Patient Navigation in Cancer Care Guiding patients to

Patient Navigation in Cancer Care Guiding patients to quality outcomes TM TM TM AOU 00157 B. 1 © 2007 Pfizer Inc. All rights reserved. Printed in USA/November 2007 TM

Patient Navigation in Cancer Care Tool Kit The Patient Navigation in Cancer Care multimedia tool kit was: – Designed to be an essential tool for health care organizations to use in the development of patient navigation programs – Developed as a cooperative effort between Pfizer Inc and the Healthcare Association of New York State (HANYS) • In consultation with Dr. Harold P. Freeman 2 TM TM

Components of the Patient Navigation in Cancer Care Tool Kit The Patient Navigation in Cancer Care tool kit consists of 3 modules: – Establishing a Patient Navigation Program: An Implementation Guide for the Program Champion – Navigation Pathways: The Patient Navigator Training Manual – Breast Cancer Pathways: A Resource Guide for the Patient Navigator 3 TM TM

Patient Navigation in Cancer Care Tool Kit Expansions Additional manuals have since been added to the core program – Colorectal Cancer Pathways: A Resource Guide for the Patient Navigator – Recent Management Strategies in Breast Cancer 4 TM TM

Presentation Contents Introduction to Patient Navigation A Model Program: Application & Adaptability Results of Successful Programs Implementation at [Add Name of Organization]: Establishing a Need Moving Toward Implementation 5 TM TM

Introduction to Patient Navigation 6 TM TM

What Is Patient Navigation? Patient navigation: – Supports patients in need of assistance with one-on-one contact – Ensures that all patients with suspicious findings receive a resolution to those findings – Utilizes a patient navigator who moves patients through the health care system – Works within the organization and through external services to eliminate barriers to health care 7 Freeman HP. Oncol Issues. 2004; 5: 44 -46. TM TM

The Origins of Patient Navigation Report to the Nation on Cancer in the Poor (1989) Harlem Cancer Education and Demonstration Project at Harlem Hospital (1990) Voices of a Broken System (2001) 8 Freeman HP, et al. Cancer Pract. 1995; 3: 19 -30. Freeman HP. Oncol Issues. 2004; 5: 44 -46. TM TM

Patient Navigator, Outreach, and Chronic Disease Prevention Act of 2005 The Patient Navigator, Outreach, and Chronic Disease Prevention Act of 2005 – Signed into law by President George W. Bush on June 29, 2005 – Recognizes the challenges facing many Americans in obtaining the health care they need – Established a 5 -year, $25 million demonstration program 9 GOP. gov. H. R. 1812—Patient Navigation Outreach and Chronic Disease Prevention Act of 2005. TM TM

Breast Health Patient Navigator Program Resource Kit First navigator resource tool kit Designed under the guidance of the Healthcare Association of New York State Breast Cancer Demonstration Project® Published in 2002 (Copyright 2002) Disseminated to hospital systems throughout New York State Used in development of Patient Navigation in Cancer Care 10 TM TM

Goals of a Patient Navigation Program The main goals of patient navigation are: – To save lives from cancer – To eliminate barriers to care – To ensure timely delivery of services 11 Freeman HP. Oncol Issues. 2004; 5: 44 -46. TM TM

Potential Barriers to Receiving Timely Health Care Barriers interfere with appropriate and timely care – Delays of 3 to 6 months in initiating breast cancer treatment were associated with lower survival rates – Strong connection found between African American race and delay in breast cancer screening and treatment Patient navigation originally targeted the poor who: – Endure greater pain and suffering than other Americans – Feel cancer education and outreach efforts are irrelevant to them Elderly experience discrimination – Health care professionals may have limited training in geriatrics – Less likely to receive preventive care or screening 12 Freeman HP, et al. Cancer Pract. 1995; 3: 19 -30. Richards MA, et al. Lancet. 1999; 353: 1119 -1126. Sheinfeld Gorin SN, et al. Presented at: 41 st Annual Meeting of the ASCO; May 13 -17, 2005; Orlando, Fla. Alliance for Aging Research. Washington, DC; 2003. TM TM

Potential Barriers to Receiving Timely Health Care (cont’d) Barrier Examples Financial and economic Transportation Difficulty arranging transportation Cultural beliefs regarding treatment Communication and language Difficulty telling desires/needs Health care system Fragmentation of care Bias based on race/age Fear and mistrust by patients; inadequate screening of the elderly Fear 13 Lack of or inadequate insurance Delay or refusal of care Freeman HP, Reuben SH. Voices of a Broken System. Bethesda, Md: NIH, NCI; 2001. TM TM

A Model Program Application & Adaptability 14 TM TM

Patient Navigation’s Guiding Principles Ensure that quality, confidentiality, and professionalism are threaded throughout all aspects of care and programming. Inherent in patient navigation is continuous quality care for patients from screening through diagnosis and treatment, based on the following tenets: – Culturally competent care – Confidentiality – Respect – Compassion – Patient safety 15 TM TM

The Patient Navigation Model The Cancer Care Continuum 16 Freeman HP, et al. Cancer Pract. 1995; 3: 19 -30. TM TM

Suitable for Many Health Care Settings The navigation program: – Is adaptable to different settings and needs – Encourages compassion toward persons who are being served – Defines at what point a navigator is engaged and what a navigator does – Respects the confidentiality of the patients involved – Is reliable so that patients and navigators in the program can trust the information and help received – Evaluates the effectiveness of the program 17 TM TM

Responsibilities of a Navigator Meet with patients at point of suspicious finding Identify any barriers or potential barriers to care Streamline appointments and paperwork Maintain open communication with health care providers, caregivers, and patients Assist in increasing access to culturally appropriate, supportive care when and where possible Link patients, caregivers, and families with appropriate follow-up services Maintain personal contact with patients throughout the health care continuum and follow their progress HANYS BCDP®. Breast Health Patient Navigator Program Resource Kit. Rensselaer, NY: HANYS; 2002. 18 Long Island College Hospital. Breast Health Navigator Program. Rensselaer, NY: HANYS; 2002. TM TM

Characteristics of a Navigator Preferably selected from the community of patients being served Compassionate with a sincere desire to help people Understands the issues of financial, cultural, educational, and social barriers to information and care in the patient community Can communicate effectively with patients, their families, and health care providers Is organized and can demonstrate creative problem-solving solutions Is highly resourceful and able to research resources for patients Freeman HP. Oncol Issues. 2004; 5: 44 -46. 19 Long Island College Hospital. Breast Health Navigator Program. Rensselaer, NY: HANYS; 2002. TM TM

Patient Navigators and Other Cancer Support Personnel • Deliver specific services • Address individual patients only Social workers and case managers • Seek solutions to various problems • Address individual patients only Community outreach workers Navigators • Deliver specific services • Address individual patients and health care system Advocates • Address individual patients and health care system 20 Dohan D, Schrag D. Cancer. 2005; 104: 848 -855. TM TM

Where Should Navigation Be Implemented? Organizations providing care within the cancer continuum – Hospitals – Clinics – Screening centers – Community not-for-profits – Oncology and radiology offices Organizations with an underserved population Organizations wishing to provide a premier cancer care center delivery model 21 TM TM

Making a Patient Navigation Program Work Organizational buy-in and support Dedicated resources Supportive leadership An established alliance between the navigator and highly connected, key decision makers in the organization, especially those involved in financial decisions A patient navigator dedicated to expediting patient access and improving continuity and coordination of care 22 TM TM

Results of Successful Programs 23 TM TM

Harlem Hospital Center: Improved Access to Screening and Patient Navigation 100 After access to screening and patient navigation program (1995– 2000) 90 80 Patients (%) 70 60 50 Before access to screening and patient navigation program (1964– 1986) 70% 40 30 39% 20 10 n=457 n=74 5 -Year Survival Rate Freeman HP. Oncol Issues. 2004; 5: 44 -46. Oluwole SF, et al. J Am Coll Surg. 2003; 196: 180 -188. 24 Freeman HP, et al. Cancer. 1989; 63: 2562 -2569. TM TM

Navigated Patients Were More Likely to Complete Biopsies 100 90 80 85. 7% Patients (%) 70 60 Had Biopsies Completed Within 4 Weeks 71. 4% 50 56. 5% 40 30 38. 5% 20 10 Navigated Patients 25 Freeman HP, et al. Cancer Pract. 1995; 3: 19 -30. Non-navigated Patients TM TM

Nova Scotia Breast Screening Program: Shortened Wait Time to Biopsy Group Navigation Median Wait Time to Biopsy (days) Screening (n=97) Yes 12 Referral (n=144) No 20 Screening (n=133) Yes 13 Referral (n=162) Yes 14 1999 2000 26 Psooy BJ, et al. Can Assoc Radiol J. 2004; 55: 145 -150. TM TM

Long Island College Hospital: Self-Reported Positive Findings Positive results after instituting a breast health navigator program at Long Island College Hospital: – 99% of all clinic patients had follow-up appointments scheduled before leaving the hospital vs 25% previously – Attendance at breast cancer support groups increased 20% – Reasons for missed mammograms were tracked and addressed – 28% of patients referred for physical therapy following breast cancer surgery vs 6% prior to the program 27 Long Island College Hospital. Breast Health Navigator Program. Rensselaer, NY: HANYS; 2002. TM TM

Improving Follow-up to Abnormal Breast Cancer Screening via Patient Navigation Timely Follow-Up 100 Follow-up Within 120 Days (%) 90 80 78% 70 60 50 64% 40 30 20 10 Preintervention Group 28 Battaglia TA, et al. Cancer. 2007; 109 (2 suppl): 359 -367. Intervention Group TM TM

Screening Adherence Follow-up Program (SAFe) Reducing Barriers to Follow-up and Treatment First Treatment Within 30 Days of Diagnosis Woman in SAFe Program 62% 24 Days Women Not in SAFe Program 29 Median Time From Diagnosis to Treatment 40% 29 Days Ell K et al. Cancer Pract. 2002; 10: 130 -138. TM TM

Possible Benefits of Patient Navigation Programs Improved coordination of high-quality care Enhanced access to services for all populations Removal of barriers to care More efficient delivery of care Improved outcomes Improved sharing of resources Enhanced relationships with the community Increased patient satisfaction 30 TM TM

Implementation at [your organization name] Establishing a Need 31 NOTE TO CHAMPION: Customize the following slides with data specific to your organization. TM TM

Patient Navigation Is Appropriate for [Your Organization] Patient demographics Statistics concerning patient populations Outcomes Number of patients who complete a treatment plan to resolution 32 NOTE TO CHAMPION: Customize the following slides with data specific to your organization. TM TM

Patient Population Likely to Benefit From Program Insurance level – Percentage uninsured – Percentage underinsured Cancer stage at intake – Percentage in stages 0–I (early) – Percentage in stage II – Percentage in stages III–IV & recurrent Percentage of patients speaking a primary language other than English 33 NOTE TO CHAMPION: Customize the following slides with data specific to your organization. TM TM

Barriers That Inhibit Optimal Health Care Appointments missed per week Percentage of patients lost to follow-up Average time from suspicious finding to follow-up appointment Average time from suspicious finding to diagnosis and/or treatment Lack of coordination between departments 34 NOTE TO CHAMPION: Customize the following slides with data specific to your organization. TM TM

Moving Toward Implementation 35 TM TM

Action Plan: Setting Goals for Success Step 1 Define program goals, objectives, budget, evaluation mechanisms, and time frame Step 2 Formulate a patient navigator role description Step 3 Develop tools from provided templates: Intake Form and Tracking Tool Promotional materials 36 TM TM

Action Plan: Promote Awareness of the Program Step 4 Identify other departments involved in overseeing care (eg, radiology, radiation oncology, patient billing, social work) Step 5 Formulate outreach and educational strategies Step 6 Work with the public relations department to promote and publicize program, both internally and externally 37 TM TM

Action Plan: Demonstrate Program Success Data should be gathered at the start of the program and tracked throughout to: – Identify system changes that need to be made – Determine resources that are lacking – Track success of interventions – Assure that the intended audience is being served Choice and complexity of evaluation measurements: – Should be determined based on the resources available – Will vary from program to program 38 TM TM

Budgetary Considerations for the Program Patient navigator selection, salary, benefits, and training Supplies, materials, and office space with computer access for the navigator Program promotion for patients and professionals Outreach incentives to patients to use navigation Evaluation costs in implementing tracking systems, if not already incorporated into the existing structure 39 TM TM

Implementing a Navigation Program Step 1: Assess need for implementation Step 2: Enlist internal support Step 3 a: Evaluate potential obstacles to implementation; brainstorm for solutions Step 3 b: Determine program scope, cost, and implementation strategy Step 3 c: Collect baseline data for needs assessment and evaluation Step 4: Implement program and identify a patient navigator Task: Coordinate program planning with appropriate departments Task: Prepare documents (eg, posters, brochures, policies, procedures, forms) Task: Implement support systems, referral processes, outreach strategies Task: Track responses, appointments, and other relevant data Step 5: Assess program effectiveness 40 HANYS BCDP®. Breast Health Patient Navigator Program Resource Kit. Rensselaer, NY: HANYS; 2002. TM TM

Conclusion Patient navigation eliminates barriers to enable individuals with a suspicious finding to receive timely diagnosis and treatment Patient navigation keeps patients from falling through the cracks Patient navigation programs exist across the United States and Canada US legislation signed into law in support of patient navigation programs Patient navigation can be of great benefit to [Name of our organization] 41 TM TM