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

4. 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)

5. 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

6. 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

7. 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?”

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

9. 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

10. 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

11. 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

12. 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

13. 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, 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, Fitch, M. Supportive Care Framework . Canadian Oncology Nursing Journal, 18, Freeman, H. P. , Rodriguez, R. L. History and principles of patient navigation. Cancer, 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, Jones, L. A., Enard, K., Lucinda, N., & Jones, L. A. The role of patient navigators in eliminating health disparities. Cancer, Paskett, E.D., Harrop, P., Wells, K. Patient Navigation: An Update on the State of the Science . CA: A Cancer Journal For Clinicians , 61, Personal Valuess, Belief and Attitudes. (2009, January 1). . Retrieved April 25, 2014, from Providing Person-Centered Cancer Care: A Learning Kit For Volunteers. (2009, July 1). . Retrieved April 25, 2014, from Raich, P. Metrics for evaluating patient navigation during cancer diagnosis and treatment. Cancer, Street, R. L. The Values and Value of Patient-Centered Care. The Annals of Family Medicine, 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.