Thanks Sandi. Other models also exist to utilize community health workers to navigate not just the "medical system", but also the social service and support system (i.e housing, SSI, and a variety of other services). And also in other areas. I can't provide an exact reference right now, but there are research articles written on the "promatoras" model. Unfortunately, these CHW are severely underpaid, and then it becomes a vicious cycle. Those that have gain experiences move on to something else, some either getting a higher degree in health education, nursing and etc. They've also been attacked by other "professional" as underequipped. It's debatable whether these were due to fear of losing their own jobs. I have encountered CHWs that are highly competent, very caring and real advocates for their clients/pateints. I am always in favor of a blended model to utilize both nurses or other professionals and CHWs. Well, just some thoughts on this.
>>> Sandi Pniauskas <[log in to unmask]> 04/18/07 8:00 AM >>>
This is not at all 'innovative', simply terminology as acknowledged by
the authors of the paper.
'Patient' Navigator programs exist sporadically in Canada and the U.S..
In fact, both in Canada and the U.S. discussions exist on how, when and
where to implement 'Patient' Navigator programs. The U.S. NCI has a 5 yr
Patient Navigator Research Program (PNRP) as indicated in the study. The
American Cancer Society, as an example, has a 'Patient' Navigator
program
(http://www.cancer.org/docroot/SPC/content/SPC_1_ACS_Patient_Navigator_Program.asp)
and others have 'Nurse' Navigator programs. Nurse navigators are
typically, of course nursing professionals, however, I believe the ACS
includes professionals such as social workers. The original concept of
Patients *as* Navigators has been lost and I have followed this
particular area somewhat closely for several years. As a generalization,
'Patients' as Navigators are volunteer positions and I emphatically
believe that these should be paid positions.
The report does indicate that the findings should meet the future needs
of all cancer patients, but this opinion, in my view is flawed, due to
selection bias. It indicated that recruitment of patients was difficult
with few referrals due to a variety of system issues. Yet, I know with
certainty that cancer patients/survivours/caregivers (caregivers in the
sense of family/friends) could have hand-picked many more than the
actual 27 patients included in the study given the opportunity.
Patients, in general terms, have a 'zone' alarm and they intrinsically
understand, without explanation, those most in need and in a very short
period of time - minutes within initial conversation(s). This is a
common denominator within cancer patient populations and most certainly
stems from trust.
The cost? I have not researched economic analyses but this information
might be included in the PNRP research and will exist at hospital levels
for those who have existing programs. The issue, prior to any meaningful
economic analysis, is that the fundamentals of the needs/disparities
need to be fully address. However, what is disturbing is the cost of
this study ($530,000.) and yet I assume, with a high degree of
confidence, the fact that a cancer patient was found sleeping on the
hospital floor will be a surprize to many - in Canada.
I hate to be so critical of a study which was meant to highlight the
issues and bring forward an awareness. Further, I have not yet read the
full 100 page report which may allow for further insight. However, on
the surface, this study was lacking in many areas and in particular,
some of which include: full definition of 'underserved'; psychosocial
benefit(s) economic and otherwise of survivour-surviour connection(s);
implications of 'off-loading' patient care; concept of patient
empowerment; lack of appreciation (ie; conclusions) for the differences
between cancer care and chronic disease (not all cancers are chronic).
Many of the authors involved are highly regarded and respected in their
fields and this needs to be acknowledged.
Sandi
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