The CATCH: In Support of Overcoming Barriers to Care

This article is supported by funding from AstraZeneca.

Kaamela Davis, RN, GI Nurse Navigator With Orlando Health

Kaamela has done an excellent job navigating this patient’s barriers along with communication to other healthcare facilities and family members.

—Zilipah Cruz, MSN-RN
Senior Director for Oncology Navigation, Survivorship, and Community Outreach
Orlando Health Cancer Institute

A CATCH is a navigation success story where a navigation tactic improved a patient’s situation. The CATCH Initiative, short for Catching & Addressing Threats to Care & Health, tracks and acknowledges positive outcomes of navigation tactics.

THE CATCH OF THE MONTH

Background: Oncology patient with multiple comorbidities and psychosocial challenges needing navigation services to remove barriers to care.

The Incident: Patient with hepatocellular carcinoma presented to clinic with numerous comorbidities, including cognitive decline and aggressive behavior with Alzheimer’s. Patient living in an unstable family setting with care coordination, healthcare proxy, housing, transportation, psychosocial, and pain management needs currently unmet.

The CATCH (Intervention): Due to the patient’s unstable living arrangement, lack of resources, and mental capacity, he was unable to make his appointments for cancer care, thus affecting his overall plan of care (eg, cancer treatment, pain management, and nutritional needs). The navigator also noticed the patient was not able to make decisions for himself regarding treatment and lacked a healthcare proxy to assist with this. Recognizing the complexity and severity of barriers the patient and family faced, the navigator utilized her care coordination skills to address these challenges. The navigator was able to coordinate care with the multidisciplinary team, including case management and all healthcare providers involved in the patient’s care. The navigator also educated the patient’s spouse on a healthcare proxy and the importance of having this in place due to the patient’s diminished mental capacity and urgency of treatment decisions needing to be made.

Outcome: Once to the navigator coordinated care with multiple entities, she was able to successfully remove barriers so the patient could begin cancer treatment while also addressing the emotional needs of the patient’s family. Because of the navigator’s intervention, the patient has been able to attend all needed appointments for radiation, scans, nutrition, medical oncology, and pain management.

The Importance of the CATCH

Due to the physical and mental behavior displayed by the patient and the lack of a healthcare proxy, there were many challenges with coordinating care and trying to avoid delaying needed treatment. The navigator was determined to have the patient seen for oncology care and assist with other barriers.

Because the navigator was able to coordinate care for all appointments, the patient has attended all required appointments, has been compliant with his care, is residing in a stable living environment, and has reliable transportation. Since seeing a pain management provider and following up with his primary care provider, the patient has displayed less aggresive behavior.

This CATCH demonstrates the perseverance navigators need in complex situations and the importance of relying on their navigation skillset and instincts to address the multitude of barriers patients face from all dimensions of care (eg., physical, mental, psychosocial, and emotional).

Source

• Bellomo C, Christensen D, Strusowski T. Seasoned navigator: a case study on patient advocacy/patient empowerment. Journal of Oncology Navigation & Survivorship. 2016;7(8):31-32.

Tell us about the navigation tactics that improve the lives of your patients!