Screen the Lungs!

By Brian Shim

Patient Navigation - Drawing the map to better cancer care

Previously on Screen the Lungs!, we discussed some of the challenges and barriers that cancer patients face in deciding whether lung cancer screening is right for them.

In today’s discussion, I want to talk more about how we can help patients navigate not only the initial decision to screen, but their entire cancer journey.

What is Patient Navigation?

At any stage of cancer, every patient will have a unique experience that determines their ability to engage with their care. Inequalities in social position, economic status, culture, education, environment, and other social determinants of health are critical factors of their cancer experience. Many underserved, marginalized, or disadvantaged patients face barriers that prevent them from getting what they need.

Patient Navigation programs are designed to help address these barriers by supporting and guiding cancer patients longitudinally throughout their cancer journey, to mitigate barriers to receiving care at every step.

Trained Patient Navigators (PNs) act as liaisons that bridge many of the gaps that alienate patients by working with patients on an individual and personalized basis, answering questions, offering support, and ultimately acting as their compass through the cancer screening and care experience.

Since the 1990s, PN programs for various cancer diseases have seen great effectiveness, especially in preventive screening programs.

Across multiple cancer diseases, including lung cancer, screening programs with dedicated PN have demonstrated significantly increased screening use and adherence to annual screening programs. PN is also especially effective at reaching traditionally undeserved and marginalized patients, such as low-Socio-Economic Status (SES) groups and minority populations, thus, improving cancer care equity as well as longitudinal disease outcomes and health disparities.

A recent randomized trial studying lung cancer screening PN within communities of low SES strongly demonstrates the potential of PN specifically designed for lung cancer screening (LCS) programs. In this study, patients at 5 community health centers who were provided a novel patient navigation intervention saw an almost three times greater rate of LCS usage as compared to non-navigated patients.

Who are Patient Navigators?

While embedded healthcare professionals, such as nurse practitioners, make great PNs, non-professionals can also make a significant impact and vastly widen the ability of community health systems to develop navigation programs.

Any health system can look to its patient and cancer community to build PN networks. Typical non-health professional PNs that staff successful navigation programs are trained laypersons who are representatives of or have some connection to the cancer patient community. These community-based PNs may include cancer survivors, relatives of cancer patients, or those that share a community of identity with patients.

The shared lived experiences of such PNs with patients can allow them to make connections with their patients and cultivate a level of trust that patients may not have with other healthcare providers.

The Key Stages of Patient Navigation

Effective PN for lung cancer must address three primary stages in the screening process:

Firstly, initial navigation to screening must be provided to all patients in the health system that are eligible for LCS according to updated USPSTF guidelines. This pool of eligible patients should be provided LCS education and patient decision aids (PDAs); shared decision-making (SDM) with their physician or other healthcare provider; assistance with scheduling appointments for annual screenings; and facilitation of logistics, such as transportation or referral to child care services.
Secondly, navigation of post-screen diagnoses must be provided to all patients that undergo screening and are enrolled in an annual screening program. This involves communicating with patients about evaluations, coordinating post-screening appointments, and follow-up assessments. It is also essential that patients already enrolled in a screening program are highly supported by Navigators to help them adhere to the annual screening schedule.
Thirdly, patients with positive findings after screening or a cancer diagnosis must be given comprehensive navigation of their options for treatment. After a positive diagnosis, patient anxiety and distress may be high, so it is paramount that navigation at this stage be especially sensitive and personalized. PNs must help patients manage their clinical work-up; help them negotiate their treatment plans; support adjustment into a new lifestyle; identify and schedule appointments with specialists; and navigate and engage care or treatment options quickly.

The needs of cancer patients and their families are constantly shifting. Thus, Patient Navigation must be dynamic and flexible. To promote mindfulness and keep PN programs adaptive, PN programs should be constantly evaluated and refined to maximize the effectiveness of navigation practices, consider the evolving needs of patients, and propose new strategies for helping patients. The key metrics used to evaluate PN program success should include patient satisfaction, longitudinal outcomes, health equity, as well as time to diagnosis and treatment.

Key Take-Away Points:

Patients may face a variety of barriers to accessing cancer screening and care
Patient Navigation is a tried and tested way to help patients navigate barriers to care, improve outcomes, and ameliorate disparities
Effective Patient Navigators (PN) can be health professionals or trained laypersons
PNs should guide patients through the cancer journey, from screening to treatment management
Strong Patient Navigation programs should be dynamic and constantly adapting to the evolving needs of the patient community