Coaching-Based Lay Navigation Improves Patient Activation Among Recently Diagnosed Cancer Patients with a High-Need Cancer

Background: The American Cancer Society (ACS) recently completed a quality improvement program pilot designed to test the feasibility and effectiveness of coaching-based navigation among ACS lay navigators; 6 sites were selected for the pilot.

Objectives: The goal of the pilot was to show effectiveness across diverse sites with diverse patient populations. This abstract focuses on one of those sites with a high patient volume and high-need population.

Methods: Navigators were trained in coaching, the Patient Activation Measure (PAM), and a 7-part module series applying coaching techniques to common lay navigation situations. Following training, navigators implemented the new coaching-based navigation model with new patients for 12 months and attempted to have 2 follow-up visits with each patient over an additional 6 months. The total pilot period was 18 months. PAM was administered at the first and final visits. The site discussed is a safety net hospital in a metropolitan area of the United States. One ACS navigator is located at the site and serves approximately 650 patients per year.

Results: The navigator saw 657 patients during the enrollment period of the pilot; 305 patients were enrolled in the program pilot, completed the initial PAM assessment, and created an action plan with the navigator. Patients not enrolled were patients who the navigator was not able to have an initial coaching visit with. This rate of 46% enrolled was consistent with the pilot average of 44% of patients enrolled. Of the 305 patients enrolled in the pilot, 88% were minority, with 54% being Hispanic/Latino, and 90% were on Medicaid or uninsured. No patients enrolled at this site had private insurance. All 305 patients completed an action plan with the navigator. Patients had a baseline PAM score of 53.0. Patients were most commonly working with the navigator on transportation barriers (59%), financial barriers (55%), and social support barriers (50%). Patients could work on up to 5 barriers with the navigator. The average barrier per patient at this site was 2.3. Over the course of the pilot, 94% of patients had at least 1 follow-up visit with the navigator, with patients making progress or achieving 77% of actions set in the initial visit. Sixty-eight percent of patients completed the full program during the pilot period (all-site average, 50%). Patients completing the program overcame 87% of barriers identified in earlier coaching sessions. The final average PAM score was 54.9. Patients with an initial level 1 PAM score, indicating the lowest patient activation level, saw the most dramatic increase in PAM score, an average of 4.41 points.

Conclusions: Coaching-based lay navigation is achievable and effective in a high-volume, high-need cancer center. Patient activation improved, and patients were able to overcome nonmedical barriers, ultimately making it easier for patients to maintain their treatment schedule.

Note: This program pilot was sponsored in part by the Merck Foundation (grant award).