Introduction NCONN Core Competency Area 4: Advocacy Kathleen Gamblin, RN, BSN, OCN June 12-14, 2014 5th Annual NCONN Conference Atlanta, Georgia

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Disclosure Kathleen Gamblin, RN, BSN, OCN has no significant financial relationships to disclose.

Competency Area 4: Advocacy “The Oncology Nurse Navigator will guide and direct the patient through a collaborative environment of health care disciplines to maintain dignity and autonomy of the individual patient.” (NCONN 2013)

Objectives State barriers and obstacles patients face in their cancer treatment and how navigation improves the delivery of care to oncology patients Identify interventions navigators implement to decrease health disparity and pertaining to cultural differences in diverse populations

Barriers and Obstacles to Care Physical Informational Emotional Psychological Social Spiritual Practical Providing Person-Centered Cancer Care: A Learning Kit For Volunteers. (2009, July 1). . Retrieved April 25, 2014, from http://www.partnershipagainstcancer.ca/wp-content/uploads/2.4.0.1.4.3.1-Learning-Kit_guide_July09.pdf

Being A Patient Advocate Patient-Centered Care Patients Unique Living Beings Listened To Informed Respected Involved in Own Care Wishes Honored Patients Have Right to Make Their Own Decision “What Is Most Important To You?”

Improving Delivery of Care Anecdotally Research Studies Quantitative Prevention Screening Diagnostic Follow-up Stage at Diagnosis Treatment Qualitative and Descriptive

Improving the Delivery of Care Clinical Trial Accrual Major barrier in recruitment/enrollment of patients is lack of knowledge 40% of adults don’t understand clinical trials Area ONN Can Have Positive Impact Education of patients often primary responsibility Educating patients and informing of available clinical trials First Contact Captures patient that might have been lost

Health Disparities Frequently tied to financial status Definition “Adverse differences in cancer incidence (new cases), cancer prevalence (all existing cases), cancer death (mortality), cancer survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States .” (National Cancer Institute) Specific Population Groups Racial Cultural Community Workplace

Health Disparities Past Identification of Problem Philadelphia Negro (1899) Henschke et al. landmark report (1973) American Cancer Society “Report to the Nation on Cancer in the Poor” (1989) Present Continued documentation of problem Institute of Medicine Report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” (2002) Future Potential Solutions for Problem Affordable Health Care Act Prevention and Early Detection Health care Access and Coordination Insurance Coverage and Continuity Diversity and Cultural Competency

Where Does Navigation Begin in Eliminating Health Disparities? Education Know Yourself Personal Values, Beliefs and Attitudes Know Others Cultural Competence Know Your Community Community Assessment Community Partners Community Resources

References Clayton, S. M., Holmes, D., Major, J., Lyonga, D., & Alleyene, R. Increasing minority patient participation in cancer clinical trials using oncology nurse navigation. The American Journal of Surgery, 415-422. Epstein, R. Understanding the Processes of Patient Navigation to Reduce Disparities in Cancer Care: Perspectives of Trained Navigators from the Field. Journal of Cancer Education, 111-120. Fitch, M. Supportive Care Framework . Canadian Oncology Nursing Journal, 18, 6-14. Freeman, H. P. , Rodriguez, R. L. History and principles of patient navigation. Cancer, 3537-3540. Hendren, S., N, C., Fisher, S., Griggs, J., Mohile, S., & Fiscella, K. Patients' barriers to receipt of cancer care and factors associated with needing more assistance from a patient navigator . Journal National Medical Association , 103, 701-10. Jones, L. A., Enard, K., Lucinda, N., & Jones, L. A. The role of patient navigators in eliminating health disparities. Cancer, 3541-3550. Paskett, E.D., Harrop, P., Wells, K. Patient Navigation: An Update on the State of the Science . CA: A Cancer Journal For Clinicians , 61, 237-249. Personal Valuess, Belief and Attitudes. (2009, January 1). . Retrieved April 25, 2014, from http://sielearning.tafensw.edu.au/MCS/CHCAOD402A/chcaod402a_csw/knowledge/values/values.htm Providing Person-Centered Cancer Care: A Learning Kit For Volunteers. (2009, July 1). . Retrieved April 25, 2014, from http://www.partnershipagainstcancer.ca/wp-content/uploads/2.4.0.1.4.3.1-Learning-Kit_guide_July09.pdf Raich, P. Metrics for evaluating patient navigation during cancer diagnosis and treatment. Cancer, 3563-3572. Street, R. L. The Values and Value of Patient-Centered Care. The Annals of Family Medicine, 100-103. Tu-Uyen N., Kagawa-Singer, M. Overcoming barriers to cancer care through health navigation programs. Seminars in Oncology Nursing 12/2008; 24(4):270-8.