Patient navigation programs in Alberta, Canada: an environmental scan

Emergency Department Navigator Interventions and Outcome Measures: A Scoping Review

INTRODUCTION

Emergency department (ED) patient navigators are increasingly used, but a lack of understanding of how ED navigator interventions are designed, described, and evaluated creates gaps in our ability to understand, monitor and improve care. The purpose of this scoping review is to identify how the literature describes and evaluates ED patient navigator interventions for older people transitioning to a primary care setting.

METHODS

A scoping review was conducted following the Johanna Briggs Institute updated methodological guidance for the conduct of scoping reviews. We searched three databases: MEDLINE, EMBASE and CINAHL. We included English language articles without any restrictions on study designs that two reviewers screened. All articles focused on distinct ED navigator roles to facilitate transitions for older people from the ED to primary care were included. Data extraction was completed by the primary reviewer and validated by two secondary reviewers. We report study characteristics in a table. Descriptive content analysis was used to analyse the main findings.

RESULTS

A total of 10 studies were included out of 2102 articles identified. All studies used quantitative designs except one, which used a qualitative research design. Four studies were conducted in the United States, two in Australia and the UK and one in Canada and Belgium. Twenty unique outcome measures were identified, with hospital admission rate, frequency of ED presentations and ED/hospital length of stay being the most common. We identified six intervention components: assessment, consultation, liaison, development of care plan, referral and follow-up. Interventions using 4 or more components more commonly reported positive outcomes. Outcome measures used to evaluate interventions were often not tracked across care settings, potentially obscuring the impact of ED navigator interventions across the care continuum.

CONCLUSION

Future research should examine which patients benefit from ED navigation and which outcome measures might help contextualise intervention effectiveness across care settings.

Transition experiences of adolescents and young adults working with a patient navigator

Introduction

The transition from pediatric to adult care poses challenges for adolescents and young adults (AYA) with chronic conditions and their caregivers. A patient navigator (PN) intervention may mitigate transition-related barriers.

Methods

A qualitative study was conducted within a pragmatic randomized controlled trial. A purposive sample was recruited of AYA with diverse diagnostic and demographic characteristics who worked with the PN and/or their caregivers. Seventeen participants completed semi-structured interviews at baseline and post-intervention and optional journal entries. Thematic analysis was used inductively.

Results

Analysis yielded two themes from baseline interviews: 1) uncertainty and hesitation with leaving a place of support, 2) navigator assistance with post-secondary education, and three themes from post-intervention interviews: 1) emotional support, 2) informational and task-focused support, 3) navigator guidance to become more independent.

Discussion

Our findings describe the needs of AYA and the experience of PN support; our findings may guide future implementation of PNs in transition care.

Patient navigation job roles by levels of experience: Workforce Development Task Group, National Navigation Roundtable

PLAIN LANGUAGE SUMMARY

Cancer patient navigators work in diverse settings ranging from community-based programs to comprehensive cancer centers to improve outcomes in underserved populations by eliminating barriers to timely cancer prevention, early detection, diagnosis, treatment, and survivorship in a culturally appropriate and competent manner. This article clarifies the roles and responsibilities of Entry, Intermediate, and Advanced level cancer patient navigators. The competencies described in this article apply to patient navigators, nurse navigators, and social work navigators. This article provides a resource for administrators to create job descriptions for navigators with specific levels of expertise and for patient navigators to advance their oncology careers and attain a higher level of expertise.

'Snapshot in time': a cross-sectional study exploring stakeholder experiences with environmental scans in health services delivery research

OBJECTIVE

To describe stakeholder characteristics and perspectives about experiences, challenges and information needs related to the use of environmental scans (ESs).

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A web-based survey platform was used to disseminate an online survey to stakeholders who had experience with conducting ESs in a health services delivery context (eg, researchers, policy makers, practitioners). Participants were recruited through purposive and snowball sampling. The survey was disseminated internationally, was available in English and French, and remained open for 6 weeks (15 October to 30 November 2022).

ANALYSIS

Descriptive statistics were used to describe the characteristics and experiences of stakeholders. Thematic analysis was used to analyse the open-text questions.

RESULTS

Of 47 participants who responded to the survey, 94% were from Canada, 4% from the USA and 2% from Australia. Respondents represented academic institutions (57%), health agency/government (32%) and non-government organisations or agencies (11%). Three themes were identified: (a) having a sense of value and utility; (b) experiencing uncertainty and confusion; and (c) seeking guidance. The data suggest stakeholders found value and utility in ESs and conducted them for varied purposes including to: (a) enhance knowledge, understanding and learning about the current landscape or state of various features of health services delivery (eg, programmes, practices, policies, services, best practices); (b) expose needs, service barriers, challenges, gaps, threats, opportunities; (c) help guide action for planning, policy and programme development; and (d) inform recommendations and decision-making. Stakeholders also experienced conceptual, methodological and practical barriers when conducting ESs, and expressed a need for methodological guidance delivered through published guidelines, checklists and other means.

CONCLUSION

ESs have value and utility for addressing health services delivery concerns, but conceptual and methodological challenges exist. Further research is needed to help advance the ES as a distinct design that provides a systematic approach to planning and conducting ESs.

Relationship between using cancer resource center services and patient outcomes

PURPOSE

Psychological and social support are crucial in treating cancer. Cancer resource centers provide patients with cancer and their families with services that can help them through cancer treatment, ensure that patients receive adequate treatment, and reduce cancer-related stress. These centers offer various services, including medical guidance, health education, emotional assistance (e.g., consultations for cancer care), and access to resources such as financial aid and post recovery programs. In this study, we comprehensively analyzed how cancer resource centers assist patients with cancer and improve their clinical outcomes.

METHODS

The study participants comprised patients initially diagnosed with head and neck cancer or esophageal cancer. A total of 2442 patients from a medical center in Taiwan were included in the study. Data were analyzed through logistic regression and Cox proportional hazards regression.

RESULTS

The results indicate that unemployment, blue-collar work, and a lower education level were associated with higher utilization of cancer resource center services. The patients who were unemployed or engaged in blue-collar work had higher risks of mortality than did their white-collar counterparts. Patient education programs can significantly improve the survival probability of patients with cancer. On the basis of our evaluation of the utilization and benefits of services provided by cancer resource centers, we offer recommendations for improving the functioning of support systems for patients with cancer and provide suggestions for relevant future research.

CONCLUSIONS

We conclude that cancer resource centers provide substantial support for patients of low socioeconomic status and improve patients' survival.

Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.

Enterprise Healthcare Physician Services in Canada: An Environmental Scan

Employers in Canada are increasingly offering physician services to their employees through third-party "enterprise" virtual care platforms. In our environmental scan, we identified nine enterprise healthcare companies offering physician services to millions of Canadian employees via enterprise platforms. All platforms offered rapid access to virtual physician services. Some offered in-person visits, access to specialists, health system navigation and sharing of information with an employee's regular care provider. Almost half shared aggregate or de-identified health data with employers. These platforms provide rapid and convenient access to physician services but also disrupt the continuity of care, pose risks to employee privacy and expand two-tiered healthcare.

Pan-Canadian caregiver experiences in accessing government disability programs: A mixed methods study

BACKGROUND

At present, little is known about the factors that contribute to the relatively low uptake of government-funded disability programs in Canada.

AIM

Understand how parents/caregivers of Canadian youth with neurodevelopmental disability (NDD) experience the process of applying for and accessing disability programs.

METHODS AND PROCEDURES

This mixed methods sequential explanatory study utilized two phases: an online survey (quantitative), followed by semi-structured interviews (qualitative). The quantitative phase gathered sociodemographic information and preliminary information about participant experiences applying for and accessing programs. The qualitative phase provided greater depth by asking participants to describe barriers and facilitators to program access.

OUTCOMES AND RESULTS

499 participants completed the online survey and 81 participants completed an interview. Analysis of survey data revealed that many participants are not accessing disability programs and experience difficulty when applying. Regression analyses revealed that factors relating to the process of applying and applicant/family attributes are significantly associated with program access. Inductive thematic analysis of interview data revealed four barriers and three facilitators to access. Integration of findings provided an overview of the multi-faceted journey to program access.

CONCLUSIONS AND IMPLICATIONS

The results of this study highlight policy changes that are needed to ensure disability programs adequately support Canadian families.