Standardized Role Implementation Effect on Patient Referrals for Psychosocial Support

Background: Cancer care involves a multitude of healthcare professionals and treatment modalities. This can be overwhelming for patients.¹ Addressing psychosocial barriers that interfere with the continuum of care can positively affect patient compliance.¹ In the early 1990s, navigation services were established to provide added support and resources for patients and their caregivers.² However, patient experiences and outcomes differed greatly due to lack of standardization.³

Objectives: Compare and contrast resource referrals for psychosocial support in relation to distress assessments pre- and poststandardization of the navigation role. Utilize results to evaluate if role standardization influenced referrals provided.

Methods: Distress assessment referrals from January 2016 through May 2019 were tracked and monitored from ad hoc reports from the standardized navigation tool and translated into Excel format. Standardization of navigation role was implemented December 2017. Overall volume, referrals provided, and documentation was tracked.

Results: Twenty-three months were included as preimplementation, and 18 months were postimplementation. A total of 804 overall distress assessments were reviewed. Prior to standardized role implementation, a total of 419 assessments recommended referrals; from those, 244 (58.2%) referrals for psychosocial support were provided. Referrals included American Cancer Society (39.4%), support groups (36.2%), psychological practitioner referrals (4.1%), social work support services (15.7%), and miscellaneous referrals (5.1%). Poststandardization, a total of 384 assessments required referrals; from those, 308 (80.2%) referrals for psychosocial support were provided; they included American Cancer Society (35.5%), support groups (31.1%), psychological practitioner referrals (15.8%), social work support services (14.5%), and miscellaneous referrals (3.0%). Variances noted when documentation was provided outside of the distress assessment tool within the software and not included on the ad hoc report.

Conclusion: The findings revealed a 20% increase of psychosocial support referrals after the implementation of standardized navigation role. Simple conclusions show a positive effect on patient referrals for psychosocial support directly related to standardizing the navigator role as no other structurally significant changes were made.

References

1. Grassi L, Spiegel D, Riba M. Advancing psychosocial care in cancer patients. F1000Res. 2017;6:2083.
2. Freeman HP. The origin, evolution, and principles of patient navigation. Am Assoc Cancer Res. 2012;21:1614-1617.
3. Strusowski T, Sein E, Johnston D, et al. Standardized evidence-based oncology navigation metrics for all models: a powerful tool in assessing the value and impact of navigation programs. Journal of Oncology Navigation & Survivorship. 2017;8(5):220-237.