Navegação de pacientes em oncologia : investigação em um serviço no estado do Rio Grande do Sul.

Abstract

Introduction: Cancer patients, in addition to dealing with the disease and the adverse effects of treatment, often face barriers in accessing healthcare services, requiring them to coordinate their own care, balance situations, and make decisions. Patient navigation aims to coordinate the journey of these patients within the healthcare system, breaking down barriers, offering timely access to care, filling gaps in patient and family knowledge, and providing support in decision-making. Objective: To know the implementation process and operationalization of the patient navigation program in an oncology service in Rio Grande do Sul, Brazil. Article I: Patient navigation program as a promising tool in cancer treatment: an integrative literature review- Objective: to systematize the national and international scientific production on the benefits of the patient navigation program in oncology care. Methodology: An integrative literature review was carried out in the database LILACS, PubMed e Scopus, including studies that contained the descriptors "patient navigation" and "neoplasms", as well as their equivalents in English and Spanish, in the title, abstract, body of the text, or keywords. Original and review articles published between 2017 and 2022, available online and free of charge, in Portuguese, English, and Spanish were included in the study. Books, theses, dissertations, undergraduate course papers, and scientific event papers were excluded, as well as any study that addressed patient navigation with a different focus from that proposed in the research. The data collection process, analysis, and selection of articles were based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Data categorization was based on the thematic analysis technique, and the analysis and discussion of the data were based on Content Analysis. The results were divided into three thematic fields: clinical/assistance benefits of the navigation program, care coordination and protagonism, and costs and processes optimization in the healthcare institution. Results: Reduction in symptoms such as suffering and anxiety, depression severity, signs and symptoms arising from oncological treatment, and stress level and improvement in quality of life were identified. Improvement in punctuality in diagnostic exams; reduction in the time between medical diagnosis and treatment start; increased adherence and reduced treatment abandonment by the patient. The study evidenced effective health education practices, patient empowerment, coordination of appointments, surgeries, and exams, and the individual's ability to overcome sociocultural and financial barriers. The benefits for healthcare institutions included substantial reductions in resources and costs of care for navigated patients compared to non-navigated patients, as well as reduced hospitalization time and the number of appointments for emergency services. Conclusion: Different models and strategies for navigation programs have been developed and played a fundamental role in the cancer process, providing benefits for both patients and healthcare institutions. Article II: Patient navigation program in oncology: challenges and potentialities of the implementation and operationalization process - Objective: to know the implementation and operationalization process of the patient navigation program in an oncology service in Rio Grande do Sul (RS). Methodology: This is a qualitative, exploratory, and descriptive study conducted in a cancer treatment service linked to the supplementary health system, investigating the manager, healthcare professionals, nurse navigators, and patients involved in the navigation program. The inclusion and exclusion criteria were defined according to the subject segments being investigated. Data collection took place between December 2022 and February 2023 through semi-structured interviews. The interviews were conducted in a hybrid format, with some individuals participating in person and others virtually. In both formats, the interviews were recorded for later data transcription. After data collection, the interviews were fully transcribed into a digital file. Codenames were assigned, referring to each subject segment: Manager = M; Healthcare Professional = HP; Nurse Navigator = NN; Patient = P, followed by Arabic numerals as the interviews progressed, except for the manager segment, where there was only one interviewee, not requiring enumeration. The research findings were analyzed using the Content Analysis method and organized into two thematic categories: Implementation of the patient navigation program and Operationalization of the patient navigation program. Results: The implementation process of the patient program in the service involved a proposal based on epidemiological and care profile of the institution, requiring the relocation of a direct patient care professional to serve as a patient navigator. An institutional protocol was developed describing the program's standardizations. It was evident that the organizational vision of the healthcare system to which the service is linked understood the importance of the patient navigation care model. It was shown that demonstrating its relevance, gaining space, and establishing the best way to navigate patients were challenges encountered in the program's. In the operational process, patients began to be navigated from the beginning of the patient's treatment, where the diagnostic phase had already been completed. The operationalization of the patient navigation program considers the institutional and population characteristics, personalizing the care based on knowledge of the pathology, treatment, and patient. Care is provided individually through interaction with the multi professional team, assistance with administrative issues, or health education to address questions. Patients felt very satisfied and supported in their minimal demands, where questions that might seem trivial to others impact care for those who are ill. The potential benefit of patient-centered care leads to service improvement and resource optimization. Among the difficulties mentioned in the operationalization of the service were issues related to information systems, indicators, and prescription-related matters. Conclusion: There is no evidence of the best way to implement and operationalize a patient navigation program. Each institution has its own characteristics and peculiarities, and the population served has different needs. Therefore, knowledge about patient navigation programs is of utmost importance. However, each service needs to build a protocol based on the scientific literature corresponding to its reality to achieve the ultimate goal.