with NCI on an evaluation of these patient navigator programs.16 NCI’s Community Cancer Centers Pilot Program includes patient navigators as one facet of these new centers (NCI, undated).
Supporting Patients in Managing Their Illness
Illness self-management is defined as an individual’s “ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition” (Barlow et al., 2002:178). Effective approaches for providing this support are reviewed in Chapter 3. Given the diverse physical, psychological, and social challenges posed by cancer, its treatment, and its sequelae, providing patients and their caregivers with knowledge, skills, abilities, and support in managing the psychosocial and biomedical dimensions of their illness and health is critical to effective health care and health outcomes for these patients.
Coordinating Psychosocial and Biomedical Health Care
A 2007 systematic review of systematic reviews of the effectiveness of care coordination, conducted by the Agency for Healthcare Research and Quality (AHRQ) (McDonald et al., 2007), found more than 40 definitions of care coordination and related terminology and 20 different coordination interventions.17 The report provides the following working definition of care coordination:
Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for different aspects of care. (McDonald et al., 2007:v)
The AHRQ review found that the most common care coordination mechanisms addressed in the literature are multidisciplinary team care, case management, and disease management (the last of which is defined variably or not at all). The review found the strongest evidence for the effectiveness
16Personal communication, Nancy Single, PhD, ACS, September 11, 2006.
17Case management, collaborative care, disease management, geriatric assessment/evaluation and management, integrated programs, interprofessional education, key worker assigned coordination function, multidisciplinary clinic, multidisciplinary program (comprehensive), multidisciplinary teams, navigation program, nurse-doctor collaboration, organized specialty clinic, organized cooperation, shared care, specialist outreach clinic, assertive community treatment, team coordination, team coordination and delivery, and system-level interventions.