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Lesson1:AnOverviewofPatientNavigationandCompetencies

LearningObjectives
x Describesocialdeterminantsofhealthandhealthdisparities
x Definepatientnavigation
x Discussthehistoryandevolutionofpatientnavigation
x Explainmodelsofpatientnavigation
x DiscusstheprocessfordevelopingtheCoreCompetenciesforPatientNavigators

KeyTakeaways
x Socialdeterminantsofhealthcanleadtocancerhealthdisparities.
x Patientnavigationisaninterventioncreatedthataddresseshealthdisparities.
x ThefieldofpatientnavigationhasquicklygrownsincethefirstprograminHarlemin
1990.
x Patientnavigationprogramsvaryintheirstructure,andpatientnavigatorscancome
fromdifferentbackgrounds.
x TheGeorgeWashingtonUniversity(GW)CancerInstitutecreatedthefirstever
consensusbasedcompetenciesforoncologypatientnavigatorswhodonothavea
clinicallicense.
x TheGWCancerInstitutecreatedthistrainingbasedonthosecompetencies.


 

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LESSON1:ANOVERVIEWOFPATIENT
NAVIGATIONANDCOMPETENCIES

PrinciplesofPatientNavigation
OncologyPatientNavigatorCore
Competencies
RelevantArticlesonPatientNavigation
ResourcesforPatientNavigators

PrinciplesofPatientNavigation

Inanarticleonthehistoryandprinciplesofpatientnavigation,HaroldP.FreemanandRianL.
Rodriguezidentifiedthefollowing9principles:

1. Patientnavigationisapatientcentrichealthcareservicedeliverymodel.
2. Patientnavigationservestovirtuallyintegrateafragmentedhealthcaresystemforthe
individualpatient.
3. Thecorefunctionofpatientnavigationistheeliminationofbarrierstotimelycareacrossall
segmentsofthehealthcarecontinuum.
4. Patientnavigationshouldbedefinedwithaclearscopeofpracticethatdistinguishesthe
roleandresponsibilitiesofthenavigatorfromthatofallotherproviders.
5. Deliveryofpatientnavigationservicesshouldbecosteffectiveandcommensuratewiththe
trainingandskillsnecessarytonavigateanindividualthroughaparticularphaseofthecare
continuum.
6. Thedeterminationofwhoshouldnavigateshouldbedeterminedbythelevelofskills
requiredatagivenphaseofnavigation.
7. Inagivensystemofcarethereistheneedtodefinethepointatwhichnavigationbegins
andthepointatwhichnavigationends.
8. Thereisaneedtonavigatepatientsacrossdisconnectedsystemsofcare,suchasprimary
caresitesandtertiarycaresites.
9. PatientNavigationsystemsrequirecoordination.

Source:Freemanetal.2011.

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OncologyPatientNavigatorCoreCompetencies

TheCoreCompetenciesforNonClinicallyLicensedPatientNavigatorsweredevelopedbythe
GWCancerInstitutethroughacollaborative,multiphaseprocess.Thecompetenciescanalso
befoundontheGWCancerInstitutewebsite.Thefullcompetenciesarealsolistedhere.

Domain1:PatientCare
Facilitatepatientcenteredcarethatiscompassionate,appropriateandeffectiveforthe
treatmentofcancerandthepromotionofhealth.

1.1Assistpatientsinaccessingcancercareandnavigatinghealthcaresystems.Assess
barrierstocareandengagepatientsandfamiliesincreatingpotentialsolutionstofinancial,
practicalandsocialchallenges.
1.2Identifyappropriateandcredibleresourcesresponsivetopatientneeds(practical,social,
physical,emotional,spiritual)takingintoconsiderationreadinglevel,healthliteracy,culture,
languageandamountofinformationdesired.Forphysicalconcerns,emotionalneedsor
clinicalinformation,refertolicensedclinicians.
1.3Educatepatientsandcaregiversonthemultidisciplinarynatureofcancertreatment,the
rolesofteammembersandwhattoexpectfromthehealthcaresystem.Providepatientsand
caregiversevidencebasedinformationandrefertoclinicalstafftoanswerquestionsabout
clinicalinformation,treatmentchoicesandpotentialoutcomes.
1.4Empowerpatientstocommunicatetheirpreferencesandprioritiesfortreatmenttotheir
healthcareteam;facilitateshareddecisionmakinginthepatient'shealthcare.
1.5Empowerpatientstoparticipateintheirwellnessbyprovidingselfmanagementand
healthpromotionresourcesandreferrals.
1.6Followupwithpatientstosupportadherencetoagreedupontreatmentplanthrough
continuednonclinicalbarrierassessmentandreferralstosupportiveresourcesin
collaborationwiththeclinicalteam.
Domain2:KnowledgeforPractice
Demonstratebasicunderstandingofcancer,healthcaresystemsandhowpatientsaccess
careandservicesacrossthecancercontinuumtosupportandassistpatients.
NOTE:Thisdomainreferstofoundationalknowledgeappliedacrossotherdomains.

2.1Demonstratebasicknowledgeofmedicalandcancerterminology.
2.2Demonstratefamiliaritywithandknowhowtoaccessandreferenceevidencebased
informationregardingcancerscreening,diagnosis,treatmentandsurvivorship.
2.3Demonstratebasicknowledgeofcancer,cancertreatmentandsupportivecareoptions,
includingrisksandbenefitsofclinicaltrialsandintegrativetherapies.
2.4Demonstratebasicknowledgeofhealthsystemoperations.
2.5Identifypotentialphysical,psychological,socialandspiritualimpactsofcancerandits
treatment.

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2.6Demonstrategeneralunderstandingofhealthcarepaymentstructure,financing,and
wheretoreferpatientsforanswersregardinginsurancecoverage,andfinancialassistance.
Domain3:PracticeBasedLearningandImprovement
Improvepatientnavigationprocessthroughcontinualselfevaluationandquality
improvement.Promoteandadvancetheprofession.

3.1Contributetopatientnavigationprogramdevelopment,implementationandevaluation.
3.2Useevaluationdata(barrierstocare,patientencounters,resourceprovision,population
healthdisparitiesdataandqualityindicators)tocollaborativelyimprovenavigationprocess
andparticipateinqualityimprovement.
3.3Incorporatefeedbackonperformancetoimprovedailywork.
3.4Useinformationtechnologytomaximizeefficiencyofpatientnavigator'stime.
3.5Continuallyidentify,analyzeandusenewknowledgetomitigatebarrierstocare.
3.6Maintaincomprehensive,timelyandlegiblerecordscapturingongoingpatientbarriers,
patientinteractions,barrierresolutionandotherevaluationmetricsandreportdatatoshow
valuetoadministratorsandfunders.
3.7Promotenavigationrole,responsibilitiesandvaluetopatients,providersandthelarger
community.
Domain4:InterpersonalandCommunicationSkills
Demonstrateinterpersonalandcommunicationskillsthatresultintheeffectiveexchange
ofinformationandcollaborationwithpatients,theirfamiliesandhealthprofessionals.

4.1Assesspatientcapacitytoselfadvocate;Helppatientsoptimizetimewiththeirdoctors
andtreatmentteam(e.g.prioritizequestions,clarifyinformationwithtreatmentteam).
4.2Communicateeffectivelywithpatients,familiesandthepublictobuildtrusting
relationshipsacrossabroadrangeofsocioeconomicandculturalbackgrounds.
4.3Employactivelisteningandremainsolutionsorientedininteractionswithpatients,
familiesandmembersofthehealthcareteam.
4.4Encourageactivecommunicationbetweenpatients/familiesandhealthcareprovidersto
optimizepatientoutcomes.
4.5Communicateeffectivelywithnavigatorcolleagues,healthprofessionalsandhealth
relatedagenciestopromotepatientnavigationservicesandleveragecommunityresources
toassistpatients.
4.6Demonstrateempathy,integrity,honestyandcompassionindifficultconversations.
4.7KnowandsupportNationalStandardsforCulturallyandLinguisticallyAppropriate
Services(CLAS)inHealthandHealthCaretoadvancehealthequity,improvequalityand
reducehealthdisparities.
4.8Applyinsightandunderstandingaboutemotionsandhumanresponsestoemotionsto
createandmaintainpositiveinterpersonalinteractions.


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Domain5:Professionalism
Demonstrateacommitmenttocarryingoutprofessionalresponsibilitiesandanadherence
toethicalprinciples.

5.1Applyknowledgeofthedifferenceinrolesbetweenclinicallylicensedandnonlicensed
professionalsandactwithinprofessionalboundaries
5.2Buildtrustbybeingaccessible,accurate,supportiveandactingwithinscopeofpractice.
5.3Useorganization,timemanagement,problemsolvingandcriticalthinkingtoassist
patientsefficientlyandeffectively.
5.4Demonstrateresponsivenesstopatientneedswithinscopeofpracticeandprofessional
boundaries.
5.5Knowandsupportpatientrights.
5.6Demonstratesensitivityandresponsivenesstoadiversepatientpopulation,includingbut
notlimitedtodiversityingender,age,culture,race,religion,abilitiesandsexualorientation.
5.7Demonstrateacommitmenttoethicalprinciplespertainingtoconfidentiality,informed
consent,businesspracticesandcompliancewithrelevantlaws,policiesandregulations(e.g.
HIPAA,agencyabusereportingrules,DutytoWarn,safetycontracting).
5.8Performadministrativedutiesaccuratelyandefficiently.
Domain6:SystemsBasedPractice
Demonstrateanawarenessofandresponsivenesstothelargercontextandsystemof
healthcare,aswellastheabilitytocalleffectivelyonotherresourcesinthesystemto
provideoptimalhealthcare.

6.1Supportasmoothtransitionofpatientsacrossscreening,diagnosis,activetreatment,
survivorshipand/orendoflifecare,workingwiththepatient'sclinicalcareteam.
6.2Advocateforqualitypatientcareandoptimalpatientcaresystems.
6.3Organizeandprioritizeresourcestooptimizeaccesstocareacrossthecancercontinuum
forthemostvulnerablepatients.
Domain7:InterprofessionalCollaboration
Demonstrateabilitytoengageinaninterprofessionalteaminamannerthatoptimizes
safe,effectivepatientandpopulationcenteredcare.

7.1Workwithotherhealthprofessionalstoestablishandmaintainaclimateofmutual
respect,dignity,diversity,ethicalintegrityandtrust.
7.2Useknowledgeofone'sroleandtherolesofotherhealthprofessionalstoappropriately
assessandaddresstheneedsofpatientsandpopulationsservedtooptimizehealthand
wellness.
7.3Participateininterprofessionalteamstoprovidepatientandpopulationcenteredcare
thatissafe,timely,efficient,effectiveandequitable.

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Domain8:PersonalandProfessionalDevelopment
Demonstratequalitiesrequiredtosustainlifelongpersonalandprofessionalgrowth.

8.1Setlearningandimprovementgoals.Identifyandperformlearningactivitiesthataddress
one'sgapsinknowledge,skills,attitudesandabilities.
8.2Demonstratehealthycopingmechanismstorespondtostress;employselfcare
strategies.
8.3Managepossibleandactualconflictsbetweenpersonalandprofessionalresponsibilities.
8.4Recognizethatambiguityispartofpatientcareandrespondbyutilizingappropriate
resourcesindealingwithuncertainty.


OncologyNursingSocietyOncologyNurseNavigatorCoreCompetencies

In2013,theOncologyNursingSocietypublisheditsOncologyNurseNavigatorCore
Competenciesbasedonarigorousprocess.Thecompetenciescover:

x ProfessionalRole
x Education
x CoordinationofCare
x Communication

 

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RelevantArticlesonPatientNavigation

x PrattChapmanM,WillisA.CommunityCancerCenterAdministrationandSupportfor
NavigationServices.SeminarsinOncologyNursingMay2013.
x PrattChapmanM,WillisA,MasselinkL.CoreCompetenciesforNonClinicallyLicensed
PatientNavigators.JournalofOncologyNavigationandSurvivorship.2015.
x WillisA,PrattChapmanM,ReedE,Hatcher,E.BestPracticesinPatientNavigationand
CancerSurvivorship:MovingTowardQualityPatientCenteredCare.JournalofOncology
NavigationandSurvivorship.2014.
x WillisA,Reed,PrattChapmanM,KappH,HatcherE,VaitonesV,CollinsS,BiresJ,
WashingtonEC.DevelopmentofaFrameworkforPatientNavigation:DelineatingRoles
AcrossNavigatorTypes.JournalofOncologyNavigationandSurvivorship.2013.
x NationalPatientNavigationLeadershipSummit(NPNLS):MeasuringtheImpactand
PotentialofPatientNavigation.SupplementtoCancer.2011.

ResourcesforPatientNavigators

x ColoradoCoalitionfortheMedicallyUnderserved(CCMU)
CCMUoffersinformationforhealthcareprofessionalswhoworkwiththeunderserved.
Youcangothroughtheirstudyguideonthemedicallyunderservedafterwatchingthe
videointhelesson.
x InterculturalCancerCouncil(ICC)
TheICCoffersaseriesofCancerFactSheetsonavarietyofmedicallyunderserved
populations.
x NationalCancerInstitutesCentertoReduceHealthDisparities(CRCHD)
CRCHDinitiates,integrates,andengagesincollaborativeresearchstudieswithNCI
divisionsandNIHinstitutesandcenterstopromoteresearchandtrainingincancer
healthdisparitiesandtoidentifynewandinnovativescientificopportunitiestoimprove
canceroutcomesincommunitiesexperiencinganexcessburdenofcancer.
x OfficeofMinorityHealthsThinkCulturalHealthWebsite
Thissite,sponsoredbytheDepartmentofHealthandHumanServicesOfficeof
MinorityHealth,offersthelatestresourcesandtoolstopromoteculturalandlinguistic
competencyinhealthcare.Youmayaccessfreeandaccreditedcontinuingeducation
programsaswellastoolstohelpyouandyourorganizationproviderespectful,
understandableandeffectiveservices.
 

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Module2,Lesson1:AnOverviewofPatientNavigationandCompetencies
References:Presentation
BlasegKD,DaughertyP,GamblinKA.2014.OncologyNurseNavigation:DeliveringPatient
CenteredCareAcrosstheContinuum.Pittsburg(PA):OncologyNursingSociety.ISBN10:
1935864351.
ColoradoCoalitionfortheMedicallyUnderserved.[CCMU].2003.SocialDeterminantsofHealth
[Videofile].Retrievedfrom:
https://www.youtube.com/watch?v=I7iSYi3ziTI&index=3&list=PLAO0U2GXUBQFyPdyzgZ1h4cljJ
p7caG8h.
DepartmentofHealthandHumanServices.SocialDeterminantsofHealth.n.d.Retrievedfrom:
http://www.healthypeople.gov/2020/topicsobjectives/topic/socialdeterminantshealth.
FreemanHP,RodriguezRL.Historyandprinciplesofpatientnavigation.Cancer.2011;117(15
Suppl):35393542.doi:10.1002/cncr.26262.
InstituteofMedicine(US)CommitteeonCancerResearchAmongMinoritiesandtheMedically
Underserved.1999.TheBurdenofCancerAmongEthnicMinoritiesandMedicallyUnderserved
Populations.InHaynesMA,SmedleyBD(Eds.).TheUnequalBurdenofCancer:AnAssessment
ofNIHResearchandProgramsforEthnicMinoritiesandtheMedicallyUnderserved.
Washington(DC):NationalAcademiesPress(US).ISBN10:0309071542.Retrievedfrom:
http://www.ncbi.nlm.nih.gov/books/NBK1788/.
NationalCancerInstitute.CancerHealthDisparitiesDefinitions.2015.Retrievedfrom:
http://www.cancer.gov/aboutnci/organization/crchd/abouthealthdisparities/definitions.
NationalCancerInstitute.CancerHealthDisparities.2008.Retrievedfrom:
http://www.cancer.gov/cancertopics/factsheet/disparities/cancerhealthdisparities.
NationalCancerInstitute.PatientNavigationResearchProgram(PNRP).2015.Retrievedfrom:
http://www.cancer.gov/aboutnci/organization/crchd/disparitiesresearch/pnrp.
WorldHealthOrganization.Equity.n.d.Retrivedfrom:
http://www.who.int/healthsystems/topics/equity/en/.
References:BriefQuiz
AmericanAssociationforCancerResearch.2011.CancerHealthDisparities:Challengesand
Opportunities[Videofile].Retrievedfrom:https://www.youtube.com/watch?v=0C5KEoydluc.
AvonFoundationforWomen.TheBostonMedicalCenterPatientNavigationToolkit,1stEdition.
n.d.Retrievedfrom:http://www.avonfoundation.org/assets/bmcpatientnavigationtoolkit
vol2.pdf.

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BlasegKD,DaughertyP,GamblinKA.2014.OncologyNurseNavigation:DeliveringPatient
CenteredCareAcrosstheContinuum.Pittsburg(PA):OncologyNursingSociety.ISBN10:
1935864351.
DepartmentofHealthandHumanServices.SocialDeterminantsofHealth.n.d.Retrievedfrom:
http://www.healthypeople.gov/2020/topicsobjectives/topic/socialdeterminantshealth.
FreemanHP,RodriguezRL.Historyandprinciplesofpatientnavigation.Cancer.2011;117(15
Suppl):35393542.doi:10.1002/cncr.26262.
HealthAffairs.AchievingEquityinHealth.2011.Retrievedfrom:
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=53.
NationalCancerInstitute.CancerHealthDisparitiesDefinitions.2015.Retrievedfrom:
http://www.cancer.gov/aboutnci/organization/crchd/abouthealthdisparities/definitions.
NationalCancerInstitute.CancerHealthDisparities.n.d.Retrievedfrom:
http://www.cancer.gov/cancertopics/disparities.
NationalCancerInstitute.PatientNavigationResearchProgram(PNRP).2015.Retrievedfrom:
http://www.cancer.gov/aboutnci/organization/crchd/disparitiesresearch/pnrp.
PaskettED,HarropPH,WellsKJ.Patientnavigation:Anupdateonthestateofthescience.CA:
CancerJClin.2011;61(4):237249.doi:10.3322/caac.20111.
PrattChapmanM,KappH,WillisA,BiresJ.Catalyzingpatientcenteredcare:Startingwhere
youareandsharingwhatyouknow.OncologyIssues.2014;3039.
PrattChapmanM,WillisA,MasselinkL.Corecompetenciesforoncologypatientnavigators.
JournalofOncologyNavigationandSurvivorship.2015;6(2).
PrattChapmanML,WillisLA,MasselinkL.CoreCompetenciesforNonClinicallyLicensed
PatientNavigators.TheGeorgeWashingtonUniversityCancerInstituteCenterforthe
AdvancementofCancerSurvivorship,NavigationandPolicy:WashingtonDC,2014.
VargasRB,RyanGW,JacksonCA,RodriguezR,FreemanHP.Characteristicsoftheoriginal
patientnavigationprogramstoreducedisparitiesinthediagnosisandtreatmentofbreast
cancer.Cancer.2008;113(2):426433.doi:10.1002/cncr.23547.
WellsKJ,BattagliaTA,DudleyDJ,GarciaR,GreeneA,CalhounE,MandelblattJ,PaskettE,Raich
P.Patientnavigation:Stateoftheart,orisitscience.Cancer.2008;113(8):19992010.doi:
10.1002/cncr.23815.
WillisA,ReedE,PrattChapmanM,etal.Developmentofaframeworkforpatientnavigation:
Delineatingrolesacrossnavigatortypes.JournalofOncologyNavigation&Survivorship.2013;
4(6):2026.
WorldHealthOrganization.HealthImpactAssessment:TheDeterminantsofHealth.n.d.
Retrievedfrom:http://www.who.int/hia/evidence/doh/en/.

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