Revista»Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
BACKGROUND: There is limited high-quality evidence about the impact of patient navigation (PN) on outcomes for patients with diagnosed cancer.
METHODS: We pooled data from two sites from the national Patient Navigation Research Program. Patients (n = 438) with newly diagnosed breast (n = 353) or colorectal cancer (n = 85) were randomized to PN or usual care. Trained lay navigators met with patients randomized to PN to help them assess treatment barriers and identify resources to overcome barriers. We used intent-to-treat analysis to assess time to completion of primary treatment, psychologic distress (impact of events scale), and satisfaction (patient satisfaction with cancer-related care) within 3 months after initiation of cancer treatment.
RESULTS: The sample was predominantly middle-aged (mean age = 57) and female (90%); 44% were race-ethnic minorities (44%), 46% reported lower education levels, 18% were uninsured, and 9% reported a non-English primary language. The randomized groups were comparable in baseline characteristics. Primary analysis showed no statistically significant group differences in time to completion of primary cancer treatment, satisfaction with cancer-related care, or psychologic distress. Subgroup analysis showed that socially disadvantaged patients (i.e., uninsured, low English proficiency, and non-English primary language) who received PN reported higher satisfaction than those receiving usual care (all P < 0.05). Navigated patients living alone reported greater distress than those receiving usual care.
CONCLUSIONS: Although the primary analysis showed no overall benefit, the subgroup analysis suggests that PN may improve satisfaction with care for certain disadvantaged individuals.
IMPACT: PN for cancer patients may not necessarily reduce treatment time nor distress.
BACKGROUND: Care coordination has received increased attention in recent years because it critically affects patient safety and care quality across services and settings.
OBJECTIVE: The effectiveness of systematically developed nurse navigator interventions for newly diagnosed cancer patients was evaluated.
METHODS: Seventy-eight patients participated in a nonequivalent control group pretest-posttest design study. The study design spanned a 3-month period for all participants. Patient outcome measures included quality of life, satisfaction with care, and length of hospital stay.
RESULTS: Participants in the experimental program reported significant increases in several components of quality of life and with satisfaction with care and experienced fewer hospital stay days compared with the control group.
CONCLUSION: This study provides evidence that standardized nurse navigator programs can improve patient outcomes in cancer care.
IMPLICATIONS FOR PRACTICE: Positive outcomes of the reduced length of stay and improved quality of life and patient satisfaction may help transform the cancer care delivery model toward more nurse-initiated cost-effective model.
OBJECTIVES: To discuss professional cancer navigation roles, models, implementation process and outcomes of patients and families dealing with head and neck cancers. One specific research is presented as an illustration.
DATA SOURCES: Published scientific papers, research review articles, implementations studies.
CONCLUSION: Two independent cohorts of patients with head and neck cancers were compared according to the presence of the professional navigator (Exposed cohort n=83) or not (Historical cohort n=75). The Exposed cohort showed a better profile on several indicators of outcomes. The results clearly indicate an association between the presence of the professional navigator with continuity of care (higher satisfaction and shorter duration of hospitalization), and empowerment (fewer cancer-related problems, including body images concerns, and better emotional quality of life).
IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can not only play an important role in continuity of care but also in supportive care by helping patients to cope better with cancer treatments, recovery or cancer progression and death issues.
El retraso en el seguimiento después de una mamografía anormal se asocia con enfermedad en estadio avanzado, una peor supervivencia y mayor ansiedad. A pesar de la implementación de muchos programas Patient Navigator en todo el país, hay pocos publicados, estudios revisados por colegas que documentan su eficacia. Pusimos a prueba la eficacia de un navegador de pacientes en la mejora de la puntualidad en el diagnóstico, disminuyendo la ansiedad y aumentar la satisfacción en las mujeres de minorías urbanas después de una mamografía anormal. Las mujeres con mamografías sospechosas fueron asignados al azar a la atención habitual (n = 50) o la atención habitual más la intervención con un paciente navegador (N = 55). No hubo diferencias demográficas entre los dos grupos. Las mujeres del grupo de intervención tuvieron menos tiempo a la resolución de diagnóstico (media 25,0 vs 42,7 días, p = .001), con un 22% de las mujeres en el grupo de control sin un diagnóstico final a los 60 días frente a 6% en el grupo de intervención. El grupo de intervención también tenían menores puntuaciones de ansiedad media (disminución de 8,0 en la intervención frente a aumento de 5,8 en el control, p <.001), y puntajes más altos de satisfacción media (4,3 frente a 2,9, p <0,001). Paciente de navegación es una estrategia eficaz para mejorar la resolución de diagnóstico oportuno, disminuyen significativamente la ansiedad y aumentar la satisfacción del paciente entre las mujeres de minorías urbanas con mamografías anormales.
There is limited high-quality evidence about the impact of patient navigation (PN) on outcomes for patients with diagnosed cancer.
METHODS:
We pooled data from two sites from the national Patient Navigation Research Program. Patients (n = 438) with newly diagnosed breast (n = 353) or colorectal cancer (n = 85) were randomized to PN or usual care. Trained lay navigators met with patients randomized to PN to help them assess treatment barriers and identify resources to overcome barriers. We used intent-to-treat analysis to assess time to completion of primary treatment, psychologic distress (impact of events scale), and satisfaction (patient satisfaction with cancer-related care) within 3 months after initiation of cancer treatment.
RESULTS:
The sample was predominantly middle-aged (mean age = 57) and female (90%); 44% were race-ethnic minorities (44%), 46% reported lower education levels, 18% were uninsured, and 9% reported a non-English primary language. The randomized groups were comparable in baseline characteristics. Primary analysis showed no statistically significant group differences in time to completion of primary cancer treatment, satisfaction with cancer-related care, or psychologic distress. Subgroup analysis showed that socially disadvantaged patients (i.e., uninsured, low English proficiency, and non-English primary language) who received PN reported higher satisfaction than those receiving usual care (all P < 0.05). Navigated patients living alone reported greater distress than those receiving usual care.
CONCLUSIONS:
Although the primary analysis showed no overall benefit, the subgroup analysis suggests that PN may improve satisfaction with care for certain disadvantaged individuals.
IMPACT:
PN for cancer patients may not necessarily reduce treatment time nor distress.
Diseño del estudio»Ensayo controlado aleatorizado (ECA)
