Freund Karen M
a Institute of Clinical Research and Health Policy Studies, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine , Boston , Massachusetts , USA.
Acta Oncol. 2017 Feb;56(2):123-127. doi: 10.1080/0284186X.2016.1266078. Epub 2016 Dec 29.
Patient navigation refers to a direct patient care role that links patients with clinical providers and their support system and provides individualized support during cancer care, ensuring that patients have access to the knowledge and resources necessary to complete recommended treatment. While most reports have studied the role of patient navigators during the cancer screening or diagnostic process, emerging evidence indicates the benefits of patient navigation during active cancer treatment.
Reports in the literature are conflicting on the impact of patient navigation during cancer care and on the benefits to timely or quality care in all populations. Recent sub-analyses of the Patient Navigation Research Program data demonstrated specifically the benefits of targeting patient navigation to the most vulnerable populations, including those with low educational attainment, low income and unstable housing, less social support, multiple comorbidities, and minority race/ethnicity.
The implications of the Patient Navigation Research Program are that this resource is best utilized when directed to support the care of patients at locations with known challenges to timely care and for specific patients with risk factors for delays in care, including comorbidities, low educational attainment and low income. Implementation of patient navigation programs requires the following processes: needs assessment, selection of a navigator to meet the community and care needs, supervision and integration of the navigator into clinical processes, and systems support to facilitate the identification and tracking of those patients requiring patient navigation. There is a need for ongoing research on methods to fund and sustain patient navigation programs.
患者导航是指一种直接的患者护理角色,它将患者与临床医疗服务提供者及其支持系统联系起来,并在癌症护理期间提供个性化支持,确保患者能够获取完成推荐治疗所需的知识和资源。虽然大多数报告研究了患者导航员在癌症筛查或诊断过程中的作用,但新出现的证据表明了在积极的癌症治疗期间患者导航的益处。
文献中的报告在癌症护理期间患者导航的影响以及对所有人群及时或高质量护理的益处方面存在冲突。患者导航研究项目数据的近期亚分析具体证明了将患者导航针对最脆弱人群的益处,这些人群包括教育程度低、收入低、住房不稳定、社会支持较少、有多种合并症以及少数族裔/种族的人群。
患者导航研究项目的意义在于,当该资源用于支持在及时护理方面存在已知挑战的地点的患者护理,以及针对有护理延迟风险因素(包括合并症、教育程度低和收入低)的特定患者时,能得到最佳利用。实施患者导航项目需要以下过程:需求评估、选择一名能满足社区和护理需求的导航员、对导航员进行监督并将其融入临床流程,以及提供系统支持以促进对那些需要患者导航的患者的识别和跟踪。需要对资助和维持患者导航项目的方法进行持续研究。