A new proactive virtual resource center navigation model identifies patient risk factors to reduce barriers to cancer care during the COVID-19 pandemic

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.

Nurse Navigators’ Views on Patient and System Factors Associated with Navigation Needs among Women with Breast Cancer

“…An important study limitation is that we did not explore the patient perspective—healthcare providers and healthcare users have different views on how and why they use a given service, and both are important to inform program planning and referral practices. However, our results were consistent with the patient perspective reported by previous studies, which reduces the chance of having missed vital insights [ 30 , 31 ]. Future research should investigate whether the identified factors are generalizable to other navigation settings and jurisdictions (particularly elsewhere in Canada) with varying navigator roles and responsibilities [ 33 ], the prevalence of these factors among a general cancer population and whether a quantitative association can be observed between these factors and use of CPN services (among NS patients and elsewhere).…”

“…This is consistent with the existing evidence on patient navigation programs [3] and the goals of the original patient navigation program, established in 1990 in Harlem, NY [32]. Overall, there is strong evidence from our study, prior studies [3,14,30,31] and the historical circumstances of the first patient navigation program [32] that patients' sociodemographic and psychological factors influence their need for navigation, and thus should act as triggers for program referral. Further, CPN training should continue to emphasize training for the psychosocial, practical and emotional support roles that address the needs associated with these factors.…”

“…These studies both examined the question from the patient perspective, and so their findings make an interesting complement to our study. Many reported factors overlapped among the current study and those previously published, such as low education level, low income, low social support/living alone, greater travel distance to reach healthcare and higher anxiety or depression levels [ 30 , 31 ]. Sociodemographic factors, particularly those related to socioeconomic status and distance from healthcare, are consistently identified as being associated with barriers to accessing quality cancer care [ 14 , 31 ].…”

“…Sociodemographic factors (particularly low income) were generally found to be the most emphasized in discussions. To our knowledge, only two other studies have previously examined specific factors associated with need for navigation in cancer, both conducted in the United States [ 30 , 31 ]. These studies both examined the question from the patient perspective, and so their findings make an interesting complement to our study.…”

“…This will allow for a more practical understanding of which factors are most relevant to target for referral to CPN in clinical practice. Targeting patients with such factors for referral to patient navigation has already been successfully implemented in one other known jurisdiction [ 31 ].…”