
- Department of Obstetrics and Gynecology Kaiser Permanente Panorama City Panorama City California
| | - Abdulrahman K. Sinno
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Christine H. Holschneider
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
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Berezowska A, Passchier E, Bleiker E. Professional patient navigation in a hospital setting: a randomized controlled trial. Support Care Cancer 2020; 29:2111-2123. [PMID: 32864723 DOI: 10.1007/s00520-020-05721-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to determine the effect of patient navigation on health-related quality of life, distress, self-care knowledge, self-efficacy, satisfaction, and healthcare usage. METHODS Patients newly diagnosed with ovarian, vulvar, endometrial, melanoma stage III/IV, lung, or renal cancer were randomly assigned to either care as usual or care as usual plus consultations with a patient navigator (i.e., specially trained oncology nurse who monitors, advises, and refers patients to supportive cancer care). Measures included the EORTC-QLQ-C30, distress thermometer, and study-specific questions inspired by the Symptom-Management Self-Efficacy Scale Breast Cancer, Patient Satisfaction with Cancer Care Scale, and the Medical Consumption Questionnaire. Measures were completed before randomization (baseline) and at 1 month, 3 months, and 5 months after baseline. RESULTS In the case of health-related quality of life, no significant difference was observed between the intervention (n = 42) and the control group (n = 47). Consumption of supportive cancer care was low for both the intervention and the control group but relatively lower for the intervention group. Also, participants who consulted the patient navigator seemed to have higher levels of self-efficacy and satisfaction. CONCLUSION Although the intervention sorted no relevant effects on health-related quality of life, it did affect patients' experience of cancer care and self-efficacy. We recommend that patient navigators monitor and advise on unmet supportive care needs, but only in the case of high-risk patients. Furthermore, considering current and prior research, it is wise to study patient navigation using more sensitive outcome measures than health-related quality of life.
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Affiliation(s)
- Aleksandra Berezowska
- Center for Quality of Life, Netherlands Cancer Institute, Mailbox 90203, 1006 BE, Amsterdam, Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Mailbox 90203, 1006 BE, Amsterdam, Netherlands
| | - Ellen Passchier
- Center for Quality of Life, Netherlands Cancer Institute, Mailbox 90203, 1006 BE, Amsterdam, Netherlands
| | - Eveline Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Mailbox 90203, 1006 BE, Amsterdam, Netherlands.
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How comfortable are primary care physicians and oncologists prescribing medications for comorbidities in patients with cancer? Res Social Adm Pharm 2020; 16:1087-1094. [DOI: 10.1016/j.sapharm.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/21/2022]
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Schutt RK, Woodford ML. Increasing health service access by expanding disease coverage and adding patient navigation: challenges for patient satisfaction. BMC Health Serv Res 2020; 20:175. [PMID: 32143726 PMCID: PMC7059366 DOI: 10.1186/s12913-020-5009-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cancer control programs have added patient navigation to improve effectiveness in underserved populations, but research has yielded mixed results about their impact on patient satisfaction. This study focuses on three related research questions in a U.S. state cancer screening program before and after a redesign that added patient navigators and services for chronic illness: Did patient diversity increase; Did satisfaction levels improve; Did socioeconomic characteristics or perceived barriers explain improved satisfaction. METHODS Representative statewide patient samples were surveyed by phone both before and after the program design. Measures included satisfaction with overall health care and specific services, as well as experience of eleven barriers to accessing health care and self-reported health and sociodemographic characteristics. Multiple regression analysis is used to identify independent effects. RESULTS After the program redesign, the percentage of Hispanic and African American patients increased by more than 200% and satisfaction with overall health care quality rose significantly, but satisfaction with the program and with primary program staff declined. Sociodemographic characteristics explained the apparent program effects on overall satisfaction, but perceived barriers did not. Further analysis indicates that patients being seen for cancer risk were more satisfied if they had a patient navigator. CONCLUSIONS Health care access can be improved and patient diversity increased in public health programs by adding patient navigators and delivering more holistic care. Effects on patient satisfaction vary with patient health needs, with those being seen for chronic illness likely to be less satisfied with their health care than those being seen for cancer risk. It is important to use appropriate comparison groups when evaluating the effect of program changes on patient satisfaction and to consider establishing appropriate satisfaction benchmarks for patients being seen for chronic illness.
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Affiliation(s)
- Russell K Schutt
- Department of Sociology, University of Massachusetts Boston and Harvard Medical School, Boston, MA, 02125-3393, USA.
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Bergerød IJ, Dalen I, Braut GS, Gilje B, Wiig S. Measuring next of kin satisfaction with hospital cancer care: Using a mixed-method approach as basis for improving quality and safety. J Adv Nurs 2020; 76:1232-1246. [PMID: 32026486 DOI: 10.1111/jan.14315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/02/2020] [Accepted: 01/23/2020] [Indexed: 12/16/2022]
Abstract
AIM/S To explore next of kin satisfaction with cancer care, map next of kin suggestions for involvement and combine this information to create a basis for improving quality and safety in hospitals. DESIGN Convergent parallel mixed-methods design applying the 20-item FAMCARE Scale survey instrument for quantitative measurement of satisfaction with care and with an open-ended question used for qualitative analysis. DATA SOURCES Responses from 238 next of kin (November 2016-November 2017). METHODS Exploratory factor analysis, regression analysis and qualitative content analysis were combined. RESULTS Both hospitals scored better in medical treatment (median, interquartile range: 1.5, 1.1-2.0), than in satisfaction with information and involvement of next of kin (1.9, 1.3-2.4), p < .001 (Wilcoxon signed ranks test). After adjusting for differences in demographical and clinical variables, the total FAMCARE scores were 13% higher (95% confidence interval: 1%-27%, Wald p = .029) at one of the hospitals. Qualitative findings support that the hospitals are not providing an equal offer to next of kin involvement in hospital cancer care that includes a proactive approach. CONCLUSION As a basis for quality and safety improvement, next of kin satisfaction and involvement in cancer care should be addressed in a two-sided perspective, balancing the next of kin's need for involvement in cancer treatment with the patient's perspective. IMPACT There is limited knowledge of next of kin satisfaction with hospital cancer care and how next of kin would like to be involved in this trajectory. Several aspects of satisfaction with cancer care can prompt change to improve service quality and safety (e.g. information, involvement, practical care), but this is an underused source of information. Next of kin are key in cancer care and our study demonstrates a potential large impact on future practical ways of improving cancer care service provision in an integrative perspective including next of kin.
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Affiliation(s)
- Inger J Bergerød
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | | | - Geir S Braut
- Stavanger University Hospital, Stavanger, Norway
| | - Bjørnar Gilje
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Bernardo BM, Zhang X, Beverly Hery CM, Meadows RJ, Paskett ED. The efficacy and cost-effectiveness of patient navigation programs across the cancer continuum: A systematic review. Cancer 2019; 125:2747-2761. [PMID: 31034604 DOI: 10.1002/cncr.32147] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost-effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost-effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow-up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost-effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost-effectiveness and more rigorous reporting of study designs and results in published articles.
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Affiliation(s)
- Brittany M Bernardo
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Xiaochen Zhang
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Chloe M Beverly Hery
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Rachel J Meadows
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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Development and Psychometric Evaluation of the Cancer Health Literacy Scale in Newly Diagnosed Cancer Patients. Cancer Nurs 2019; 43:E291-E303. [PMID: 30998604 DOI: 10.1097/ncc.0000000000000711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Health literacy (HL) influences a patient's comprehension and judgment of health-related information. A rigorous assessment tool is needed to screen for low HL in order to improve it. OBJECTIVE The aim of this study was to develop and validate the Cancer Health Literacy Scale (C-HLS). METHODS The framework of the C-HLS is based on the Levels of Prevention model. The scale items were developed according to Nutbeam's 3 constructs of HL. We employed several procedures to develop the C-HLS, including focus group interviews, item generation, the expert Delphi process, and face validity. Various types of analysis, including reliability and split-half reliability testing, confirmatory factor analysis, and criterion-related validity testing, were performed; receiver operating characteristic curve analysis was also performed to confirm sensitivity and specificity. RESULTS There were 33 items included in the C-HLS for validation; 360 newly diagnosed cancer patients completed the survey. The administration time is only 10 to 15 minutes. Results showed that C-HLS had good reliability, split-half reliability, and validity. All confirmatory factor analysis model fit indices reached acceptable thresholds. The receiver operating characteristic curve analyses suggested that the C-HLS had an adequate combination of sensitivity and specificity to distinguish between high and low HL. CONCLUSIONS The C-HLS is a reliable, valid tool capable of discriminating levels of HL in the assessment of cancer patients and does not have an excessive administration time. IMPLICATIONS FOR PRACTICE This scale can aid our understanding of HL in newly diagnosed cancer patients and can serve as a basis for providing individual care interventions.
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Evaluating a professional patient navigation intervention in a supportive care setting. Support Care Cancer 2019; 27:3281-3290. [PMID: 30612239 DOI: 10.1007/s00520-018-4622-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Unmet supportive care needs are common among cancer patients. This study evaluates a patient navigation intervention (i.e., specially trained oncology nurse who monitors, advises, and (if needed) refers patients to supportive cancer care) in terms of need, satisfaction, advice uptake, and consumption of supportive cancer care. METHODS Using a cross-sectional design, the intervention was evaluated among healthcare professionals, patients who participated, and patients who did not participate in the intervention. All patients were newly diagnosed with breast cancer or melanoma. Data was collected through medical records and online surveys. RESULTS In total, 1091 patients were offered patient navigation. Most of these patients (755) were willing to consult the patient navigator (PN). Approximately 90% of patients who completed both the intervention and the questionnaire (N = 120, response rate 54%) perceived the PN as valuable, accessible, and reliable. Approximately 80% of respondents who needed advice regarding nutrition (n = 67), fatigue (n = 98), emotions (n = 106), and work (n = 79) were adequately informed by the PN. Of the 120 respondents, 59 used some form of supportive cancer care. Most of the responding healthcare professionals (N = 70, response rate 45%) perceived the intervention as a valuable addition to current cancer care (n = 51) and mentioned that the PN should be available to all patients (n = 54). CONCLUSIONS The intervention was perceived as valuable by both patients and healthcare professionals. The results may, however, been biased by the large number of patients who were omitted from participation due to logistical reasons.
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