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Background Northside Hospital Cancer Institute (NHCI) is an integrated cancer care network with locations throughout the state of Georgia. Tremendous growth in patient numbers, diversity of patients, and areas served and the increase in psychosocial needs led to the addition of nonclinically licensed patient navigators to the navigation team. This change prompted an evaluation of the method used to assess and identify barriers to care. The previous barrier assessment was based on best practice examples at the time of program inception in 2010. Record review and feedback received from patients and from navigators showed gaps in identified barriers, and these unidentified barriers were not included in the existing barrier assessment.
A subsequent literature review found support for the use of a conceptual framework to guide the navigation process and improve the effectiveness of programs.1 The NHCI Oncology Patient Navigation Leadership team selected the validated Supportive Care Framework for Cancer Care as a foundation for developing a standardized barrier assessment tool to resolve the gaps in barrier identification due to the framework concepts and philosophy in conceptualizing and conducting an individualized oncology patient assessment.2
Objective To expand barrier assessment to include elements beyond those of physical care, using the 7 domains of the Supportive Care Framework for Cancer Care and promoting an individualized approach to patient assessment. We hypothesized that the new standardized assessment tool would result in an increase in the number of identified barriers to care.
Methods A quantitative data collection method totaling the number of barriers identified per navigator from 55 randomly selected new patients in 2017 before the implementation of the new barrier assessment tool and 55 randomly selected patients in 2018 after the implementation of the new barrier assessment tool. Data collection in both 2017 and 2018 controlled for the following variables: new patients, disease type, location of the navigator, and navigator staff member.
Results Implementing the new barrier assessment tool using the Supportive Care Framework for Cancer Care resulted in a dramatic increase in the identification of barriers from 0.85 barriers identified per patient in 2017 to 3.3 barriers identified per patient in 2018. An unexpected finding was the need to research, identify, and incorporate additional resources into the existing resource database to resolve barriers not identified using the previous assessment.
Conclusions Incorporating the validated Supportive Care Framework into a standardized barrier assessment tool has provided the NHCI oncology patient navigation team with an enhanced method for identifying barriers that deter or prevent patients from receiving needed care. The resultant increase in the numbers of identified barriers demonstrates the need for a standardized barrier assessment with a holistic focus. We also believe that the new standardized barrier assessment tool has enhanced the assessment skills of both nurse and nonclinically licensed patient navigators, and has uncovered the need for further identification of resources in areas not typically considered in barrier assessments. A limitation of this study was small sample size resulting from the need to obtain metrics from 2 separate navigation software systems.
1. McMullen L. Oncology nurse navigators and the continuum of cancer care. Semin Oncol Nurs. 2013;29(2):105-117.
2. Fitch MI. Supportive care framework [in English, French]. Can Oncol Nurs J. 2008;18(1):6-14.