Welcome back to Navigation Refresh, a recurring, informative feature for novice and seasoned patient navigators alike. In this issue, we cover the role of cultural humility in patient navigation.
Cultural humility means reflecting on one’s own assumptions and biases while recognizing, respecting, and integrating the cultural beliefs, values, practices, and needs of patients and families from diverse backgrounds when planning and implementing cancer treatment and supportive care interventions. People of different lived experiences hold different beliefs and values about what illness, health, and wellness mean in the context of cancer care. Knowing that their healthcare team cares about and respects these beliefs and values is foundational to patient–provider trust.
Cultural concordance has long been a value of community health work, meaning that community health workers were traditionally valued members that were embedded within a community.1 Cultural competency is one of the pillars in the overarching framework2 that served as a foundation for oncology patient navigator core competencies.3 While historically referred to as “cultural competency,” “competency” implies the achievement of something, whereas “humility” infers the practice of recognizing, respecting, and integrating diverse cultural beliefs with ongoing learning.4 Integrating a patient and family’s culture into communication and resource referral optimizes retention of information and alignment of services to actual needs. In addition, supporting Culturally and Linguistically Appropriate Services is core to the navigation role.5
Discriminatory practices in the delivery of past research and healthcare, lack of healthcare clinicians who are concordant with the populations being cared for, and suboptimal healthcare due to lack of comprehensive insurance and lack of needed resources have led to earned mistrust of the medical establishment by people in many communities, including African American, American Indian/Alaskan Native, and Asian/Pacific Islander communities across the United States.6 Medical mistrust has contributed to underutilization of cancer screening, less adherence to treatment plans, lack of representation in clinical trials, and more dissatisfaction with care among racial and ethnic minorities.7
Recognizing and integrating a patient’s cultural beliefs and needs into treatment planning and support can enhance patient and family trust.8,9 In the words of oncology patient navigators, we found that there were 11 ways that navigators provide culturally responsive care: assessing patient needs, tailoring care, building rapport, facilitating communication, providing resources, advocating, ongoing learning, addressing barriers to care, involving family to support patient needs, educating the healthcare team, and supporting patient empowerment.10
Cultural humility arises with lifelong learning about the cultures of people with different lived experiences from our own. One resource that specifically aims to broadly help navigators in a healthcare context is The Cross Cultural Health Care Program’s Connecting to Care: Cultural Navigator Training.11 Other resources include community panels and speakers from specific communities.4
Spanish is the second most spoken language in the United States. The GW Cancer Center’s Oncology Patient Navigation Training: The Fundamentals12 has been used for several years by Navegación de Pacientes Internacional to provide in-person training to South American patient navigators in Spanish. Working with Navegación de Pacientes Internacional and Nuestras Voces Adelante, the GW Cancer Center Technical Assistance Program team is excited and proud to release the fully Spanish language version of our online Capacitación para los Navegadores de pacientes oncológicos: Los conceptos fundamentales, accessible via https://bit.ly/PN-SPAN and the QR code to the left.
This edition of Navigation Refresh aligns with Standard 4: Cultural and Linguistic Humility of the Professional Oncology Navigation Task Force (PONT).6
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