Evolution of a longitudinal, multidisciplinary, and scalable patient navigation matrix model

Abstract

This Longitudinal patient navigation Matrix Model was developed to overcome barriers across the cancer care continuum by offering prepatients, patients, and their families with support services. The extraordinary heterogeneity of patient needs during cancer screening, risk assessment, treatment, and survivorship as well as the vast heterogeneity of oncology care settings make it nearly impossible to follow a static navigation model. Our model of patient cancer navigation is unique as it enhances the traditional model by being highly adaptable based on both patient and family needs and scalable based on institutional needs and resources (eg, clinical volumes, financial resources, and community-based resources). This relatively new operational model for system-wide and systematic navigation incorporates a carefully cultivated supportive care program that evolved over the last decade from a bottom up approach that identified patient and family needs and developed appropriate resources. A core component of this model includes shifting away from department-centric operations.This model does not require a patient to opt in or independently be able to report their needs or ask for services-it is an opt out model. The multidisciplinary "crosstraining" model can also facilitate reimbursement and sustainability by clarifying the differentiating actions that define navigation services: identification of barriers to quality care and specific actions taken to overcome those barriers, across the full continue of cancer care from community engagement to survivorship or end-of-life care. K E Y W O R D Spatient navigation,

Strategies to Advance Equity in Cancer Clinical Trials

“…Understanding of trial Community-based or tailored outreach 46,[48][49][50][51] ; informed-consent models 52 ; language interpreters; patient navigators 53,46,[54][55][56][57][58][59] Addresses health care mistrust; improves understanding of trial benefits; provides decision-making support…”

Perspectives of Aboriginal People Affected by Cancer on the Need for an Aboriginal Navigator in Cancer Treatment and Support: A Qualitative Study

“…While AHLOs can address some of the needs identified, their numbers are small, and their input is required across many departments and areas of the hospital. Participants had little interaction with AHLOs, yet it has long been known that Aboriginal patients in hospital want Aboriginal people to be involved in their care and that unmet social support needs exacerbate stress and worry [9,11,14]. Issues identified around the coordination of care and frequent references to loneliness and isolation highlight the contribution that an Aboriginal Patient Navigator could make by interfacing with Aboriginal patients directly and linking them with their wider family, providing the anchor that many patients felt that they needed.…”

“…Well-designed and community-informed models of patient navigation implemented internationally have successfully built bridges between underserved and culturally diverse populations and the providers of health services, resulting in improved access and levels of satisfaction with cancer care [11][12][13][14][15][16]. Indigenous Australians face similar barriers to care, including a long history of exclusion and racism.…”

“…Navigation roles vary, with lay navigators employed for their personal expertise and cultural knowledge, while professional navigators often have more familiarity with the healthcare system and the health issues experienced in their communities. Consequently, it has been suggested that navigator roles should not be too narrowly defined; rather, they should be integrated into a cohesive model of care, from community engagement to survivorship or end-of-life care [14]. An important strength of these programs is that patient navigators usually come from the communities that they serve; being embedded in the community likely increases the identification of local barriers to care and improves patients' trust and adherence to recommended treatments.…”

U.S. Maternal Mortality Within a Global Context: Historical Trends, Current State, and Future Directions

“…Patient navigation and other health system-barrier interventions have worked well to dismantle obstacles to health care access and utilization. [69][70][71] As part of maternal and infant care integration, the AIM program has developed sets of standardized, bundled guidance supported by perinatal quality collaboratives, which are state-based initiatives that aim to improve the quality of care for mothers and infants. 72 These quality care initiatives can be enhanced to address all causes of MM.…”