cancer navigation: a discussion on barriers and obstacles all clinical navigators face
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Cancer Navigation: A Discussion on Barriers and Obstacles All
Clinical Navigators Face
Sharon Gentry RN, MSN, AOCN, CBCNBreast Nurse Navigator
Derrick L Davis Forsyth Regional Cancer Center
Objectives
• Identify common types of barriers that healthcare clinical navigators may face.
• Explore solutions to address the barriers
• Share experiences among navigators on overcoming healthcare barriers
Defining barriers
• Barriers to health care are obstacles within our health care system that prevent vulnerable patient populations from getting needed health care, or that cause them to get inferior health care compared to advantaged patient populations.
• American Medical Student Association Foundation by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Medicine and Dentistry. http://www.amsa.org/programs/barriers/intro.html
Potential Barriers toReceiving Timely Health Care
Freeman HP, Reuben SH. Voices of a Broken System. Bethesda, Md: NIH, NCI; 2001.
Financial and economic Lack of or inadequate insurance
Transportation Difficulty arranging transportation
Cultural Cultural beliefs regarding treatment
Communication and language Difficulty telling desires/needs
Health care system Fragmentation of care
Bias based on race/age Fear and mistrust by patients; inadequate screening of the elderly
Fear Delay or refusal of care
ExamplesBarrier
Types of Barriers• Geographic/Cultural
• Socioeconomic
• Organizational/Systemic
***Combination of above factors are likely to increase disparities of care
• Navigator role specific
Geographic/Cultural
Veteransborn prior 1946Affected by wars
Baby Boomers born between 1946 and 1964* largest population
Gen X was born between 1965 and 1979 “latchkey kids”
Gen Y was born between 1980 and 1995 Millennium or Net Generation.
Generation Z was born after 1995Digital Natives
Disciplined respect law & order.Consistency -do not like change.Fixed views on role gender and workplace.A directive, command & control management style.
Youth = open-minded and rebellious. Adult = more conservative.Job status and social standing are important. Tend to be optimistic, ambitious, & loyal. Employment is for life.
Both parents working.Daycare and divorce.Well-educated generation.Resourceful. Individualistic. Self reliant. Skeptical of authority.Focus on relationships, outcomes, their rights and skills.
Technology wise. Comfortable with ethnically diverse groups. Optimistic, confident, sociable, and strong morals with sense of civic duty.Not brand loyal. Flexible and changing in fashion, style consciousness.
Instant action and satisfaction.Smaller families with older Moms.Online communities and social media.Rather than personally meeting.not perform well in public speaking.
Geographic/Cultural
• Rural, suburban, inner-city…..• Veterans, Baby boomers, generations X, Y & Z
• health beliefs and behaviors• Patient beliefs as well as practitioner beliefs
Geographic/Cultural
Care
Language
Information
BiasFears
Health Literacy
• “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
US Dept of Health and Human Sciences
Teach back method
http://minorityhealth.hhs.gov/templates
http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf
Examples
Following directions
Methods Commonly Used In U.S. Hospitals To Provide Language ServicesSource: Health Research and Educational Trust, 2006Robert Wood Foundation
One solution
Implicit Bias in Healthcare
Unconscious (Implicit) Bias and Health Disparities: Where Do We Go from Here?Perm J. 2011 Spring; 15(2): 71–78. https://implicit.harvard.edu
Socioeconomic barriers“drivers of healthcare disparities”
• lack of health insurance• inability to pay out of pocket – transportation,
child care• Inadequate education• Employment issues• Psychosocial concerns
What is the socioeconomic status of the navigated population?
• Who are the people?Community profile 2015 Commission on Cancer requirement
Komen report
Census data
• EMPLOYMENT STATUS COMMUTING TO WORK OCCUPATION INDUSTRY CLASS OF WORKER INCOME AND BENEFITS
• HEALTH INSURANCE COVERAGE
• BELOW THE POVERTY LEVEL
http://factfinder2.census.gov/faces/tableservices/
Psychosocial Concerns
• Fear
• Mistrust
• Emotions
• Distress – *Distress monitoring for Commission on Cancer by 2015
Organizational/Systemic
Organizational/Systemic
Accessibility – • How accessible is your care ? Can the patient
find it?
• Physical barriers Accessible toilet and dressing rooms
http://www.cdc.gov/ncbddd/disabilityandhealth/accessibility.html
• Timely access for all
Organizational/SystemicCommunication
• “Removing Barriers to Health Care A Guide for Health Professionals” http://projects.fpg.unc.edu/~ncodh/rbar/
• Insufficient cultural sensitive information Drop-out – give up in misunderstanding or frustration
Organizational/Systemic
• Unspoken rules
• Chain of command
• Guarded reactions
Navigation as a Solution• Being there…trust
• Negative research (clinical trial) experiences
Unspoken Rules
• Family members are usually expected to keep problems a secret...
Navigator role specific
• Role definition
• Acceptance by leaders and peers
• Job sustainability
Barrier Solution• Cancer Patient Navigation Programs are designed to help patients receive the best care
possible. And they help the team that serves patients provide better care. Cancer Patient Navigation is not the cure for the disease, but it can be the lifesaver for the patient.
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