Implementing patient navigation programs: Considerations and lessons learned from the Alliance to Advance Patient-Centered Cancer Care.

BACKGROUND: Six multidisciplinary cancer centers were selected and funded by the Merck Foundation (2017-2021) to collaborate in the Alliance to Advance Patient-Centered Cancer Care ("Alliance"), an initiative to improve patient access, minimize health disparities, and enhance the quality of patient-centered cancer care. These sites share their insights on implementation and expansion of their patient navigation efforts. METHODS: Patient navigation represents an evidence-based health care intervention designed to enhance patient-centered care and care coordination. Investigators at 6 National Cancer Institute-designated cancer centers outline their approaches to reducing health care disparities and synthesize their efforts to ensure sustainability and successful transferability in the management of patients with cancer and their families in real-world health care settings. RESULTS: Insights are outlined within the context of patient navigation program effectiveness and supported by examples from Alliance cancer center sites: 1) understand the patient populations, particularly underserved and high-risk patients; 2) capitalize on the existing infrastructure and institutional commitment to support and sustain patient navigation; and 3) build capacity by mobilizing community support outside of the cancer center. CONCLUSIONS: This process-level article reflects the importance of collaboration and the usefulness of partnering with other cancer centers to share interdisciplinary insights while undergoing intervention development, implementation, and expansion. These collective insights may be useful to staff at other cancer centers that look to implement, enhance, or evaluate the effectiveness of their patient navigation interventions.

The history of psychosocial screening among cancer patients.

Over the past ten years, the concept of psychosocial screening has received a great deal of attention. Guidelines, recommendations, and standards have been developed to encourage or require that all patients be screened for their distress at the time of diagnosis or when patients commence care in a cancer center for the first time. However, the concept of psychosocial screening has long history in the cancer literature.

Mixed anxiety/depression symptoms in a large cancer cohort: prevalence by cancer type.

BACKGROUND: Mixed anxiety/depression is associated with poorer psychosocial and treatment outcomes, worse quality of life, pooreradherence to treatment, slower recovery, greater suicide risk, and highercost-utilization. OBJECTIVE: This study aimed to examine the cancer-specific prevalence of these symptoms. METHOD: Cross-sectional anxiety and depression symptom data were collected with the Brief Symptom Inventory from adult outpatients presenting to a tertiary cancer center (N=8,265). RESULTS: Mixed anxiety/depression symptoms were seen in 12.4% of patients; overall depression symptoms in 18.3%, overall anxiety symptoms in 24.0%, pure anxiety symptoms in 11.7%, and pure depression symptoms in 6.0%; 70% had neither. Higher rates of mixed anxiety/depression symptoms were seen with stomach, pancreatic, head and neck, and lung cancers, but lower rates were seen in those with breast cancers. The mixed anxiety/depression phenotype occurs in two-thirds of depressed cancer patients. DISCUSSION: The fact that 70% of patients did not meet thresholds for depression or anxiety symptoms can be interpreted as a reflection of the resistance to developing a significant level of these symptoms. However, because stomach, pancreatic, head and neck, and lung cancers have higher levels of mixed anxiety/depression symptoms, the question can be raised as to whether these are associated with a more biological type of anxiety/depression (e.g., due to cytokine release) and whether this phenotype should be actively targeted because of its frequent occurrence in these cancers.

The challenges of the integration of cancer survivorship care plans with electronic medical records.

OBJECTIVES: To provide an overview of issues and challenges associated with integrating development of survivorship care plan processes with electronic medical records (EMRs). DATA SOURCES: Published peer-reviewed literature. CONCLUSION: Evidence seems to indicate that survivorship care plans have value to survivors, oncology specialist providers, and primary care providers. Yet, the existence of cost and time restraints are major barriers to creation and use of survivorship care plans, and the expectations that EMR can simplify and expedite survivorship care plan development have yet to be realized. IMPLICATIONS FOR NURSING PRACTICE: Nurses participating in the development of survivorship programs can contribute to successful implementation of EMR-facilitated survivorship care plans by involvement in strategic planning processes, and establishment of reasonable timelines to address the known and unknown barriers, and assuring the resulting EMR product includes essential data and information.

Managing complications in cancer: identifying and responding to the patient's perspective.

OBJECTIVES: To describe psychosocial problems experienced by cancer patients and present assessment tools to evaluate these issues and develop effective management programs. DATA SOURCES: Published literature and clinical experience. CONCLUSION: A screening program may identify patients needing psychologic evaluation and treatment and reduce distress for patients and caregivers. IMPLICATIONS FOR NURSING PRACTICE: Use of screening tools allows critical decisions to be made regarding treatment for patients with high levels of distress, fatigue, and other conditions.

A culturally targeted intervention to promote breast cancer screening among low-income women in East Baltimore, Maryland.

In Maryland, outreach initiatives have been unsuccessful in engaging low-income African American women in mammography screening. This study aimed to identify factors influencing screening rates for low-income African American women. Based on the Health Belief Model, a modified time series design was used to implement a culturally targeted intervention to promote a no-cost mammography-screening program. Data were collected from women 40 years of age and older on their history of mammography use and their knowledge and beliefs about breast cancer. A 50% screening rate was achieved among 119 eligible participants. Significant predictors of screening behaviors were perceived barriers, lack of insurance, and limited knowledge. This culturally targeted intervention resulted in an unprecedented screening rate among low-income African American women in Baltimore, Maryland.