Background: Kenyatta National Hospital (KNH) is the only public hospital in Kenya delivering comprehensive cancer care and receives patients from throughout the country. A strong body of evidence has established that patient support programs increase patients’ follow-up and adherence to cancer treatment. In 2015, KNH partnered with the American Cancer Society (ACS) to assess patient barriers to cancer care. The results of this study informed the design of a patient navigation program to address many of these barriers.
Objectives: KNH and ACS codesigned a navigation program to address identified barriers to cancer care by ensuring patients diagnosed with cancer are well informed, have timely access to quality cancer treatment, and can achieve improved treatment adherence/completion rates.
Methods: Following the patient needs assessment, a team of KNH staff and navigation champions consulted with KNH management and cancer treatment specialists to develop a cancer care committee consisting of representatives from various hospital departments. The committee gained broad buy-in and institutional ownership as well as defined the scope and design of the navigation program within the KNH setting. The team then developed key program components, including a resource directory, care coordination protocols, standard operating procedures, patient education materials, hospital maps/signage, a navigator training program, a data/performance measurement system, and public awareness/education materials. In addition, they outfitted the program’s physical space with needed furniture and equipment, redesigned patient flow around the navigator encounter, and planned ongoing monitoring and evaluation activities.
Results: A patient navigation program was designed, launched in June 2017, and implemented for over a year. The program includes 3 types of navigation to address barriers identified in the patient needs assessment: (1) Physical: Guide patients to service points within KNH while ensuring their safety/security; (2) Clinical: Assess patient/caregiver needs, answer questions, and provide tailored information on their diagnosis, treatment plan, and potential treatment side effects; and (3) Lay: Work with clinical navigators to provide patients with resources and assistance to address logistical, cultural, structural, financial, communication, spiritual, and psychological barriers.
Navigators were hired and participated in a 5-day training led by ACS staff. The training included simulations in which navigators role-played the patient and navigator experience. In its first year (June 2017-July 2018), 2850 patients were navigated. Given the volume of patients at KNH, many barriers to care remain, but patients affirm that they are better informed and feel supported by the program. The team faced numerous challenges, including managing change within the hospital system, but have learned many key lessons and have succeeded in building navigation into the hospital strategic plan.
Conclusions: This program relied on assessment data to identify barriers to care, build the case for navigation, and gain broad buy-in and support from both hospital management and healthcare providers. The development of detailed procedures and data collection/tracking systems to ensure efficient program delivery, coordination with other departments, timely patient follow-up, and outcome measurement were key to success. Ongoing management of the change process throughout the hospital system has been instrumental for early program acceptance and to identify additional program improvements.
Sources
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Cazap E, Magrath I, Kingham TP, Elzawawy A. Structural barriers to diagnosis and treatment of cancer in low- and middle-income countries: the urgent need for scaling up. J Clin Oncol. 2016;34:14-19.
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