The cancer center has patient navigators who specialize in particular cancers, and they are permanently assigned to specific patients.
Specialized patient navigators are making a difference for patients and care teams at Detroit-based Karmanos Cancer Institute.
At health systems and hospitals, patient navigators are deployed to play a key patient engagement role in the organization. Patient navigators can be involved in the patient journey in several ways, including helping patients communicate with care teams, setting appointments for doctor visits, and securing financial, legal, and social support.
At Karmanos, specialized patient navigators are trained to work with patients who have specific kinds of cancer. "Patient navigators are better equipped to assist their patients when they understand the way the cancer affects the patient. At Karmanos, our physicians are specialists, and our patient navigators are specialists. What we decided to do was embed our navigators into a multidisciplinary team, where they specialize in a particular kind of cancer such as breast cancer or head and neck cancer," says April Brown, director of concierge services at Karmanos.
Having specialized patient navigators drives several benefits for patients and the cancer institute, she says.
"The benefit of having specialized patient navigators is understanding a particular kind of cancer and the needs that those patients have. For example, for a breast cancer patient versus a head and neck cancer patient, they are going to have different needs in areas such as medical records, treatments, and psychosocial issues. Our patient navigators also address financial toxicity. We do a lot of research on cancer-specific endowments and patient assistance programs. There can be a set of money available for lung cancer patients or a set of money for lymphoma patients. With patient navigators focused on specific cancers, they know what financial assistance is available for specific patient populations."
The specialized patient navigators received extensive training, Brown says. "Our patient navigators undergo online training with George Washington University and online training with the American Cancer Society. Our clinical staff also mentors the patient navigators. They work with our physicians to understand a particular type of cancer. We also utilize our pharmaceutical companies—they come in as new drugs are developed for various types of cancer. They educate us about these new drugs. We also have an education office that works with our patient navigators."
There are several best practices for running a specialized patient navigator program, Brown says.
At Karmanos, a patient is assigned to a particular specialized patient navigator. "When a patient navigator starts working with a patient, they are often the first point of contact. The patient navigator begins to build a relationship with the patient. Then, that patient knows that when they run up against an issue or a concern, they can feel comfortable seeking out their particular patient navigator. The patient knows the patient navigator is always there for them," she says.
After a clinic visit, the patient navigators have a follow-up phone call with their patients and have a conversation, Brown says. "We have found that those calls are like peeling back an onion because there are multiple layers to our patients. Listening to our patients is another best practice. Sometimes, our patients just want the patient navigators to listen to them."
Specialized patient navigators have multiple points of contact with patients throughout the patient journey, she says. "It makes the patients feel comfortable reaching out to our navigators. If a patient misses an appointment, the patient navigator will call and ask, 'What is going on?' It does not have to be a long conversation—just the fact that you called and checked on the patient makes them feel more comfortable."
Generating positive results
Having specialized patient navigators has resulted in positive results for patients and the cancer institute, Brown says. "Our no-show rates decreased because patient navigators were following up with patients. We have improved dealing with financial toxicity, and we have improved our bottom line. Patients are adhering better to their chemotherapy appointments because patient navigators address barriers such as transportation difficulties. Patient satisfaction has also improved. It helps to have one person the patient speaks to when they have a problem."
The work specialized patient navigators conduct to connect patients with financial resources is a financial benefit for patients and Karmanos, she says. "We found that we were writing off bills because patients were not able to pay for deductibles and co-pays. By getting our patient navigators to find financial assistance such as payments from the pharmaceutical companies, that affected our bottom line."
Part of the care team
Specialized patient navigators are a vital part of the Karmanos care teams, Brown says. "Patient navigators are in constant contact with our physicians, sometimes three times a day depending on the situation. The patient could have a new issue that is going on. Patient navigators are also in constant contact with our nursing staff and social workers. Patient navigators are a central point of contact for everyone. They go between the patient and all of the resources that we have at Karmanos."
Although specialized patient navigators are not clinical specialists, they often facilitate clinical care, she says. "After a clinical visit, patients may have questions about their treatment and contact their patient navigator. That will prompt a call to a physician or a nurse, who will be asked to call the patient. Sometimes, the patient is not feeling well, and they reach out to their patient navigator. They know that we will take the call and connect them with a clinical team member who can assist them quickly."
The specialized patient navigators also get involved in care coordination, Brown says.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Specialized patient navigators benefit patients because they are familiar with the needs associated with specific cancers such as treatments and psychosocial needs.
Specialized patient navigators address financial toxicity and are familiar with the financial assistance that is available for specific patient populations.
The specialized patient navigators receive extensive training, including online training with George Washington University and the American Cancer Society.