Addressing Socioeconomic Challenges in Patient Navigation

Addressing cultural and economic challenges is a key objective for patient navigators, according to a presentation at the Second Annual Patient Navigation Initiative (PNI) Conference.

Patrick Borgen, MD, Chairman, Department of Surgery, and Director of the Breast Center at Maimonides Medical Center — the only dedicated breast cancer center in Brooklyn, NY – spoke at the conference, held in New York City on Feb. 5, about some of the challenges of working with a large, diverse, undocumented and uninsured population.

The PNI conference, organized by the Susan G. Komen Greater New York City affiliate (Komen NYC), was based on the premise that a more focused approach to navigation is required to reduce the number of late-stage diagnoses and high breast cancer mortality rates, particularly among African-American and Latina women.

A significant number of Maimonides Medical Center’s patients are on the lower end of the socioeconomic scale. Eighty percent of patients with breast cancer who come to Maimonides Medical Center are on Medicare or Medicaid.

“No one gets turned away,” Borgen said. Yet he acknowledges that there are many challenges in serving this population.

Cultural and Economic Challenges

To start, Borgen highlighted the various areas that need to be addressed.

“We have to be culturally sensitive and overcome language barriers. We have to worry about things like patient compliance. We have to look at disparities — how often patients got the treatments we thought they got.”

There is a significant problem with compliance among women treated at the center. If they cannot afford treatments, or time off work to attend appointments, they often skip them. If they cannot afford medications, they may skip doses.

How can a health system ensure that they can support diverse needs and rise to the challenge? Navigators.

“What matters is you,” he said, addressing the conference attendees. “What matters is relationships. You can have all the tools you want, but if you don’t have strong successful navigation, you are not going to be successful.”

Who Are Patient Navigators?

The word “navigator” is used in a very broad way in the current environment, where standardization is lacking, Borgen said in an interview with Oncology Nursing News.

“You have to broaden the concept,” he said. “In our practice, prior to getting a navigator, my physician’s assistant functioned as a navigator… the idea here is not to check off a box, oh yes, there’s a navigator, but that someone is functioning in the navigator role. The patient needs a point of contact that allows her to have a clear understanding of her trajectory, what tests are next, what procedures are next, how do I schedule those, how do I get the results of those … there has to be a way to have completely open access to that information for patients. That’s really central to the navigator’s role.”

Northwell Health, which is has entered into a strategic partnership with Maimonides, has an interdisciplinary team approach to patient navigation. A nurse practitioner, a nurse, a social worker, and a resource coordinator (non-licensed clinical professional) work together to provide a holistic experience of care to the woman going through the traumatic experience of breast cancer.

During the conference, Zenobia Brown, MD, MPH, Medical Director, Northwell Health, also emphasized the importance of incorporating non-licensed professional, or lay navigators, into the navigation team. There are aspects of coordinating care that do not require a license, for example, arranging transportation and tracking appointments.

Sourcing navigators from the communities local to the cancer center could benefit the people who are treated there who might have an elevated level of comfort with a navigator who is familiar, of similar ethnicity, or speaks the same language.

Recruiting the right people as navigators is essential, Borgen said. “Our strategy at Maimonides is to recruit for values first. Then we start looking at abilities. Smart is easy. Nice is not so easy. If you don’t find nice first, smart doesn’t matter. We have learned that as much as you might try, you can’t really teach empathy.”

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