1. Process Indicators for Patient Navigation
Process Indicators for the Implementation of Patient Navigation for Colorectal Cancer Screening and Treatment
Cam Escoffery,1 PhD, Amy DeGroff,2 PhD, Anamika Satsangi,2 MPH
1. Rollins School of Public Health at Emory University, Atlanta, GA; 2. Centers for Disease Control and Prevention, Atlanta, GA
Process Indicators for Patient Navigation
INTRODUCTION
CONCLUSION
Type
Definition
PN Example
Intervention Processes
Recruitment
Processes or channels to recruit participants
Enrollment channels for program
Reach
Number of program participants
Number of participants enrolled and/or navigated
Number of different demographic and clinical characteristics
Implementation
Delivery of navigation program activities
Mode of navigation; No. of encounters; Time spent with participants; PN actions; Referrals made; PN tracking system
Intervention
Fidelity
Extent to which the intervention was delivered as intended
Adherence to PN protocol; PN Quality improvement; Monitoring of calls/interactions
Dose delivered
Number of intervention components or elements delivered
PN protocol with actions/services offered
Maintenance
Sustaining program over time
Discussion about maintaining program
Organizational
Resources
Materials or supports of agencies, implementers or participants necessary to attain program goals
Cost of PN program; Personnel involved (# PN)
Context
Organizational characteristics and factors; setting characteristics
PN description and role; Workflow (PN integration); Partnerships; Community referral services
Intervention Participant
Dosed received
Number of intervention components received/used
Receipt of services in PN protocol
Satisfaction
Ratings and reactions to the program
Satisfaction with navigator/navigation services
Patient navigation (PN) offers assistance to patients, families, and caregivers to help overcome barriers to cancer care and facilitate access to quality health and psychosocial services from screening through survivorship. PN has been effective in reducing health disparities through navigators’ roles in addressing these barriers, patient education and empowerment and assistance with care coordination. Reviews of PN have found that it is effective in improving cancer screening completion, adherence to follow-up care after abnormal results, and timeliness of diagnostic resolution.
Intervention trials of PN for colorectal cancer (CRC) demonstrate increased screening completion. While some studies have systematically examined health outcomes related to PN activities, no study has examined process evaluation across PN interventions for cancer screening.
This study examined process indicators reported in the published literature describing PN for CRC. Key findings were:
Most process data centered around PN implementation; mostly related to recruitment, reach, actions, and mode of contact.
Some important process evaluation components have been reported very infrequently (e.g., dose, fidelity, resources-costs, tracking).
Many studies used quantitative data collection or a mixed methods approach.
Common sources for data were surveys, interviews or PN databases.
IMPLICATIONS
There are a range of process evaluation measures for patient navigation reported in the literature.
In designing evaluations of PN, evaluators should consider data collection tools appropriate to the measure (e.g., PN database for tracking contacts and outcomes, interviews to assess satisfaction).
Developing standardized process measures based on PE components may benefit practitioners implementing PN programs. It may be useful to the field to have a set of standard process metrics associated with services and activities undertaken by navigators.
RESULTS
PURPOSE
We identified 29 articles of PN for colorectal cancer.
The PN studies were primarily non-experimental (n=12, 41.4%) or experimental designs (i.e., RCTs) (n=11, 37.9%).
Of studies reporting baseline and follow-up data, most had medium follow-up of 6 months to a year (n= 13) or strong follow-up of more than a year (n=11).
Almost all programs were located in medical centers or health systems setting (n=27, 93.1%) and 2 were located in churches.
Patients were navigated primarily for cancer screening (n=21, 73.4%) and diagnosis (n=6, 20.8%) with only 2 for treatment (6.9%).
Data sources were surveys, interviews or PN databases.
We conducted a systematic review examining PN implementation and process evaluation measures for CRC screening. We identified common types of process indicators and related data sources reported in the literature.
METHODS
We conducted a literature search on PN articles published from 2000 to 2015, using a variety of databases (PubMed, PsychInfo, Medline, CINAHL, ERIC, SocialSciSearch, Google Scholar, etc.) and search terms (navigation, cancer, neoplasm). Identified articles were abstracted using a structured Excel tool.
CONTACT
Cam Escoffery, PhD, MPH, CHES
Rollins School of Public Health, Emory University
Address: 1518 Clifton Road, 5th Floor, Atlanta, GA;
Phone: ;