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Patient-oriented navigation in stroke and lung cancer patients: Results on feasibility and efficacy of two randomized
Kathrin Gödde1, Alice Schneider2, Raphael Kohl3
1Institute of Public Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
Objective:
Fragmentation within the healthcare system is a challenge to continuous care provision internationally. Patients with age-associated and chronic diseases with complex care requirements often face barriers to managing their care. Patient navigation interventions aim to support patients with their individual care coordination needs. Here, we investigate the feasibility and efficacy of a patient-oriented navigation program for stroke and lung cancer patients.
Methods:
Results of two randomized controlled trials that were part of a mixed methods study, are reported. 170 stroke patients and 64 lung cancer patients were randomized. The intervention group received the personal navigation for one year. The control group received a brochure with regional support offers. Two primary feasibility criteria were analyzed: uptake of initial navigation meetings (>70%) and drop-out of intervention (<40%). Further, we investigated the program's efficacy regarding satisfaction and trust with medical care.
Results:
Both primary feasibility criteria were met as 96.9% (95%CI: 90.8%-100.0%) of lung cancer patients and 86.9% (95%CI: 79.9%-94.1%) of stroke patients of the intervention group received a first navigation meeting and only 10.5% (95%CI: 0%-24.3%) of lung cancer patients and 8.6% (7 of 81 patients, 95%CI: 2.5%-14.8%) of stroke patients dropped out of the study. Overall, no significantly higher satisfaction levels with medical care were detected for the intervention group with control group as reference (lung cancer: OR (95%CI): 1.40 (0.44-4.46); stroke: OR (95%CI): 1.16 (0.64-2.11), values > 1 indicate higher satisfaction in intervention group). In exploratory subgroup analyses, stroke patients without partner in the intervention group reported higher levels of trust with medical care compared to controls (OR (95%CI): 3.53 (1.14-10.09)).
Conclusion:
Our findings suggest feasibility of a patient-oriented navigation program focused on care coordination and support with social care questions regarding its uptake.
Practice Implications:
Identifying patient subgroups with higher navigational need should be focussed on for efficient program implementation.
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