Purpose: Create a custom patient navigation model and standard assessment tools that support an interdisciplinary team approach to address barriers to care for Veterans with cancer.
Background: Patient navigation is utilized throughout the country to address barriers to care in the most vulnerable of populations. A community needs assessment was conducted at the VA Puget Sound Health Care System in December 2014 to identify high-risk cohorts and facility barriers to care to drive the VA Puget Sound navigation team process. Veterans in identified cohorts thought to be at highest risk for barriers to care are enrolled in navigation services. Veterans are identified through formal consult, case finding and self-referral. The VA Puget Sound uses an interdisciplinary team approach that has been found to be successful in addressing complex barriers to cancer care. The VA Puget Sound Healthcare System Cancer Care Navigation Team (CCNT) consists of a Nurse Practitioner, Registered Nurse, Social Worker and a Medical Support Assistant who work together to fully address a wide range of physical, psychological and practical barriers to care that patients may experience throughout the cancer care continuum.
Methods: The CCNT uses standardized assessment tools, including a navigation intake form, the National Comprehensive Network (NCCN) Distress Thermometer and a functional assessment. The VA Puget Sound cancer navigation model is divided into four main processes based on the
cancer care continuum.
Results: Since initiation of the program in December of 2014, CCNT has enrolled over 1,295 patients diagnosed with cancer sites including: 291 gastrointestinal, 258 genitourinary, 199 lung, 218 head and neck, 11 brain, 137 hematologic, 58 multiple, 22 breast, 18 unknown, 13 sarcoma, 71 other and 12 gynecologic cancers. CCNT has had a significant impaired for patients enrolled in the program as evidence by reduced travel to the VA, improved access to care, decreased hospital stays and improving patient, family and provider satisfaction.
Implications: We present a unique interdisciplinary team approach to patient navigation that supports patient-centered care in addressing barriers to care for Veterans and assures timely access to cancer care.
