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Navigators support, empower minority patients with cancer
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The Metropolitan Chicago Breast Cancer Task Force held an evening art gallery event for its survivors in October. For the task force, it was a celebration of successful efforts in navigating underserved, minority patients with cancer toward quality care.
For the patients, it was much more.
“They came together and celebrated the fact that they were alive, and that they were enthusiastic about life,” task force executive director Anne Marie Murphy, PhD, told HemOnc Today. “It was a lovely event.”
Murphy’s task force is a not-for-profit organization dedicated to narrowing racial and socioeconomic disparities in care for patients with cancer. It is one of several programs involved in a growing initiative toward providing race-specific navigators for minority patients facing a cancer diagnosis.
The task force runs two programs: the Extra Help, Extra Care program, which embeds a nurse navigator at three limited-service hospitals on Chicago’s South Side to advocate for women with abnormal mammograms; and the Beyond October program, which provides community outreach and education to poorer neighborhoods through lay navigators.
“One of the reasons our navigation programs exist is that safety net hospitals are so short on funds that they don’t have money for navigators, which is where we come in,” Murphy said. “We raise funds and are therefore able to navigate patients.”
A point of contact
Part of the job of a navigator is to facilitate good communication between patients and their cancer providers, ensuring that patients have a good understanding of their diagnosis and treatment options.
Maria Alejandra Combs, JD, OPN-CG, Hispanic patient navigator at Wake Forest Baptist Health from the Office of Cancer Health Equity, serves as a liaison between the Hispanic patients she serves and their health care providers. She identifies patients’ needs and not only assists in communicating with the patient and care team, but empowers patients by teaching them skills and resources so they can eventually navigate the health system independently and successfully.
“It is important for both health care providers and patients to know that certified interpreters are provided free of charge in our medical center” she told HemOnc Today. “Some patients who are not fluent in English try to utilize a family member to serve as interpreter. I encourage families to use our professional interpreters, because we want them to have a good understanding of all the information that is conveyed.”
Combs said that as a navigator, she also assists patients by connecting them with resources needed to remove barriers such as transportation, insurance, financial issues and other obstacles to timely and quality cancer care. She provides Spanish educational materials to patients about their diagnosis, including general information about clinical trials. Therefore, she works to ensure that Hispanic patients with cancer are adequately represented in clinical trials.
“We’re part of the health care team, so we work with physicians, nurses and the research staff,” she said. “We provide this support and education to patients to facilitate diverse participation in clinical trials. As a result, since 2015 — the year we started providing navigation services to Hispanic patients with cancer — clinical trial participation has significantly increased among Hispanic patients navigated.”
Racial concordance is another facet of what navigators provide to minority patients, Combs said. As patients face a daunting battle with cancer, they often take comfort in working with someone who is part of their culture.
“It’s a matter of being that point of contact for our patients, families and caregivers, empowering them to navigate the health care system,” she said. “I think what has made our program successful is the fact that I’m also bicultural, so we not only share the language, but the culture as well.”
‘Meet the patient where they are’
Poor communication between a clinician and a patient is not always related to race or culture, according to Fabian Johnston, MD, associate professor of surgery and oncology and chief of gastrointestinal surgical oncology at Johns Hopkins University.
“One of the reasons I use lay navigators is that we as physicians, no matter where we come from, often fall back into our clinical speak,” he told HemOnc Today. “That’s agnostic to ethnicity. You can be culturally competent and come from a majority population, and you can be culturally incompetent from a minority population.”
He said navigators are taught to bridge both types of communication gaps.
“This is what a navigator does; they learn this communication training,” he said. “So, I think by having racial concordance and some cultural communication training, navigators can really make a difference.”
Johnston tells new navigators that although they work for him, their larger responsibility is to the patients. In each situation, a navigator determines how much and what kind of help a patient needs, he said.
“We want to build capacity for these people to advocate for themselves,” he said. “Or, if the patient needs you to advocate for them, that’s what you do. You meet the patient where they are, and you build things up from there.”
Combs said their program is rapidly expanding; a rural navigator recently began work, and a navigator has been hired to serve the African American population. She is glad to see the program expanding to reach these patients through navigators with a common background and culture.
“That is a key component that helps a navigator build that trust with our patients and families in a fast and effective manner,” she said. “That is why population health navigation makes a difference.” – by Jennifer Byrne
For more information:
Maria Alejandra Combs, JD, OPN-CG, can be reached at marcombs@wakehealth.edu.
Fabian Johnston, MD, can be reached at fjohnst4@jhmi.edu.
Anne Marie Murphy, PhD, can be reached at annemarie_murphy@rush.edu.
Disclosures: Combs, Johnston and Murphy report no relevant financial disclosures.