Introduction
Navigation in Cancer Care
Cancer outcomes in Australia are among the best in the world, but they are not experienced equally by all Australians.1-3 The fragmented way healthcare is usually delivered can increase morbidity, heighten distress, and increase out-of-pocket costs, especially for people with complex needs.4, 5 This policy proposes how navigation in cancer care could facilitate timely access to support for individuals, families and carers to navigate the health system and address holistic, emotional, and educational/informational needs to achieve equity in cancer care. Figure 1 outlines the definition of navigation for the purposes of this policy.
Navigation in cancer care should aim to ensure timely and equitable access to healthcare and support services for all Australians irrespective of the type or location of cancer.
Figure 1. Navigation in cancer care
Navigation is a response to a complex and fragmented health system, as part of the care coordination process, helping people navigate their way through the health system, and access community, social and psychosocial services that can address personal barriers to care. Navigation support services should be person-centred, with those requiring the most help, receiving dedicated assistance and support, and those able to more independently navigate the healthcare system receiving adequate, but less intensive assistance (refer to Figure 2). The way that people navigate these services depends on their diagnosis, and where they access treatment.6 Without appropriate navigation support, some people can become lost in the health system, unable to access timely, appropriate, and well-coordinated cancer services.7, 8 Navigation support is a fundamental component of ensuring everyone has timely and appropriate access to healthcare and support services.9
Figure 2. Care coordination and navigation (adapted from Fitch 2008).10
Components of navigation in the context of cancer care include but are not limited to: care coordination; education/information provision; empowerment (psychosocial counselling, emotional and peer support); advocacy; logistics; and connecting the person with financial assistance.11 There is evidence that navigation support contributes to improving access and continuity of care, seemingly offering a promising approach to better integration of care (refer to benefits of navigation in Figure 3).11, 12
Figure 3. The benefits of navigation.12
Definitions
Navigation in Cancer Care
Consistent, individualised and safe assistance is offered to people affected by cancer, families, and carers to overcome person and system-level barriers to timely access to health, support and psychosocial care throughout the cancer experience.1
Cancer Care Coordination
The deliberate organisation between two or more participants (including the person with cancer) involved in care to facilitate the appropriate and timely delivery of healthcare and support services.2 Care coordination is a comprehensive process that operates at a clinical, organisational, administrative and policy level.
Person-Centred Care
Integrated healthcare services and support that are delivered in a setting and manner that is responsive to individuals and their goals, values, and preferences.
Priority Populations
Priority population groups, as defined in the Australian Cancer Plan (ACP), include Aboriginal and Torres Strait Islander Peoples, people living in rural and remote areas, lesbian, gay, bisexual, transgender, intersex, queer and asexual (LGBTIQA+) people, people from culturally and linguistically diverse backgrounds, people living with disability, people in lower socioeconomic groups, people living with a mental illness, older Australians, adolescents and young adults, and children.
1. Kline RM, Rocque GB, Rohan EA, et al. Patient Navigation in Cancer: The Business Case to Support Clinical Needs. Journal of Oncology Practice 2019; 15: 585-590. DOI: 10.1200/jop.19.00230.
2. McDonald K M, Sundaram V, Bravata D M, et al. Care Coordination. In: Shojania KG, McDonald K M, Wachter R M, et al. (eds) Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Rockville (US): Agency for Healthcare Research and Quality, 2007.
References
- Tervonen HE, Aranda S, Roder D, et al. Differences in impact of Aboriginal and Torres Strait Islander status on cancer stage and survival by level of socio-economic disadvantage and remoteness of residence—A population-based cohort study in Australia. Cancer Epidemiology 2016; 41: 132-138. DOI: https://doi.org/10.1016/j.canep.2016.02.006.
- Tervonen HE, Walton R, Roder D, et al. Socio-demographic disadvantage and distant summary stage of cancer at diagnosis—A population-based study in New South Wales. Cancer Epidemiology 2016; 40: 87-94. DOI: https://doi.org/10.1016/j.canep.2015.10.032.
- Australian Institute of Health and Welfare. Cancer in Australia. 2019. Canberra (AU).
- Conway A, O’Donnell C and Yates P. The Effectiveness of the Nurse Care Coordinator Role on Patient-Reported and Health Service Outcomes: A Systematic Review. Evaluation & the Health Professions 2019; 42: 263-296. DOI: 10.1177/0163278717734610.
- 5. Panozzo S, Collins A, McLachlan S-A, et al. Scope of Practice, Role Legitimacy, and Role Potential for Cancer Care Coordinators. Asia-Pacific Journal of Oncology Nursing 2019; 6: 356-362. DOI: https://doi.org/10.4103/apjon.apjon_29_19.
- McGrath Foundation. Specialist nurse advanced cancer scoping report. 2021.
- Walsh J, Harrison J, Young J, et al. What are the current barriers to effective cancer care coordination? A qualitative study. BMC health services research 2010; 10: 132.
- Sabesan S, Olver I, Poulsen M, et al. What teleoncology models of care are available to health services in Australia and overseas? 2017. Sydney (AU).
- Chan RJ, Hart N, Crawford-Williams F, et al. DEFINING THE UNMET NEEDS OF PEOPLE WITH ADVANCED SOLID AND HAEMATOLOGICAL CANCERS, AND THEIR CARERS. 2021.
- Fitch MI. Supportive care framework. Can Oncol Nurs J 2008; 18: 6-24. DOI: 10.5737/1181912x181614.
- Chan RJ, Milch VE, Crawford-Williams F, et al. Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature. CA: A Cancer Journal for Clinicians 2023; 73: 565-589. DOI: https://doi.org/10.3322/caac.21788.
- Budde H, Williams GA, Scarpetti G, et al. What are patient navigators and how can they improve integration of care? Report no. 44, 2022. Copenhagen (DK).
- Kline RM, Rocque GB, Rohan EA, et al. Patient Navigation in Cancer: The Business Case to Support Clinical Needs. Journal of Oncology Practice 2019; 15: 585-590. DOI: 10.1200/jop.19.00230.
- McDonald K M, Sundaram V, Bravata D M, et al. Care Coordination. In: Shojania KG, McDonald K M, Wachter R M, et al. (eds) Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Rockville (US): Agency for Healthcare Research and Quality, 2007.
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