Upload
jared-warren
View
214
Download
0
Tags:
Embed Size (px)
Citation preview
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Elevating Patient Navigation Practice & Policies
Mandi Pratt-Chapman, MA
Director, GW Cancer Institute
July 23, 2015
Patient-Centered Education & Research Institute
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Key Points
• Identify importance of competencies in health professions
• Describe process of developing consensus-based competencies for patient navigators
• Identify examples of core competencies for patient navigators
• Access resources to build competencies
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Lack of Role Clarity and Standardization
CHW Case
Manager
Social Worker
Nurse
Navigato
rPatient Navigator
Willis, Pratt-Chapman, Reed & Hatcher. JONS. 2014.
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Why competencies?
• Creates professional standards• Provides framework for training• Clarifies function and importance to
– Grantors– Organizations– Payors– Policymakers
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Competency and Training Development
Identify roles & responsibilities
Write competencies
Create training
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Competency and Training Development
Academy of Oncology Nurse
& Patient Navigators
Oncology Nursing Society
National Association of Social Workers
Association of Oncology Social
Workers
Association of Community
Cancer Centers
Patient navigators and
CHWs
Center for the Advancement of Cancer Survivorship, Navigation and Policy
1) Identify Roles and Responsibilities
Patient navigation training curricula
Journal articles on roles/ responsibilities/ competencies/ tasks/ activities for CHWs, patient navigators, nurse/social worker navigators
CHW, nurse navigator competencies
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Functional Domains
Professional Roles/
ResponsibilitiesCommunication Patient
Empowerment Cultural competency
Ethics & Professional Conduct
Education, Prevention & Health
Promotion
Psychosocial Support Services /
Assessment
Barriers to Care / Health Disparities
Community Resources Outreach Care Coordination Advocacy
Willis, Reed E, Pratt-Chapman, Kapp H, Hatcher E, Vaitones V, Collins S, Bires J, Washingtion E. JONS. 2013.
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Oncology Navigation Roles
DomainCommunity Health Worker Patient Navigator
Clinical Navigator (RN/SW)
Barriers to Care/Health Disparities: Identifying and addressing barriers to care and reducing health disparities as defined by age, disability, education, ethnicity, gender, sexual identification, geographic location, income or race that often bear the greater burden of disease than general population.
Address barriers to accessing the health care system. Focus on reduction of general health disparities.
Address structural, cultural, social, emotional and administrative barriers to care. Focus on reduction of cancer health disparities in medically underserved patients and timely access to care across the continuum.
Address clinical and service delivery barriers to care. Provision of services to at-risk populations which may be defined by individual need, high-acuity or high-volume at institutional level.
RN = registered nurse; SW = social worker; Dx = diagnostic; Tx = treatment.
Willis, Reed E, Pratt-Chapman, Kapp H, Hatcher E, Vaitones V, Collins S, Bires J, Washingtion E. JONS. 2013.
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Oncology Navigation Roles
DomainCommunity Health Worker Patient Navigator
Clinical Navigator (RN/SW)
Patient empowerment: Identifying problems and resources to help patients solve problems and be part of the decision-making process.11
An important facilitator of patient empowerment is development of good patient rapport.
Motivate individual and community to make positive changes in health behaviors.
Activate and empower individuals and communities to self-advocate and make healthy decisions.
Assist patient with identifying administrative, structural, social, and practical issues to participate in decision-making and solutions.
Empower patients by ensuring they know all their options; identify their preferences and priorities, and assist them to access healthcare services and self-manage their health.
Educate patients on their rights and preferences and ensure they are able to participate in the decision-making process throughout their care and into survivorship or end-of-life care.
Assist patients in decision-making regarding diagnostic testing and treatment options (specific to nurse navigators).
Provide patients with strategies to cope with disease, treatment, and stress (specific to social work navigators).
Willis, Reed E, Pratt-Chapman, Kapp H, Hatcher E, Vaitones V, Collins S, Bires J, Washingtion E. JONS. 2013.
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Focus Group Demographics
We hosted 6 focus groups (N=21). Majority:• Were female (N=19)• Were ages 55-64 (N=8) and 25-34 (N=5)• Were White (N=13) and/or non-Hispanic/Latino (N=16)• Held Bachelors (N=8) or Masters degrees (N=8)• Had varying years of experience from less than 1 to
more than 10• Worked in multiple settings (N=6) and community
organizations (N=5)• Were from GA (N=3), HI (N=3), or DC/MD/VA (N=4)
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Asking Patient Navigators
Advocacy
Barriers
Basic skills
Care coordination
Communication
Cultural sensitivity
Ethics
Evaluation
Patient assessment
Patient education
Program development
Resources
Role delineation
Center for the Advancement of Cancer Survivorship, Navigation and Policy
2) Write Competencies
• Team wrote them• Experts reviewed them• National survey with 65 competencies• 618 consented; 525 respondents eligible
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Professions Represented
Repondents
Nurse NavigatorPatient NavigatorNavigation SupervisorSocial WorkerResearcherCHWOther
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Competency DomainsPatient Care (6)
Knowledge for Practice (6)
Practice-Based Learning (7)
Interpersonal and Communication Skills (8)
Professionalism (8)
Systems-Based Practice (3)
Interprofessional Collaboration (3)
Personal and Professional Development (4)
Center for the Advancement of Cancer Survivorship, Navigation and Policy
“Shared language is important in leading adaptive change. When people begin to use the same words with the same meaning, they communicate more effectively, minimize misunderstandings, and gain the sense of being on the same page, even while grappling with significant differences on the issues.”Heifetz R et al. The Practice of Adaptive Leadership, 2009.
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Refining Competencies
Identified statements with lowest
endorsement
Assessed qualitative feedback
Refined and collapsed
statements
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Sample Competency
•Patient CareDomain
•Facilitate patient-centered care that is compassionate, appropriate and effective for the treatment of cancer and the promotion of health.
Overarching Competency
•Assist patients in accessing cancer care and navigating health care systems. Assess barriers to care and engage patients and families in creating potential solutions to financial, practical and social challenges.
Competency
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Sample Competency
•Knowledge for PracticeDomain
•Demonstrate basic understanding of cancer, health care systems and how patients access care and services across the cancer continuum to support and assist patients.
Overarching Competency
•Demonstrate basic knowledge of medical and cancer terminology.
Competency
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Sample Competency
• Practice-Based Learning and ImprovementDomain
• Improve patient navigation process through continual self-evaluation and quality improvement. Promote and advance the profession.
Overarching Competency
•Use evaluation data (barriers to care, patient encounters, resource provision, population health disparities data and quality indicators) to collaboratively improve navigation process and participate in quality improvement.
Competency
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Sample Competency
•Interpersonal & Communication SkillsDomain
•Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and health professionals.
Overarching Competency
•Employ active listening and remain solutions-oriented in interactions with patients, families and members of the health care team.
Competency
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Sample Competency
•ProfessionalismDomain
•Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principals.
Overarching Competency
•Apply knowledge of the difference in roles between clinically licensed and non-licensed professionals and act within professional boundaries.
Competency
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Sample Competency
•Systems-Based PracticeDomain
•Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
Overarching Competency
•Organize and prioritize resources to optimize access to care across the cancer continuum for the most vulnerable patients.
Competency
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Sample Competency
•Interprofessional CollaborationDomain
•Demonstrate ability to engage in an interprofessional team in a manner that optimizes safe, effective patient- and population-centered care.
Overarching Competency
•Work with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity and trust.
Competency
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Sample Competency
•Personal and Professional DevelopmentDomain
•Demonstrate qualities required to sustain lifelong personal and professional growth.
Overarching Competency
•Set learning and improvement goals. Identify and perform learning activities that address one’s gaps in knowledge, skills attitudes and abilities.
Competency
Center for the Advancement of Cancer Survivorship, Navigation and Policy
3) Create Competency-Based Training
• Accessible: Free and online • Competency-based: All competencies
addressed through adult learning methods• Supported by cooperative agreement
#1U38DP004972-01 from the Centers for Disease Control and Prevention
• Launch: May 2015
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Oncology Patient Navigator Training: The Fundamentals
•Introduction to the Online Academy•Overview of Patient Navigation (History, Model)
Introduction
•Medical Terminology•Cancer Basics•Clinical Trials•US Health Care System•Health Care Payment Financing
Basics of Health Care
•Role of the Patient Navigator•Patient Assessment•Shared Decision Making•Identifying Resources
Basics of Patient Navigation
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Oncology Patient Navigator Training: The Fundamentals (cont.)
•Communicating with Patients•Patient Advocacy•Cultural Competency
Enhancing Communication
•Scope of Practice•Ethics and Patient Rights
Professionalism
•Practicing Efficiently and Effectively•Health Care Team Collaboration•Program Evaluation & Quality Improvement•Personal & Professional Development
Enhancing Practice
Center for the Advancement of Cancer Survivorship, Navigation and Policy
GW Cancer Institute Publications
• Pratt-Chapman M, Willis A. Community Cancer Center Administration and Support for Navigation Services. Seminars in Oncology Nursing. 2013;29(2):141-148.
• Willis A, Reed, Pratt-Chapman M, Kapp H, Hatcher E, Vaitones V, Collins S, Bires J, Washington E-C. Development of a Framework for Patient Navigation: Delineating Roles Across Navigator Types. Journal of Oncology Navigation and Survivorship. 2013;4(6):20-26.
• Willis A, Pratt-Chapman M, et al. Best Practices in Patient Navigation and Cancer Survivorship: Moving Toward Quality Patient-Centered Care. Journal of Oncology Navigation and Survivorship. 2014.
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Additional References
• Association for Prevention Teaching and Research. Competency-to-curriculum toolkit. 2008.
• Englander et al. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine. 2013.
• Heifetz R et al. Leadership in (permanent) crisis. The Practice of Adaptive Leadership, 2009.
• Oncology Nursing Society. Oncology Nurse Navigator Core Competencies. 2013.
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Take Home Messages
• Role clarity and standardization is critical for the advancement of patient navigation
• Competencies help define roles and optimize team-based care
• Resources are available to build core competencies in navigation
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Acknowledgements
• The Avon Foundation for Women partially supported the development of our framework and competencies.
• The Centers for Disease Control and Prevention funds our current development of an online patient navigation training & toolkit for states as well as the online executive training.
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Steering Committee for Functional Domains
• Jennifer Bires, LICSW, OSW-C, Association of Oncology Social Workers• Susan Bowman, RN, OCN, CBCN, MSW, Oncology Nursing Society• Stacy Collins, MSW, National Association of Social Workers• Margaret Darling, Nueva Vida• Leigh Ann Eagle, MAC Inc• Lorena Gayton, City of Hope• Linda Paige, Moffitt Cancer Center• Ana Quijada, Nueva Vida• Fedra Sanchez, Nueva Vida• Lillie Shockney, RN, BS, MAS, Academy of Oncology Nurse & Patient Navigators• David Trejo, City of Hope• Virginia Vaitones, MSW, OSW-C, Association of Community Cancer Centers• Etta-Cheri Washington, Capital City Area Health Education Center• Coni Williams, MS, University of South Florida
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Competency Reviewers• Amanda Allison• Susan Bowman, RN, OCN, CBCN, MSW• Elizabeth Clark, PhD, MPH, MSW• Margaret Darling• Andrea Dwyer, MSW• Ginny Pate• Angela Patterson• Terri Salter, RN, MSN, MBA• Karen Schwaderer, RN, BSN, OCN• Lillie Shockney, RN, BS, MAS• Patricia Valverde, PhD, MPH • Etta-Cheri Washington
Center for the Advancement of Cancer Survivorship, Navigation and Policy
GW Cancer Institute Staff
PI: Mandi Pratt-Chapman, MA
Research Team: • Anne Willis, MA• Kanako Kashima• Shaira Morales• Monique House, MS, CHES• Adrienne Thomas, LGSW• Elizabeth Hatcher, RN, BSN
Former staff:• Elisabeth Reed, MPA• Heather Kapp, LICSW
Center for the Advancement of Cancer Survivorship, Navigation and Policy
Questions & Answers
Mandi Pratt-Chapman
202-994-5502