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 - PowerPoint PPT Presentation

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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

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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


1
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
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

4
Causes 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
5
Cancer Disparities Research Partnerships Program
Telesynergy
Awardee
Partner
NCI Cancer Center Partner
Pt. Navigator
Patient Navigator
Patient
6
(No Transcript)
7
Cancer Disparities Research Partnership Program
(CDRP)
  • 5-year grant
  • The program components
  • Radiation oncology clinical trials infrastructure
  • Research/Mentoring Partnerships
  • Telecommunication TELESYNERGY

8
U.S. Map
U.S. MAP
9
ULAAC
  • Urban Latino African American Cancer
  • Health Disparities Project
  • Centinela Freeman Regional Medical Center

10
ULAAC 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

11
CFHS Service Area
12
Our Patients
13
Our 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

15
INITIAL 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

16
INFRASTRUCTURE
  • 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

17
Cancer 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

19
RECRUITING 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

21
Training Program
22
Active Navigators
23
Ethnicity of Active Navigators
24
Navigators Who Are CancerSurvivors
25
Patient Navigation Data
67 accepted navigation
26
Ethnicity of Patients Approached
Percentage Breakdown 71 African Americans, 13
Latinos, 11 Caucasians, 4 Asians, 1 Other
27
Ethnicity of Patients Accepting Navigation
28
Reasons for Declining Navigation
29
ASSESSMENT 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

30
ASSESSMENT 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

31
Barriers 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
32
6 Most Common Barriers
33
Results of Clinical Trials Accrual
  • 7 Trials Open
  • 5 NCI/RTOG Sponsored Trials
  • 1 NCIC Sponsored Trial
  • 1 Multi-institution device Trial

34
Trial Enrollment
35
Accrual to Trial by Ethnicity
36
Clinical Trials Participation(14 month time
period)
37
Reasons for Non Accrual to Clinical Trial
38
Clinical 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

41
CONCLUSION
  • 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

42
Still 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

43
Still 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
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