A mixed methods study found that a lay navigation program operating outside of the clinical team at a National Cancer Institute (NCI)-designated cancer institute could not effectively overcome the system failures that can negatively impact care coordination. The findings from this study were published in the Journal of Oncology Practice.
Patient navigation programs are increasingly becoming a key component across the cancer care continuum from screening to survivorship. The role of the patient navigator may include scheduling appointments, addressing financial barriers, facilitating communication with professional staff and access to supportive services, as well as providing patient education regarding cancer treatment, the management of potential treatment-related adverse effects, and disease prognosis. Nevertheless, training for oncology patient navigators is diverse, and includes nurse navigators, social worker navigators with clinical training, as well as nonclinically trained lay navigators.
In this study, the implementation of a lay navigator program operating outside of the clinical team at an NCI-designated cancer institute with 12 tumor-specific clinics was characterized using a mixed method approach involving in-depth interviews and focus groups with navigators and clinicians, as well as direct observation of navigators. In addition, the electronic medical records were mined for data on frequency of patient contacts, patient concerns, and how these concerns were routed and whether they fell under the heading of clinical, nonclinical, or social work.
Lay navigators underwent 6 weeks of training, and the lay navigator service was primarily focused on the provision of telephone support to address nonclinical needs of patients undergoing treatment with at least 2 different modalities. Most navigators managed 50 to 60 patients.
Opinions on the implementation of the lay navigation program gleaned from interviews with 23 personnel at the cancer center (10 nurses, 7 administrators or management-level personnel, 4 social workers, and 2 physicians) were mixed, and 3 themes emerged: “the evolutionary nature of the program; navigating clinical and nonclinical issues by lay personnel; and the relationship and knowledge building necessary for coordinating care.”
Notably, two-thirds of the 1528 contacts between a lay navigator and a patient that involved a concern on the part of the patient were considered to be clinically related, and two-thirds of these were addressed by the navigator.
In this regard, the study authors commented that “navigators had to understand the difference between clinical and nonclinical needs, which was particularly challenging given that patients could present with multiple types of concerns at one time or have nuanced needs.”
“Paradoxically, navigators were unable to perform some seemingly nonclinical administrative tasks, such as scheduling, because for some appointments, scheduling is actually a complex task requiring clinical input over which members of the care team were protective,” they further noted.
The study authors opined that “lay navigators likely need to be integrated with or work at the direction of clinical teams to achieve successful implementation and produce the positive patient outcomes that many programs have demonstrated.”
Holdsworth LM, Zionts D, Wang S, et al. Negotiating lay and clinical issues: Implementing a lay navigation program in cancer care [published online November 6, 2019]. J Oncol Pract. doi: 10.1200/JOP.19.00339