LBA Category VII: Operations Management, Organizational Development, Health Economics

October 2022 Vol 13, No 10 —November 8, 2022
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E1 Development of a Navigation Program for a High Complexity Center in Oncology in Brazil


Fernanda Felipe Pautasso1-4; Cecília Dias Flores4; Rita Catalina Aquino Caregnato4

1Universidade Federal do Rio Grande do Sul; 2Irmandade Santa casa de Misericórdia de Porto Alegre; 3Universidad del Paciente y La Família; 4Universidade Federal de Ciências da Saúde de Porto Alegre

Background: Patient navigation is a process that involves a series of actions to reach a certain outcome, performed by an individual called a patient navigator. The navigation program consists of formatting this process to meet the needs of patients assisted in a particular health service. In Brazil, these programs are not common. However, given the fragmentation of our health system, navigation becomes an effective strategy to promote the population’s access to health services.

Objectives: To develop a navigation program for cancer patients, adapted to the reality of a high complexity center in oncology (CACON), located in Rio Grande do Sul.

Methods: Convergent care research for the development of a care process of patient navigation, based on the model proposed by the GW Cancer Institute at George Washington University, adapted to the Brazilian reality of the outpatient clinic of the hospital in focus. The elaboration followed the program development cycle, adapted to reality, following 4 stages: (1) diagnosis, (2) planning, (3) deployment, and (4) assessment.

Results: The diagnosis identified 7310 patients attended, 56.30% female; 43% aged 61 to 75 years; 61.46% from Porto Alegre and the metropolitan region. The specialties with the highest volume of consultations were clinical oncology with 45.17%, breast surgery 11.68%, and head and neck surgery 9.73%. The target population chosen was head and neck cancer patients because of the many demands and needs they present. Planning and implementation stages took place simultaneously and, based on a navigation pilot, the basic formatting of the program and its processes, the profiles of the navigators, and the training for their qualification were designed. The first steps were evaluated through the Plan-Do-Study-Act cycle adapted by the researcher. Each was analyzed in terms of meeting the objectives and obtaining the expected results. All achieved the established goals.

Conclusion: The research allowed the development of a navigation program, adapted to the reality of Brazilian cancer care, and adapted to the needs of patients and the functioning of the service, which was developed and structured for the profile of CACON. The implementation of these programs in the country’s cancer care scenario, the performance of the actors in this process, especially the navigator nurse, in the Brazilian context, will bring about important changes in the care context.


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E2 Validation of a Navigation Needs Assessment Instrument for Patient Navigation Programs in Brazil


Fernanda Felipe Pautasso1-4; Cecília Dias Flores4; Rita Catalina Aquino Caregnato4

1Universidade Federal do Rio Grande do Sul; 2Irmandade Santa casa de Misericórdia de Porto Alegre; 3Universidad del Paciente y La Família; 4Universidade Federal de Ciências da Saúde de Porto Alegre

Background: Patient navigation is a process in which an individual guides people diagnosed with or suspected of having cancer, helping them to “navigate” through the health system and services. It is an approach widely promoted in developed countries to increase the likelihood of patients’ effective adherence to the recommended treatment, reducing socioeconomic, racial, and ethnic barriers to care. In international programs, all patients are included; however, to optimize the resources and navigators available to carry out an effective process in this country, there was a need for an instrument that allows the evaluation of patients who should be included in the navigation program.

Objectives: To develop and validate an instrument to assess the patient’s needs to be included in navigation programs in the health scenario of countries such as Brazil.

Methods: Methodological study with the development and validation of an instrument that assesses the patient’s need to be included in a navigation program. The Delphi technique was used for validation. Selected to participate in the panel were 21 experts with knowledge and technical experience in oncology. The minimum consensus index of 80% was stipulated as a cutoff point.

Results: The Navigation Needs Assessment Scale (EANN) was developed from the implementation of a navigation pilot in a high complexity center in oncology, since patients have different needs for guidance and follow-up and diverse socioeconomic and cultural profiles. EANN validation took place in 2 rounds; in round 1, 21 experts were invited; 17 participated in this stage, and a general consensus of 74.23% was obtained. Several contributions on each of the questions were carefully considered and evaluated. Relevant modifications arising from these considerations were made, and a new version of EANN was created. In round 2, 12 experts participated, reaching a consensus of 96.42%. The statements that were evaluated as relevant and that did not require changes in the structure of the scale were judged and incorporated into the guidelines for application of the instrument, whose final version was validated.

Conclusion: EANN was developed and validated to establish which patients present a real need for admission to patient navigation and what support is recommended based on cognitive, psychosocial, and cultural categories and criteria. This enabled the nurse navigator to effectively assess the need presented by each patient directed to the navigation program.


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Last modified: August 10, 2023

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