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Lay Navigator Model for Impacting Cancer Health Disparities

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Abstract

This paper recounts experiences, challenges, and lessons learned when implementing a lay patient navigator program to improve cancer care among medically underserved patients who presented in a primary care clinic with a breast or colorectal cancer abnormality. The program employed five lay navigators to navigate 588 patients. Central programmatic elements were the following: (1) use of bilingual lay navigators with familiarity of communities they served; (2) provision of training, education, and supportive activities; (3) multidisciplinary clinical oversight that factored in caseload intensity; and (4) well-developed partnerships with community clinics and social service entities. Deconstruction of healthcare system information was fundamental to navigation processes. We conclude that a lay model of navigation is well suited to assist patients through complex healthcare systems; however, a stepped care model that includes both lay and professional navigation may be optimal to help patients across the entire continuum.

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References

  1. Committee on Understanding Eliminating Racial Ethnic Disparities in Health Care (2003) Unequal treatment: Confronting racial and ethnic disparities in Health Care. The National Academies Press, Washington D.C.

    Google Scholar 

  2. Michielutte R, Alciati MH, el Arculli R (1999) Cancer control research and literacy. J Health Care Poor Underserved 10(3):281–297

    Article  CAS  PubMed  Google Scholar 

  3. Wells KJ, Meade CD, Calcano ER, Lee JH, Rivers D, Roetzheim RG (2011) Innovative approaches to reducing cancer health disparities: the Moffitt Cancer Center patient navigator research program. J Cancer Educ Off J Am Assoc Cancer Educ 26(4):649–657. doi:10.1007/s13187-011-0238-7

    Article  Google Scholar 

  4. Freeman HP, Muth BJ, Kerner JF (1995) Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract 3(1):19–30

    CAS  PubMed  Google Scholar 

  5. Paskett ED, Harrop JP, Wells KJ (2011) Patient navigation: an update on the state of the science. CA Cancer J Clin 61(4):237–249

    Article  PubMed Central  PubMed  Google Scholar 

  6. Wells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E, Mandelblatt JS, Paskett ED, Raich PC (2008) Patient navigation: State of the art or is it science? Cancer 113(8):1999–2010

    Article  PubMed Central  PubMed  Google Scholar 

  7. Freund KM, Battaglia TA, Calhoun E, Dudley DJ, Fiscella K, Paskett E, Raich PC, Roetzheim RG (2008) National Cancer Institute Patient Navigation Research Program: Methods, protocol, and measures. Cancer 113(12):3391–3399. doi:10.1002/cncr.23960

    Article  PubMed Central  PubMed  Google Scholar 

  8. Dohan D, Schrag D (2005) Using navigators to improve care of underserved patients: Current practices and approaches. Cancer 104(4):848–855. doi:10.1002/cncr.21214

    Article  PubMed  Google Scholar 

  9. Freeman HP (2004) A model patient navigation program. Oncol Issues 19:44–46

    Google Scholar 

  10. Ell K, Padgett D, Vourlekis B, Nissly J, Pineda D, Sarabia O, Walther V, Blumenfield S, Lee PJ (2002) Abnormal mammogram follow-up: a pilot study women with low income. Cancer Pract 10(3):130–138

    Article  PubMed  Google Scholar 

  11. Petereit DG, Molloy K, Reiner ML, Helbig P, Cina K, Miner R, Spotted Tail C, Rost C, Conroy P, Roberts CR (2008) Establishing a patient navigator program to reduce cancer disparities in the American Indian communities of Western South Dakota: Initial observations and results. Cancer Control J Moffitt Cancer Cent 15(3):254–259

    Google Scholar 

  12. Carroll JK, Humiston SG, Meldrum SC, Salamone CM, Jean-Pierre P, Epstein RM, Fiscella K (2010) Patients’ experiences with navigation for cancer care. Patient Educ Couns 80(2):241–247. doi:10.1016/j.pec.2009.10.024

    Article  PubMed Central  PubMed  Google Scholar 

  13. Freeman HP, Rodriguez RL (2011) History and principles of patient navigation. Cancer 117(15 Suppl):3537–3540

    Article  Google Scholar 

  14. Wilcox B, Bruce SD (2010) Patient navigation: a “win-win” for all involved. Oncol Nurs Forum 37(1):21–25. doi:10.1188/10.ONF.21-25

    Article  PubMed  Google Scholar 

  15. Ell K, Vourlekis B, Xie B, Nedjat-Haiem FR, Lee PJ, Muderspach L, Russell C, Palinkas LA (2009) Cancer treatment adherence among low-income women with breast or gynecologic cancer: a randomized controlled trial of patient navigation. Cancer 115(19):4606–4615

    Article  PubMed Central  PubMed  Google Scholar 

  16. Oncology Nursing Society. 2010. Oncology Nursing Society, the Association of Oncology Social Work, and the National Association of Social Workers Joint Position on the Role of Oncology Nursing and Oncology Social Work in Patient Navigation. http://www.ons.org/publications/positions/navigation. Accessed

  17. American College of Surgeons (2012) Cancer program standards 2012 version 1.1: Ensuring patient centered care. American College of Surgeons, Chicago

    Google Scholar 

  18. Wells KJ, Lee JH, Calcano ER, Meade CD, Rivera M, Fulp WJ, Roetzheim RG (2012) A cluster randomized trial evaluating the efficacy of patient navigation in improving quality of diagnostic care for patients with breast or colorectal cancer abnormalities. Cancer Epidemiol Biomarkers Prev 21(10):1664–1672. doi:10.1158/1055-9965.epi-12-0448

    Article  PubMed Central  PubMed  Google Scholar 

  19. Baur C (2011) Calling the nation to act: implementing the national action plan to improve health literacy. Nurs Outlook 59(2):63–69. doi:10.1016/j.outlook.2010.12.003

    Article  PubMed  Google Scholar 

  20. Nutbeam D (2008) The evolving concept of health literacy. Soc Sci Med 67(12):2072–2078. doi:10.1016/j.socscimed.2008.09.050

    Article  PubMed  Google Scholar 

  21. Meleis AI (1999) Culturally competent care. J Transcult Nurs 10(1):12

    Article  CAS  PubMed  Google Scholar 

  22. U.S. Department of Health and Human Services, Public Health Services, Office of Minority Health (OMH): (2010) Enhanced national culturally and linguistically appropriate services (CLAS) standards, https://www.thinkculturalhealth.hhs.gov/content/clas.aspview The Blueprint and National CLAS Standards https://www.thinkculturalhealth.hhs.gov/pdfs/EnhancedCLASStandardsBlueprint.pdf

  23. Calhoun EA, Whitley EM, Esparza A, Ness E, Greene A, Garcia R, Valverde PA (2010) A national patient navigator training program. Health Promot Pract 11(2):205–215

    Article  PubMed  Google Scholar 

  24. Meade CD, Menard JM, Luque JS, Martinez-Tyson D, Gwede CK (2011) Creating community-academic partnerships for cancer disparities research and health promotion. Health Promot Pract 12(3):456–462. doi:10.1177/1524839909341035

    Article  PubMed Central  PubMed  Google Scholar 

  25. Phillips S, Nonzee N, Tom L, Murphy K, Hajjar N, Bularzik C, Dong X, Simon MA (2014) Patient Navigators’ Reflections on the Navigator-Patient Relationship. J Cancer Educ

  26. Hesselink AE, Verhoeff AP, Stronks K (2009) Ethnic health care advisors: a good strategy to improve the access to health care and social welfare services for ethnic minorities? J Community Health 34(5):419–429. doi:10.1007/s10900-009-9171-7

    Article  PubMed Central  PubMed  Google Scholar 

  27. Meade CD (2014) Community health education. In: Nies MA, McEwen M (eds) Community Health/Public Health Nursing: Promoting the health of populations. Saunders, Inc., St. Louis

    Google Scholar 

  28. Hendren S, Griggs JJ, Epstein RM, Humiston S, Rousseau S, Jean-Pierre P, Carroll J, Yosha AM, Loader S, Fiscella K (2010) Study protocol: a randomized controlled trial of patient navigation-activation to reduce cancer health disparities. BMC Cancer 10:551. doi:10.1186/1471-2407-10-551

    Article  PubMed Central  PubMed  Google Scholar 

  29. Robie L, Alexandru D, Bota DA (2011) The use of patient navigators to improve cancer care for Hispanic patients. Clin Med Insights Oncol 5:1–7. doi:10.4137/CMO.S6074

    PubMed Central  PubMed  Google Scholar 

  30. Ramirez A, Perez-Stable E, Penedo F, Talavera G, Carrillo JE, Fernández M, Holden A, Munoz E, San Miguel S, Gallion K (2013) Reducing time-to-treatment in underserved Latinas with breast cancer: the six cities study. Cancer. doi:10.1002/cncr.28450

    Google Scholar 

  31. Willis A, Reed E, Pratt-Chapman MA, Heather M, Kapp H, Hatcher E, Vaitones V, Collins S, Bires J, Washington E-C (2013) Development of a framework for patient navigation: delineating roles across navigator types. J Oncol Navig Survivorship 4(6):20–26

    Google Scholar 

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Acknowledgment

This study was funded by the National Institute of Health/National Cancer Institute through its Center to Reduce Cancer Health Disparities (5 U01 CA 117281). We gratefully recognize the many community members and health providers who participated in this project.  We also acknowledge the valuable insights of our Patient Navigator  Advisory Committee who helped to guide and shape this work.

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Authors and Affiliations

  1. Division of Population Science, Moffitt Cancer Center, 12902 Magnolia Drive, Fow-Edu, Tampa, FL, 33612, USA

    Cathy D. Meade & Yolanda Sarmiento

  2. San Diego State University, San Diego, CA, USA

    Kristen J. Wells

  3. University of Texas Health Science Center, Houston, TX, USA

    Mariana Arevalo

  4. University of South Florida, Tampa, FL, USA

    Ercilia R. Calcano & Richard G. Roetzheim

  5. St. Joseph Hospital, Tampa, FL, USA

    Marlene Rivera

  6. Harold P Freeman Patient Navigation Institute, New York, NY, USA

    Harold P. Freeman

Authors
  1. Cathy D. Meade
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  2. Kristen J. Wells
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  3. Mariana Arevalo
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  4. Ercilia R. Calcano
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  5. Marlene Rivera
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  6. Yolanda Sarmiento
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  7. Harold P. Freeman
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  8. Richard G. Roetzheim
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Corresponding author

Correspondence to Cathy D. Meade.

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Meade, C.D., Wells, K.J., Arevalo, M. et al. Lay Navigator Model for Impacting Cancer Health Disparities. J Canc Educ 29, 449–457 (2014). https://doi.org/10.1007/s13187-014-0640-z

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  • DOI: https://doi.org/10.1007/s13187-014-0640-z

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