Effectiveness of a Lay Navigation Program in an Academic Cancer Center.
JCO Oncol Pract
; 16(1): e75-e83, 2020 01.
Article
em En
| MEDLINE
| ID: mdl-31647691
ABSTRACT
PURPOSE:
A navigation program with lay navigators that targets patients with cancer who are receiving multiple treatment modalities was launched with the goal of improving care coordination. PATIENTS ANDMETHODS:
Pseudo-randomization and mixed methods were used to evaluate the program patients with even-numbered medical records were assigned to navigation help, and patients with odd-numbered medical records made up the control group. Eligible patients were those scheduled to receive at least two treatment modalities. Intent-to-treat, as-treated, and high-user cohorts with propensity matched controls were used to assess theoutcomes:
patient experience, emergency room (ER) use, and unplanned hospitalizations. In-depth patient interviews explored how and why patients interacted with the navigator program and overall patient experience.RESULTS:
Marginally lower incidence rate ratios (IRRs) for both ER visits (IRR, 1.17; 95% CI, 1.00 to 1.36) and unplanned hospitalizations (IRR, 1.18; 95% CI, 0.97 to 1.43) occurred in as-treated patients who used navigation help and who lived within 50 miles of Stanford Hospital compared with their matched controls; other cohort analyses had similar results. Survey scores for patients who received help with navigation did not differ significantly from those for corresponding controls in any of the analytic cohorts. Patient interviews suggested that the navigation program had low visibility among patients and that lay navigators drove use of the program. Patient-reported positive experiences included getting help with complex scheduling, alleviating anxiousness through access to information and educational resources, and getting help with activities outside traditional health care; negative experiences stemmed from having expectations that were not met.CONCLUSION:
Marginally lower rates of ER visits and unplanned hospitalizations for a small subset of patients, low penetration of the navigation program, and mixed comments from patient interviews suggest that a navigation program with a broad scope that targets a large population is not effective. Modifying the program to have a narrower scope of practice may help better target anxious or high-risk patients.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Institutos de Câncer
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Atenção à Saúde
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Navegação de Pacientes
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Neoplasias
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Evaluation_studies
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Incidence_studies
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Observational_studies
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Qualitative_research
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article