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Case Study

How UNC Health Virtualized Cancer Patient Navigation During Covid-19

15 Minute Read

Overview

The challenge

When the Covid-19 pandemic hit, cancer programs were forced to provide traditionally in-person services virtually, including patient navigation. Since Covid-19 disproportionately affects the most vulnerable cancer patients, it became especially important to target these newly virtual services toward the patients with the greatest need.

The organization

The N.C. Cancer Hospital is the clinical home of the NCI-designated University of North Carolina (UNC) Lineberger Comprehensive Cancer Center. For over a decade, the cancer center’s hospital-based Patient and Family Resource Center (PFRC) has successfully connected cancer patients and families to support services and resources addressing non-medical barriers to care through a patient navigation program led by three nurse navigators and staffed by many trained volunteers (there were 18 as of March 2021). In addition to the PFRC navigators, UNC Oncology employs 31 tumor site-specific nurse navigators who work directly with its medical teams and focus on medical management.

The approach

In response to Covid-19, the PFRC’s nurse navigators virtualized their patient navigation program and created a process for proactively identifying the patients most at risk for facing barriers to care. They standardized the referral and navigation processes and set up a system for volunteers and other staff to conduct scheduled navigation appointments securely by video and phone.

The result

The virtual navigation program enabled the PFRC’s navigators to reach at-risk patients during the pandemic and provide tailored interventions to the patients with the greatest need. It also boosted volunteer navigator productivity and improved patient engagement with the navigation program. This success has led the cancer center to begin expanding the program to additional sites in the UNC system.

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Approach

How UNC Health virtualized cancer patient navigation during Covid-19 

Before the Covid-19 pandemic, the PFRC’s volunteer navigators typically assessed patients for barriers to care in the clinic on an ad-hoc basis while they waited for treatment appointments, but the navigators weren’t always utilized to their full capacity. When the pandemic hit, the PFRC quickly shifted its cancer patient navigation program to a virtual model in order to safely continue delivering volunteer navigation services to patients, which also provided the opportunity to address other inefficiencies in the program. To implement the model, the PFRC’s nurse navigators created new systems for obtaining patient referrals, assessing and triaging patients based on risk level, conducting virtual barrier assessments, and providing and documenting appropriate interventions.

 

The three components

The PFRC’s method for virtualizing cancer patient navigation included three main components.

  • Component

    Develop a system for identifying and triaging at-risk patients

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  • Component

    Standardize patient interaction and follow-up

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  • Component

    Prepare navigators to provide virtual navigation services

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Results

How we know it’s working

UNC Lineberger’s PFRC began implementing its virtual navigation program within two weeks of the start of the pandemic and spent about three months improving infrastructure, engagement, and adoption. Between March and October 2020, the program engaged 586 patients in 1,459 visits. The PFRC navigators provided a variety of patient interventions, ranging from education to social work referrals to oncology dietitian referrals.

The volunteer navigators reported that the virtual navigation model allowed them to form stronger relationships with their patients. In addition, patients in the model seemingly demonstrated improved readiness to receive education and participate in interventions, which could potentially lead to improved health outcomes. The volunteer navigators also reported increased productivity and greater satisfaction, as they were able to connect with a larger number of patients from the comfort of their homes.

Now that reports about each navigation visit are collected, the PFRC nurse navigators can analyze the data to better understand the unique needs of specific patient populations. Interestingly, they have found that although Spanish-speaking cancer patients have fewer risk factors than other patient populations, they require significantly more navigation visits and different types of interventions. The PFRC nurse navigators plan to look further into the drivers of these differences and to continue exploring how the needs of other patient populations differ from the larger cancer patient cohort.

Though some in-person navigation services have returned as Covid-19 prevalence has fallen, the PFRC is committed to maintaining the virtual navigation program due to the flexibility it offers for both patients and volunteers. It is already expanding the program to additional sites in the UNC system. Now, it is working on hiring more PFRC nurse navigators, attracting additional volunteers, and recruiting three full-time employees for a new patient navigator role that will perform similar tasks to the current part-time volunteer navigators.

In the future, the PFRC wants to do further research into the risk factors used to identify eligible patients, the cost-effectiveness of the program, EHR integration, and the program’s impact on patient outcomes. The virtual navigation model has been critical in addressing patients’ barriers to care during the pandemic and will be an important part of promoting positive care experiences and outcomes moving forward.

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