Many hospitals face the problem of cancer patients not keeping their appointments for treatment. In a system where it's often easier to lose track of patients than to find ways to keep them, one hospital has attempted to reverse the trend.
The Cancer Navigator program at 236-bed Alameda County Medical
Center-Highland Campus in Oakland, Calif., was launched in 1993 after hospital staff noted that many patients were not complying with prescribed treatment programs and nobody was monitoring their care.
The successful program has been named the Marriott Service Excellence Award winner for Patient Service.
"Everyone focuses on internal treatment and support, but there was no one to go out and get the patients to come back," said James H. Devitt, associate hospital administrator. "We applied for a grant from the American Cancer Society because we thought this program would work, and our local chapter gave us $48,162 in 1993."
Under the program, a "navigator" monitors all the cancer cases diagnosed or referred to the hospital. The navigator doesn't provide care directly but helps identify potentially noncomplying cancer patients and aids in removing stumbling blocks to their care. Problems can range from babysitters not showing up to lack of education about the disease to cultural hindrances.
"I make an effort to call patients the day before their scheduled treatment to see if they are coming, and if they have any problems, like transportation," said Wendy Favilacq, a cancer navigator and patient coordinator who runs the program. "Sometimes I may even have to hand-hold them through the day, getting them registered, etc."
A former psychiatric emergency unit supervisor, vocational nurse and a lifelong area resident, Favila has held the navigator's position since the program's inception.
With the help of physicians and patient charts, she identifies patients who may not seek treatment. Later, she attempts to contact them by phone or through a personal visit.
"I go out on personal visits about three to four times a week. There is no set limit to how many times I will try to contact a person," she said. "But if a patient tells me that they are really not interested in treatment and they are mentally stable, I will contact them every three months for a year to see how they are and if they need any of the resources I can offer them. Then, once a year, I'll call them.
"We get mostly high-risk patients, some suffering a dual diagnosis, such as mental illness, drug or alcohol problems," she said. "They clearly need treatment but don't keep appointments."
She also keeps track of patients in remission.
Favila relies on volunteers, private donations and grants to run the navigator program and its support groups. She also runs a small food bank.
Favila's annual budget for the program is $50,000 a year. The hospital picks up remaining costs, or she raises the funds herself.
Devitt emphasizes the importance of the program in helping to fulfill the hospital's mission.
A new facet of the program, funded by a $25,000, one-year grant from the Susan G. Komen Breast Cancer Foundation, is the addition of a part-time navigator to focus only on breast cancer patients. Navigator Angela Lewis follows approximately 47 patients throughout treatment and helps them cope with the physical changes after mastectomy.
The breast cancer program ends
Dec. 31. Whether it will be renewed at the Highland campus is uncertain. But Favila hopes navigator programs are adopted by other public hospitals.
"Above all else, navigators provide patients with options, information and the knowledge that the healthcare system cares," Favila said.