The Role of the Indigenous Patient Navigator: A Scoping Review

Background Healthcare systems are complex and as a result patients may experience fragmentation of services. Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations. Patient navigation is known as a patient-centered approach to empower individuals to connect with appropriate services. Literature surrounding the Indigenous Patient Navigator (IPN) remains sparse necessitating this scoping review. Purpose: To map the current state of the role of the IPN internationally within Canada, United States, Australia and New Zealand. Methods Estalished methodological framework by Arksey and O’Malley and the PRISMA extension for scoping reviews was used. Results A total of 820 articles were reviewed from four databases, yielding sixteen articles. Conclusions The absence of published literature surrounding the IPN role in Australia and New Zealand was surprising considering similar histories of colonization. The term navigator was used most often and was typically used when describing lay/peer roles. Professional roles were described using specific role descriptions. Six IPN roles were identified including: (1) social service navigation, (2) wholistic support of Indigenous people, (3) advocacy/building capacity, (4) health assessment, (5) administrative navigation, and (6) outreach. Additionally, barriers and enablers IPNs address are identified. This scoping review will assist to promote and reinforce the IPN role.

Sâkipakâwin: Assessing Indigenous Cancer Supports in Saskatchewan Using a Strength-Based Approach

Given that the health care system for Indigenous people tends to be complex, fragmented, and multi-jurisdictional, their cancer experiences may be especially difficult. This needs assessment study examined system-level barriers and community strengths regarding cancer care experiences of Indigenous people in Saskatchewan. Guided by an advisory committee including Indigenous patient and family partners, we conducted key informant interviews with senior Saskatchewan health care administrators and Indigenous leaders to identify supports and barriers. A sharing circle with patients, survivors, and family members was used to gather cancer journey experiences from Indigenous communities from northern Saskatchewan. Analyses were presented to the committee for recommendations. Key informants identified cancer support barriers including access to care, coordination of care, a lack of culturally relevant health care provision, and education. Sharing circle participants discussed strengths and protective factors such as kinship, connection to culture, and spirituality. Indigenous patient navigation, inter-organization collaboration, and community relationship building were recommended to ameliorate barriers and bolster strengths. Recognizing barriers to access, coordination, culturally relevant health care provision, and education can further champion community strengths and protective factors and frame effective cancer care strategies and equitable cancer care for Indigenous people in Saskatchewan.

Is there any health and geographical disparity in indigenous and non-indigenous women of Western Australia (WA)? A retrospective review with respect to de novo metastasis.

115 Background: Indigenous women with breast cancer have substantially higher mortality then non-Indigenous women. They are more likely to live in more remote communities with potential delays to presentation, investigation and diagnosis as well as slower access to cancer treatment facilities, potentially impacting survival. Here we explore by evaluating the diagnosis of de-novo metastasis and any association of remoteness, highlighting the geographic and possibly early access to treatment. Methods: A cohort of patients was retrospectively selected comprising age- and remoteness matched Indigenous and non-Indigenous women in a 1:1 ratio from the Western Australian Cancer Registry. Further data were collected from medical records and results systems. Remoteness was defined by the ARIA system. In addition, the distance from the nearest treatment center was calculated. The survival analysis was performed by Indigenous status and remoteness. Results: The final cohort comprised 250 Indigenous and 261 non–Indigenous women. Of the total, 7.6% (19/250) and 7.7% (20/261) were identified to have de-novo metastasis. At 10 years of follow up, most de-novo metastatic patients in both groups were from remote communities, distributed as 10.1, 9.1, 7.8, 8.7 and 5.0 % in metropolitan, inner regional, outer regional, remote and very remote areas respectively. In Indigenous group with de-novo metastasis the average distance of patient from treatment center was 1720km for vs 1018 km in Non-Indigenous patient with a p-value of 0.03. In non-metastasis cohort, Indigenous patient has 1065 km v 1241 km in non-indigenous group. Considering outcomes for those developing metastatic disease, median survivals after metastatic diagnosis were shorter for Indigenous patients, 21 v 33 months, p = 0.03. Conclusions: Indigenous women in WA with metastatic breast cancer have inferior survival outcomes from diagnosis of metastases relative to non-Indigenous peers. Most de-novo metastatic patients were from remote locations in both cohorts but no relation between remoteness and de-novo metastasis, identified to be impacting survival. Future studies are needed to better elucidate if any geographical, health care disparities and improve on treatment related outcomes. It is suggested to derive targeted policies to improve survival outcome of all Indigenous cancer patients, particularly those residing in remote areas.

Validation of the primary care experiences survey developed with Indigenous patients with type 2 diabetes in Canada

Background Health disparities experienced among Indigenous populations in Canada arise from complex historical and social causes. Addressing health disparities requires a multi-sectoral approach, including measures for Indigenous patient healthcare experiences. The Canadian Institute for Health Information published Measuring Patient Experiences in Primary Health Care Survey to evaluate care experiences among general populations; it is not known whether this survey tool is appropriate to measure Indigenous people’s experiences of healthcare. As part of a large research project known as Educating for Equity (E4E), we developed an Indigenous patient experiences with diabetes care survey from existing validated primary care assessment tools, adapting items to the domains of the E4E Care Framework that addresses social and cultural factors that impact Indigenous health. This study describes the development of this Indigenous patient experiences survey, assessing the tool’s validity and reliability.Method A consensus approach was used to establish the face validity of the survey and ease of completion. The survey was administered in three on- and off-reserve practices in Northern Ontario during 2015 and 2016. In total, 154 completed surveys were collected for data analysis. Exploratory factor analysis was performed to assess the survey’s structure. Internal consistency, item convergent validity and discriminant validity were assessed to determine internal reliability and correlation of items within each scale and between scales.Results The Indigenous patient experiences survey consists of two sections: a patient demographic section of eight items and healthcare experience section of 36 items on Likert scales. Exploratory factor analysis identified seven main and sub-scales that align with the survey’s conceptual domains. Two items were removed due to insufficient loading scores. All main and sub-scales obtained acceptable internal reliability (Cronbach’s α: 0.7-0.957), item convergent validity (AVE: 0.4-0.7; CR: 0.78-0.99), and discriminant validity (√ AVE: 0.66-0.85).Conclusion The Indigenous patient experiences survey maps out the construct concepts of the E4E Care Framework: provider-patient relationship, provider cultural competence and social sensitivity, patient diabetic-related psychosocial self-efficacy, and patient-centred continuity of care. Study results indicate this culturally-tailored instrument is reliable and valid for measuring primary care experiences of Indigenous patients with diabetes in Ontario, Canada.