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Cancer Navigation: A Discussion on Barriers and Obstacles All Clinical Navigators Face. Sharon Gentry RN, MSN, AOCN, CBCN Breast Nurse Navigator Derrick L Davis Forsyth Regional Cancer Center. Objectives. Identify common types of barriers that healthcare clinical navigators may face.

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cancer navigation a discussion on barriers and obstacles all clinical navigators face

Cancer Navigation: A Discussion on Barriers and Obstacles All Clinical Navigators Face

Sharon Gentry RN, MSN, AOCN, CBCN

Breast Nurse Navigator

Derrick L Davis Forsyth Regional Cancer Center

objectives
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
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 to receiving timely health care
Potential Barriers toReceiving Timely Health Care

Barrier

Examples

Freeman HP, Reuben SH. Voices of a Broken System. Bethesda, Md: NIH, NCI; 2001.

types of barriers
Types of Barriers
  • Geographic/Cultural
  • Socioeconomic
  • Organizational/Systemic

***Combination of above factors are likely to increase disparities of care

  • Navigator role specific
geographic cultural1
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 cultural2
Geographic/Cultural

Language

Bias

Fears

Care

Information

health literacy
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

slide13

Methods Commonly Used In U.S. Hospitals To Provide Language ServicesSource: Health Research and Educational Trust, 2006Robert Wood Foundation

implicit bias in healthcare
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
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
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
Psychosocial Concerns
  • Fear
  • Mistrust
  • Emotions
  • Distress – *Distress monitoring for Commission on Cancer by 2015
organizational systemic1
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 systemic2
Organizational/Systemic

Communication

  • “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 systemic3
Organizational/Systemic
  • Unspoken rules
  • Chain of command
  • Guarded reactions
navigation as a solution
Navigation as a Solution
  • Being there…trust
  • Negative research (clinical trial) experiences
unspoken rules
Unspoken Rules
  • Family members are usually expected to keep problems a secret...
navigator role specific
Navigator role specific
  • Role definition
  • Acceptance by leaders and peers
  • Job sustainability
barrier solution
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.