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Addressing Barriers to Cancer Care: An Interdisciplinary Team Approach to Patient Navigation (FULL)
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.
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.
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.
Defining Quality Cancer Survivorship Care: Symptom Burden and Distress in Veteran Cancer Survivors. VA Puget Sound Cancer Survivorship Clinic
Purpose: Describe symptom burden and distress among Veteran cancer survivors.
Background: Survivorship is an important component of cancer care as patients transition from treatment to surveillance and cope with long-term effects of therapy. Veterans receiving care at the VA are quite different from those described in existing survivorship literature, with lower income and health literacy, poorer physical andmental health, and more comorbidities compared to the general population. Survivorship needs have not been well defined in this population.
Methods: Veterans are referred or recruited to survivorship clinic after completing definitive therapy. An NCCN distress thermometer (DT) is completed in survivorship clinic as part of routine clinical care.
Data Analysis: This analysis was restricted to cancer survivors meeting Commission on Cancer guidance for survivorship care eligibility. Descriptive statistics summarized findings from the DT. To place symptom burden in context, a comparison group was selected consisting of Veterans with comparable cancer site and stage who completed a DT at their first treatment appointment. Reported symptoms were compared to those from survivors with chi-square analysis.
Results: The DT was completed by 47 lung, colorectal, anal, and head and neck cancer survivors between February 2015 and April 2016. Most were white males, with an average age of 66. Of 39 practical, family, emotional, and physical problems included on the DT, survivors reported an average of 9.2 issues (range 0-22). The most common problems were dyspnea (64%), fatigue (60%), pain (57%), sleep (45%), worry (43%), and depression (40%). The average distress score was 3.6 (range 0-9).
The comparison group contained 147 Veterans; they reported an average of 7.4 issues as sources of distress.
Survivors were significantly more likely to report difficulty with breathing, constipation, depression, anhedonia, sadness, sleep concerns, and tingling in the hands and feet. The only issues more common in patients at the start of treatment compared to survivors were nervousness and transportation concerns. There was no difference in concerns regarding treatment decisions, pain, or finances.
Implications: Veteran cancer survivors reported significant symptom burden, particularly concerning mental health and side effects of treatment. Cancer survivorship clinic can play an important role in identifying and addressing the significant symptom burden. A multidisciplinary approach, particularly one including mental health services, is very important.
Purpose: Describe symptom burden and distress among Veteran cancer survivors.
Background: Survivorship is an important component of cancer care as patients transition from treatment to surveillance and cope with long-term effects of therapy. Veterans receiving care at the VA are quite different from those described in existing survivorship literature, with lower income and health literacy, poorer physical andmental health, and more comorbidities compared to the general population. Survivorship needs have not been well defined in this population.
Methods: Veterans are referred or recruited to survivorship clinic after completing definitive therapy. An NCCN distress thermometer (DT) is completed in survivorship clinic as part of routine clinical care.
Data Analysis: This analysis was restricted to cancer survivors meeting Commission on Cancer guidance for survivorship care eligibility. Descriptive statistics summarized findings from the DT. To place symptom burden in context, a comparison group was selected consisting of Veterans with comparable cancer site and stage who completed a DT at their first treatment appointment. Reported symptoms were compared to those from survivors with chi-square analysis.
Results: The DT was completed by 47 lung, colorectal, anal, and head and neck cancer survivors between February 2015 and April 2016. Most were white males, with an average age of 66. Of 39 practical, family, emotional, and physical problems included on the DT, survivors reported an average of 9.2 issues (range 0-22). The most common problems were dyspnea (64%), fatigue (60%), pain (57%), sleep (45%), worry (43%), and depression (40%). The average distress score was 3.6 (range 0-9).
The comparison group contained 147 Veterans; they reported an average of 7.4 issues as sources of distress.
Survivors were significantly more likely to report difficulty with breathing, constipation, depression, anhedonia, sadness, sleep concerns, and tingling in the hands and feet. The only issues more common in patients at the start of treatment compared to survivors were nervousness and transportation concerns. There was no difference in concerns regarding treatment decisions, pain, or finances.
Implications: Veteran cancer survivors reported significant symptom burden, particularly concerning mental health and side effects of treatment. Cancer survivorship clinic can play an important role in identifying and addressing the significant symptom burden. A multidisciplinary approach, particularly one including mental health services, is very important.
Purpose: Describe symptom burden and distress among Veteran cancer survivors.
Background: Survivorship is an important component of cancer care as patients transition from treatment to surveillance and cope with long-term effects of therapy. Veterans receiving care at the VA are quite different from those described in existing survivorship literature, with lower income and health literacy, poorer physical andmental health, and more comorbidities compared to the general population. Survivorship needs have not been well defined in this population.
Methods: Veterans are referred or recruited to survivorship clinic after completing definitive therapy. An NCCN distress thermometer (DT) is completed in survivorship clinic as part of routine clinical care.
Data Analysis: This analysis was restricted to cancer survivors meeting Commission on Cancer guidance for survivorship care eligibility. Descriptive statistics summarized findings from the DT. To place symptom burden in context, a comparison group was selected consisting of Veterans with comparable cancer site and stage who completed a DT at their first treatment appointment. Reported symptoms were compared to those from survivors with chi-square analysis.
Results: The DT was completed by 47 lung, colorectal, anal, and head and neck cancer survivors between February 2015 and April 2016. Most were white males, with an average age of 66. Of 39 practical, family, emotional, and physical problems included on the DT, survivors reported an average of 9.2 issues (range 0-22). The most common problems were dyspnea (64%), fatigue (60%), pain (57%), sleep (45%), worry (43%), and depression (40%). The average distress score was 3.6 (range 0-9).
The comparison group contained 147 Veterans; they reported an average of 7.4 issues as sources of distress.
Survivors were significantly more likely to report difficulty with breathing, constipation, depression, anhedonia, sadness, sleep concerns, and tingling in the hands and feet. The only issues more common in patients at the start of treatment compared to survivors were nervousness and transportation concerns. There was no difference in concerns regarding treatment decisions, pain, or finances.
Implications: Veteran cancer survivors reported significant symptom burden, particularly concerning mental health and side effects of treatment. Cancer survivorship clinic can play an important role in identifying and addressing the significant symptom burden. A multidisciplinary approach, particularly one including mental health services, is very important.