The implementation of a lay navigation program as part of the delivery of cancer care presents a number of challenges, particularly because of the complexities of treating cancer, a new study has found.
Researchers looked at a lay navigator program, which uses nonclinical members to help provide information to cancer patients about their treatments, at the University of Alabama, and how the program was doing a year after its implementation.
“Integrating lay navigators into a complex clinical environment needs careful consideration at an organizational level, because this experience demonstrates that the integration process is not straightforward for clinical teams, patients, or navigators,” wrote Laura M. Holdsworth, PhD, Stanford (Calif.) University, and colleague. Their report is in the Journal of Oncology Practice.
A key difficulty discovered through the course of the research is that approximately two-thirds of concerns brought by patients to the lay navigators were clinical in nature, though only about a third (30%) required clinical follow-up and an additional 7% required social work follow-up.
“This seeming misalignment of nonclinical staff handling clinical issues is likely explained by the fact that clinical issues were often a request to repeat information previously delivered by a clinician,” the authors wrote. “The high proportion of clinical concerns brought to navigators is likely a consequence of navigators proactively contacting patients and thus being perceived as an accessible extension of the clinical team with whom to raise concern.”
Researchers found that clinical members did find navigators useful to the care team “specifically because they brought clinical issues to the attention of the clinical team that might otherwise have been missed.”
But on the other hand, some clinicians believed that “clinical concerns being raised with navigators were a source of concern and felt to be inappropriate, suggesting a lack of compatibility of a lay service layered onto complex clinical care,” Dr. Holdsworth and colleagues stated, adding that nurses “with a negative view of lay navigation seemed to lack knowledge and information about the navigator role, which created trust issues.”
Another potential issue is staff turnover within the navigator program and an ever-changing environment of patient education and support programs. Navigators can be very beneficial connecting patients to things such as support groups or helping to connect patients to insurers, but it requires a significant effort on the part of navigators to know, understand, and keep up to date with all the nonclinical opportunities that patients have, and high turnover can be an issue here.
Overall, though, the researchers note that the key finding “was that it was difficult to implement a lay navigation program outside of the clinical team for the purposes of cancer care coordination. The navigators were not integrated into the clinical teams and as such, the navigator role was treated with some suspicion by clinical team members; there was a sense of mistrust among some clinicians, and mismatched expectations around what navigators could or should be doing.”
SOURCE: Holdsworth L et al. J Oncol Pract, 2019 Nov. 6. doi: 10.1200/JOP.19.00339.