Because cancer patients vary in their needs for cancer services, patients vary in the amount of navigation time they require. On a patient-by-patient basis, however, navigators congruously estimated the navigation intensity, and therefore the time requirement, that would be needed, reveals a first-of-its-kind study.
Lay navigators working with patients as part of a larger, randomized, controlled trial to evaluate the effectiveness of patient navigators in Rochester, New York, used a 1-item measure to guess the amount of navigation service time each patient would require. To begin, a patient completed a preliminary assessment of his or her perceived navigation needs with their navigator. Next, the navigator reviewed the needs assessment and completed the Navigator Perceived Time of Patient Navigation tool, which was developed for this study and based on expert opinion and team consensus as well as met face-validation. On this simple sheet, the navigators circled the time intensity for each barrier, along the spectrum from “not very time intensive” to “very time intensive.” Lastly, navigation services began, during which the navigator documented each activity taken on behalf of the patient and the time it took to complete as well as circled all barriers to care that applied from a list of 22 potential barriers.
Analyzing the data, Carroll and colleagues found that the total number of barriers was a better predictor of total navigation time compared with type of barrier, with navigation time increasing 16% for each additional barrier identified by the navigator. Despite this finding, some barriers were associated with increased navigator time: 62% more time with women patients; and 34% more time with African Americans and 26% more time with others (mainly Hispanics in this population) compared with whites.
In addition, the investigators achieved the first step in validating their assessment tool. For each predicted intensity unit on the 10-point scale, navigation time increased 29%. The investigators cautioned that they do not know with certainty how the navigators estimated the time requirements. They concluded, however, that “understanding of time needed to address barriers with patients in cancer navigation is one initial step towards systematically improving the delivery of psychosocial aspects of cancer care.”
The complete study is published online in the May 10 issue of the Journal of Cancer Education.
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