Communication in Cancer Care (Recent Results in Cancer Research)
Patient Navigators. There was a lot of discussion at the workshop about patient navigation and how or even whether to make more use of patient advocates or navigators, as well as how to develop a new business model to support them. During her presentation, Ms.
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This definition asserts that navigation services and programs should be provided by culturally competent professionals or nonprofessionals in a variety of medical, organizational, advocacy, or community settings. In addition, the type of navigation services will depend on the particular type, severity, and complexity of the identified barriers, which explains why both professional and nonprofessional navigators can help provide these services, Ms.
Esparza pointed out. Patient navigators who once were patients themselves can serve another important role, Mr. Mayer concurred and added that patient surveys on survivorship care plans showed that patients wanted peer navigators. Navigators have many responsibilities, as can be seen in Figure 2. They are understanding where the best place is for this patient to go to seek information or to seek resources.
The first patient navigation program was developed for medically underserved patients at Harlem Hospital and was shown to foster earlier diagnosis of breast cancer and to increase the number of patients who had colorectal cancer screening, Ms. Esparza reported.
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Since then, she said, several studies have shown numerous benefits of patient navigation, including the following Bayard et al. Esparza reported that the patient navigation services offered by the American Cancer Society ACS served more than 83, patients and caregivers in A recent internal evaluation found that the more patients met with their navigators, the more they experienced an increase in self-efficacy and understanding. They also were better able to cope with their disease.
The navigators also improved communication between the patient and the healthcare provider, decreased barriers to care, and reduced the degree of fear and anxiety patients reported when initially interacting with healthcare providers. Ganz pointed out that with the current complexity of health care, especially for cancer patients, it is not just the patients who are traditionally underserved that require patient navigation, but all patients.
Others also questioned using patient navigators as Band-Aids to an ailing healthcare system and instead called for healthcare reform. However, Ms. Esparza stressed that health disparities still exist, so some patients need navigation more than others and that navigation improves outcomes the most in those subpopulations. Patient navigation has now become more integrated in Canada as a means to improve care and increase efficiency, Ms. Esparza reported, and an ACS survey 7 found that there are more than 1, individual groups claiming to provide some type of patient navigation.
More than half of the patient navigators had been caregivers to people who had severe disease, and their average age was 59 years. Many navigators were nurses or social workers as well as other health professionals. The lay patient navigators tended to work more closely with community groups and with minority and medically underserved populations. Prior to paying these navigators competitive wages, Dr. Burhansstipanov had a problem with high turnover. Now, they only lose about one patient navigator every five years.
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John Mendelsohn, president of M. Yet he also pointed out that given the current economy and high costs of medical care, it is hard to imagine how the additional costs of.
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Kaplan suggested thinking outside the box to make a business case for patient navigation because it is likely to reduce healthcare costs by preventing readmissions, costly errors, and other medical expenses. Mendelsohn said. Esparza noted that much still needs to be defined within the burgeoning field of patient navigation, such as how patient navigators are trained and what competencies they should have. Esparza also stressed the need for common outcome measures to assess the impact of patient navigation. ACS has developed a supplement that provides navigation measures across the care continuum.
Mendelsohn suggested including improved survival and cure rates as outcome measures for patient navigation.
However, as previously noted by speakers, a major challenge of patient navigation is how to integrate it into the current healthcare system, and who will pay for this service. Esparza said. Oncology Nurses and Social Workers. Bakitas focused her remarks on the underutilization of nurse oncologists as communication resources during cancer treatment planning.
Communicating with patients with advanced and metastatic cancer
These health professionals have several assets that can aid the communication process, including being trusted by and accessible to patients, she said. A Gallup poll found that the American public judged nursing as the most trusted, honest, and ethical profession Gallup, , Dr. She added that board-certified oncology nurses also have more contact with cancer patients and their families than any other discipline, with one study documenting that nurses spend one to two hours in patient communication during each cancer treatment De Raad et al. There is also some evidence, Dr.
Communication in Cancer Care
Bakitas said, that patients may prefer nurses as information providers at specific times in their treatment, especially with regard to symptom management. Bakitas cited several studies that showed the benefits of using oncology nurses, including a study of newly diagnosed patients with solid tumors who were discharged after surgery McCorkle et al. Those who received a standardized nursing protocol, including comprehensive clinical assessments, monitoring, and teaching, had better 2-year survival rates than a control group.
Another study Northouse et al. In addition, another study found that communication about palliative care at the initiation of cancer treatment can influence quality of life and mood through the end of life and might improve survival outcomes Bakitas et al. Despite the benefits of using oncology nurses in cancer treatment planning, the IOM consensus report The Future of Nursing: Leading Change, Advancing Health found that these health professionals are underutilized in many areas of health care IOM, , Dr.
She called for making the communication role of the oncology nurse explicit through cancer treatment planning guidelines. Social workers are also communication specialists that should be used more in cancer treatment planning, according to Dr. She called for social workers to advocate for individual patients both in the healthcare system and in the policy arena, so their profession becomes an integral part of cancer treatment planning. Model Programs. A number of model programs have attempted to make cancer treatment planning and other aspects of health care more patient-centered.
These models include patient coaching programs, centers for shared decision making, enhanced discharge planning programs, accountable care systems, and self-help support groups. Patient Coaching. Kaplan has been studying programs in which patients are coached prior to seeing their physicians for care for a variety of conditions, including breast cancer, diabetes, hypertension, and rheumatoid arthritis.
Such coaching involves showing patients their medical records and explaining how to use their medical information to ask their providers questions and participate in decision making about their treatment. Compared to controls, patients receiving coached care asked three times more questions, were two times more effective in information seeking, and took more control of the conversations they had with their physicians Greenfield et al.
Decision Support. To further patient-centered decision making, the Hitchcock Breast Center at Dartmouth has a Center for Shared Decision Making to whom all patients with breast cancer are referred when they are first diagnosed. At this center, patients fill out online surveys, including those that capture their medical and family history, and ask how important it is to them to keep their breasts, avoid radiation, and other treatment-related preferences.
Patients also watch a video with a decision aid that is appropriate for their situation. Patients are then asked what treatment they are leaning toward and how certain they are about the choice. In addition, they are asked if they. All of this information from patients is placed into a clinical decision support system, which triggers different actions depending on what the patient responses were. To assess the value of this center, patients were asked questions related to their knowledge of breast cancer treatment options after a visit with their doctor, including the likelihood of the treatment options to affect survival and recurrence, and how much time they could take to decide on a treatment option.
Ninety-two percent of patients answered these questions correctly, Dr. Sepucha reported Collins et al.