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.

Patients with Advanced Cancer during the COVID‐19 Pandemic in Ukraine

COVID‐19 has overwhelmed the capacity of health care systems, limiting access to supportive and palliative care for patients with advanced cancer. Telemedicine has emerged as a tool to provide care continuity to patients while limiting the risk of contagion. However, implementing telemedicine in resource‐limited settings is challenging. We report the results of a multidisciplinary patient‐navigator‐led telemedicine supportive care program in Dnipro City. One‐hundred sixty‐five telemedicine interventions were provided to 77 patients (median age 67, 47% female). A quarter of the patients had less than or equal to elementary school education, and 18% lived in a rural area. The most common interventions were psychological care (30%), pain and symptom control (27%), and nutritional counseling (10%). Half of the interventions were provided by video conferencing. The most common patient‐reported barrier was limited experience using communication technology. Our results demonstrate the feasibility of providing supportive and palliative care interventions using telemedicine in resource‐limited settings.

Hepatitis C testing and linkage to care among adults on probation in a large US city

Background Despite constituting the largest segment of the correctional population, individuals on probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We implemented an HCV testing and patient navigation program at an adult probation department. Methods Adults were tested at a local probation department with a rapid point-of-care HCV antibody (Ab) assay followed by a lab-based HCV RNA assay if anti-HCV positive. All individuals received counseling rooted in harm-reduction principles. Individuals testing positive for HCV Ab were immediately linked to a patient navigator in person or via telephone. The patient navigator assisted patients through cure unless lost to follow-up. Study participation involved an optional survey and optional point-of-care HIV test. Results Of 417 individuals tested, 13% were HCV Ab positive and 65% of those tested for HCV RNA (34/52) had detectable HCV RNA. Of the 14 individuals who linked to an HCV treatment provider, 4 completed treatment as measured by pharmacy fill documentation in the electronic medical record, and 1 obtained sustained virologic response. 193 individuals tested for HIV; none tested positive. Conclusions The study cohort had a higher HCV seroprevalence than the general population (13% vs 2%), but linkage-to-care, completion of HCV treatment, and successful test-of-cure rates were all low. This study indicates that HCV disproportionately impacts adults on probation and prioritizing support for testing and linkage-to-care could improve health in this population. Co-localization of HCV treatment within probation programs would reduce the barrier of attending a new institution and could be highly impactful.

Designing the Ideal Patient Navigation Program for Older Adults with Complex Needs: A Qualitative Exploration of the Preferences of Key Informants

Navigating the healthcare system is complex. Many older adults and their family members report sub-optimal outcomes when transitioning from hospital to home. Patient navigation has been introduced as a model of care to help improve hospital to home transitions and to better integrate care across care environments. There are no best-practice guidelines for designing a patient navigation program for older adults with complex needs. This qualitative descriptive study interviewed 38 healthcare professionals to determine key characteristics of the “ideal” patient navigator program. Thematic analysis revealed four themes describing key components of an ideal patient navigator program for older adults with complex needs: (1) Easy accessibility and open communication amongst staff; (2) flexible eligibility requirements; (3) characteristics of the patient navigator; and (4) appropriate program size and duration. We suggest directions for future research, program design, and implementation considers to improve patient navigation for older adults and their family caregivers.

“I think like if Albert Einstein and Superman had a baby, that's what it would take”: The experiences and perceptions of community and hospital healthcare professionals in a seniors’ patient navigator program

Introduction The success of new patient navigation programs have mostly been described from the perspectives of patient outcomes. Little is known about how patient navigators interact with healthcare professionals in the community and in hospital settings. Methods A qualitative study using a phenomenological analysis was undertaken to depict the lived experiences of Ontario (Canada) healthcare providers who have interacted with a patient navigator. Semi-structured interviews were conducted with 42 healthcare professionals, including frontline care providers ( n = 25) and administrators ( n = 16) from hospital ( n = 21) and community care settings ( n = 21). Results Participants’ experiences were reflected in one overarching theme: role clarity and three emergent themes related to the overarching theme: (i) concerns over accountability of patient care (ii) trust (iii) attainable-but-not. Participants described an inconsistent understanding of the role of patient navigators which led to uncertainty regarding their role in patient care. The current nature of the healthcare system influenced participants’ belief in the sustainability of patient navigation model of care. Despite these experiences, participants felt that patient navigators could help healthcare providers care for patients by preventing potential crises from developing and enhancing their knowledge about services. Discussion This study expands our understanding of patient navigation programs by exploring the experiences and perceptions of healthcare professionals, thereby providing new perspectives into components that support the successful health outcomes of older adults being supported by a patient navigator. The implications of findings for research, clinical practice, and policy are described.

Support Methodologies for African American Women With Lupus – Comparing Three Methods’ Effects on Patient Activation and Coping

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which the immune system attacks healthy tissues. While pharmaceutical therapies are an important part of disease management, behavioral interventions have been implemented to increase patients’ disease self-management skills, provide social support, and encourage patients to take a more active role in their care.Methods: Three interventions are considered in this study; peer-to-peer methodology, patient support group, and a patient navigator program that were implemented among largely African American women with SLE at the Medical University of South Carolina (MUSC). Outcomes of interest were patient activation and lupus self-efficacy. We used a Least Squares Means model to analyze change in total patient activation and lupus self-efficacy independently in each cohort. We adjusted for demographic variables of age, education, income, employment, and insurance.Results: In both unadjusted and adjusted models for patient activation, there were no statistically significant differences among the three intervention methodologies when comparing changes from baseline to post intervention. Differences in total coping score from baseline to post intervention in the patient navigator group (−101.23, p-value 0.04) and differences in scores comparing the patient navigator with the support group were statistically significant (116.96, p-value 0.038). However, only the difference in total coping from baseline to post intervention for the patient navigator program remained statistically significant (−98.78, p-value 0.04) in the adjusted model.Conclusion: Tailored interventions are a critical pathway toward improving disease self-management among SLE patients. Interventions should consider including patient navigation because this method was shown to be superior in improving self-efficacy (coping scores).