A User-Centered Need Analysis of Cancer Patient Navigation — An Intersection of Collaborative Work and Collaborative Health IT

Cancer care is becoming more complex each year, making the patient’s path to, and through the care continuum confusing and daunting. Patient-navigation programs for cancer patients have grown in recent years, but their navigation support is fragmented in many ways and often incomplete, lessening their effectiveness. Digital tools to support the cancer patient navigator can make them more effective and allow more patients to receive navigation support. A multifaceted analysis of the needs for such tools is presented. The analysis methods include literature review, domain analysis, and qualitative interviews with a sample of ten cancer patient navigators.

The Development of Cancer Patient Navigation Program in Taiwan

Background and context: Cancer has been the leading cause of death since 1982 in Taiwan. Taiwan cancer case management program started from major 4 cancers (breast cancer, liver cancer, colorectal cancer, oral cancer) since 2004. However, only 82% of patients with a confirmed cancer diagnosis received their first cancer treatment within 3 months in 2012. Aim: To increase the navigation coverage for all cancer patients, Health Promotion Administration (HPA) sets the goal that 91% of patients with a confirmed cancer diagnosis should receive their first cancer treatment within 3 months in 2018. Strategy/Tactics: (1) Subsidize cancer hospitals (2) Accreditation for oncology case management (3) Pay for performance (P4P) Program/Policy process: We subsidized hospitals to establish oncology case manager since 2004. Gradually, hospitals in Taiwan accept this new nursing role and recognize its positive impacts on cancer care. Moreover, Taiwan Accreditation Program of Cancer Care mandated all cancer care institutes to establish the program for oncology case management since 2010. However, there were only 4-6 major cancer patients got the case management service. Thus HPA launched P4P Cancer Patient Navigation Program in 2014 and established reporting system. Outcomes: 95% of newly cancer diagnosis patients (including 92 hospitals) in Taiwan receive the service and 96% of patients with a confirmed cancer diagnosis receive their first cancer treatment within 3 months in 2017. Through the implementation of subsidy, accreditation and P4P, the relative survival rate showed significant improved. The 5-year relative survival rate for all cancers increases from 49% during 2003-2007% to 55.8% during 2011-2015. What was learned: A successful program might start small from few trial sites, should be fully supported and well established the systems by government and will move fast by all healthcare professionals.

Comparing enrolees with non-enrolees of cancer-patient navigation at end of life

Background Cancer-patient navigators who are oncology nurses support and connect patients to resources throughout the cancer care trajectory, including end of life. Although qualitative and cohort studies of navigated patients have been reported, no population-based studies were found. The present population-based study compared demographic, disease, and outcome characteristics for decedents who had been diagnosed with cancer by whether they did or did not see a navigator.Methods This retrospective study used patient-based administrative data in Nova Scotia (cancer registry, death certificates, navigation visits) to generate descriptive statistics. The study population included all adults diagnosed with cancer who died during 2011–2014 of a cancer or non-cancer cause of death.Results Of the 7694 study decedents, 74.9% had died of cancer. Of those individuals, 40% had seen a navigator at some point in their disease trajectory. The comparable percentage for those who did not die of cancer was 11.9%. Decedents at the oldest ages had the lowest navigation rates. Navigation rates, time from diagnosis to death, and time from last navigation visit to death varied by disease site.Conclusions This population-based study of cancer-patient navigation enrolees compared with non-enrolees is the first of its kind. Most findings were consistent with expectations. However, we do not know whether the rates of navigation are consistent with the navigation needs of the population diagnosed with cancer. Because more people are living longer with cancer and because the population is aging, ongoing surveillance of who requires and who is using navigation services is warranted.