Title: The Use of Lay Patient Navigators to Improve Quality of Care and Accrual to Clinical Trials for Radiation Oncology Patients who are Minorities or of Low Socioeconomic Status ASTRO Philadelphia, Pa. November,2006
1The Use of Lay Patient Navigators to Improve
Quality of Care and Accrual to Clinical Trials
for Radiation Oncology Patients who are
Minorities or of Low Socioeconomic
StatusASTROPhiladelphia, Pa.November,2006
- Principal Investigator
- Michael L. Steinberg, MD, FACR
- Co-Principal Investigators
- David Huang, MD
- David Khan, MD
- Allen Fremont, MD, PhD
- Nell Forge, PhD
- Oscar Streeter, MD
- Mack Roach, MD
2- Profound advances in medical science have
contributed to - Increased longevity
- Improved quality of life for many Americans.
H.Freeman
3- Despite these advances, some Americans have not
fully benefited from this progress - particularly
the poor and underserved - - as evidenced by their higher cancer incidence
and lower survival. - H Freeman
4Causes of Health Disparities
Poverty/Low EconomicStatus
Social Injustice
Culture
Post Treatment/Quality of Life
Early Detection
Diagnosis/Incidence
Survival and Mortality
Prevention
Treatment
Freeman, Adapted from Cancer Epidemiology
Biomarkers Prevention, April 2003
5Cancer Disparities Research Partnerships Program
Telesynergy
Awardee
Partner
NCI Cancer Center Partner
Pt. Navigator
Patient Navigator
Patient
6(No Transcript)
7Cancer Disparities Research Partnership Program
(CDRP)
- 5-year grant
- The program components
- Radiation oncology clinical trials infrastructure
- Research/Mentoring Partnerships
- Telecommunication TELESYNERGY
8U.S. Map
U.S. MAP
9ULAAC
- Urban Latino African American Cancer
- Health Disparities Project
- Centinela Freeman Regional Medical Center
10ULAAC OBJECTIVES
- Established the infrastructure to conduct cancer
clinical trials - Developed a lay patient navigator program
primary goals - To decrease barriers to receiving cancer care
- To examine the possibility of increasing
voluntary accrual to clinical trials though the
function of the lay navigator
11CFHS Service Area
12Our Patients
13Our Partners
- Centinela Freeman
- USC
- UCSF
- RAND
14 Initial Navigator Concepts
- Cancer care is a complex and multi-factorial
series of interactions with the healthcare system
- Patient navigators (culturally appropriate
personal patient advocates) can facilitate
patients through the care process. - The concept of a patient navigator and the
corresponding literature shows wide variance in
definitions and implementation
15INITIAL CONSIDERATIONS
- Lay Navigator program best fit our needs
- Diversity of ethnicity and language in service
area - Perceived cost
- All patients are offered navigation and continue
to receive navigation whether they qualify for or
participate in clinical trials
16INFRASTRUCTURE
- Offices/Community Center
- Staff
- Debbie Karaman, MPH, Community Health Educator
- Erika Cobb, Administrative Assistant
- Hershel Knapp, PhD, MSW
- Magdalena Serrano, USC MSW Intern
- Nicole Harada, Clinical Trials Coordinator
- Susan Richardson, RN, Oncology Nurse
- Keith Andre, MA, Project Administrator
- Community Liaison
- MAB
- CAB
17Cancer Disparities Research Partnership
(CDRP) Patient Navigation Model
Patient Navigation
Rehabilitation
Outreach
Cancer Diagnosis
Resolution
Abnormal Finding
Abnormal Results
Diagnosis
Treatment
ConcludeNavigation
Freeman, et.al., Cancer Practice, 1995.
Diagnosis
Treatment
Abnormal results
ConcludeNavigation
18 LAY NAVIGATOR ROLE
- The navigators primary function is guiding
cancer patients through the health care system - Assisting with access issues
- Developing relationships with service providers
- Tracking interventions and outcomes
19RECRUITING AND SCREENING PROSPECTIVE LAY
NAVIGATORS
- Community Health Educator Networking
- Phone
- E-mail
- Community Advisory Board
- Screening
- Phone
- Orientation Session Prior to Training
- Motivations
20 TRAINING COURSE
- The navigator 6 hour training course over 3 days
emphasizes - Investigating and implementing resources for
patients in a timely fashion - Offering compassionate and non-judgmental
communicationactive listening skills - Completing appropriate records of all
interactions on behalf of patient - Empowering patients to self-advocate in the
healthcare realm
21Training Program
22Active Navigators
23Ethnicity of Active Navigators
24Navigators Who Are CancerSurvivors
25Patient Navigation Data
67 accepted navigation
26Ethnicity of Patients Approached
Percentage Breakdown 71 African Americans, 13
Latinos, 11 Caucasians, 4 Asians, 1 Other
27Ethnicity of Patients Accepting Navigation
28Reasons for Declining Navigation
29ASSESSMENT OF EFFECTIVENESS AND QUALITY ASSURANCE
- Navigators and patients queried multiple times
and in various ways during the navigation process - Assessments used to modify training and
navigation process - Assess effectiveness of various components of the
program
30ASSESSMENT OF EFFECTIVENESS ADDRESSING BARRIERS
- Identification of patient specific barriers to
care - Chart and navigation records are audited to
determine time to solution of barrier - The deficiencies receive follow up by staff and
are identified and tracked in a database
31Barriers to Care Chart Audit
PT ID Dx Barriers Navigator Assigned Date of Review Date closed Days open Resources Identified Did ULAAC staff assist Navigator?
009 Colon Transportation 132 04/29/05 04/30/05 2 Taxi voucher program No
2. Financial 131 04/29/05 04/30/05 2 Beckstrand Cancer Foundation No
326 Most Common Barriers
33Results of Clinical Trials Accrual
- 7 Trials Open
- 5 NCI/RTOG Sponsored Trials
- 1 NCIC Sponsored Trial
- 1 Multi-institution device Trial
34Trial Enrollment
35Accrual to Trial by Ethnicity
36Clinical Trials Participation(14 month time
period)
37Reasons for Non Accrual to Clinical Trial
38Clinical Trial Accrual/Navigation
39 Cancer Post-Treatment Survey
- Are there quantitative differences between
patients who received navigation versus those who
did not in various QOL domains? - Are there patient perceived quality of care
differences in the two groups?
40 Cancer Post-Treatment Survey
- Source
- RTOG A-5 Demographic Survey
- FACIT and Model Questions
- Domains Evaluated
- Spiritual
- Social/Family
- Physical
- Emotional
- Functional
- Patient Centered Questions
- Relationship Based Questions
41CONCLUSION
- Ongoing Evaluation Will Provide Practical
Information Regarding - Elimination of barriers to care
- Quality assessment of lay navigation
- Effects of navigation on accrual to clinical
trials
42Still Too Separate, Not Yet Equal
A. Epstein
- Most Existing Information On Disparity Focuses On
- Ability To Afford Care
- Knowledge, Beliefs, Preferences
- Doctor/Patient Relationship
- Bach Suggests That Structural Features Of The
Delivery System Contribute To Disparity in
Quality
43Still Too Separate, Not Yet Equal
A. Epstein
- Describing And Explaining Disparities Is Much
Easier Than Devising Strategies To Reduce
Disparities - Researchers Should Shift Focus To Developing
Infrastructure and Improving Policies That Will
Reduce Disparities