Barriers to and Facilitators of a Novel Preprofessional Patient Navigation Program in Surgery
Patients without adequate insurance often face barriers to surgical care, resulting in disparities in health outcomes. Patient navigation programs, often reliant on trained health professionals, have been successful in addressing these barriers in oncology, but few exist for patients with benign sur...
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| Vydáno v: | The Journal of surgical research Ročník 311; s. 54 - 63 |
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United States
Elsevier Inc
01.07.2025
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| ISSN: | 0022-4804, 1095-8673, 1095-8673 |
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| Abstract | Patients without adequate insurance often face barriers to surgical care, resulting in disparities in health outcomes. Patient navigation programs, often reliant on trained health professionals, have been successful in addressing these barriers in oncology, but few exist for patients with benign surgical disease. This study aims to identify the barriers to and facilitators of a novel surgical preprofessional patient navigation program for underinsured patients.
A semistructured qualitative interview study was performed from February 7, 2023, to November 2, 2023, at a single center using freelisting and open-ended responses. Preprofessional navigators included volunteer medical students, postbaccalaureate students, and research personnel. Navigators with an active or prior affiliation with the navigation program and who had navigated at least two patients, were selected using purposeful sampling. The primary outcomes were navigator perceptions of barriers to and facilitators of patient navigation and suggested interventions to improve the navigation experience. Interview responses were analyzed using salience indices and a modified grounded theory approach.
Among 22 navigators interviewed (14 women [63.6%], 14 medical students [63.6%]), the average navigation experience was 1.3 y. In freelisting and open-ended responses, participants reported barriers and facilitators related to patient, provider, administrative, and health system factors. Key barriers included language and cultural barriers, patient engagement, and limited workforce. Facilitators included organizational leadership support, standardized navigator operating procedures, and coordination within the health system. Participants suggested several interventions to improve patient navigation, including patient support groups, language support, integration of social support services, and establishment of shadowing opportunities during the navigator onboarding process.
Preprofessional navigators can expand the workforce and provide critical experiences with underinsured populations for future health professionals. Surgical patient navigation was impacted by four disparity domains including patient, provider, administrative, and health system factors. Standardized procedures for navigators and the complexity of the insurance application impact the success of navigation toward surgical health equity. Broad institutional, state, and national support for patient navigation may be associated with increase reductions in disparities for marginalized patient populations.
•Preprofessional navigator experiences are similar to those of professionals.•Standardized leadership and protocols are strong facilitators of navigation.•Language and culture function as both a barrier and facilitator of navigation.•Complexity of insurance securement processes hindered successful patient navigation. |
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| AbstractList | Patients without adequate insurance often face barriers to surgical care, resulting in disparities in health outcomes. Patient navigation programs, often reliant on trained health professionals, have been successful in addressing these barriers in oncology, but few exist for patients with benign surgical disease. This study aims to identify the barriers to and facilitators of a novel surgical preprofessional patient navigation program for underinsured patients.
A semistructured qualitative interview study was performed from February 7, 2023, to November 2, 2023, at a single center using freelisting and open-ended responses. Preprofessional navigators included volunteer medical students, postbaccalaureate students, and research personnel. Navigators with an active or prior affiliation with the navigation program and who had navigated at least two patients, were selected using purposeful sampling. The primary outcomes were navigator perceptions of barriers to and facilitators of patient navigation and suggested interventions to improve the navigation experience. Interview responses were analyzed using salience indices and a modified grounded theory approach.
Among 22 navigators interviewed (14 women [63.6%], 14 medical students [63.6%]), the average navigation experience was 1.3 y. In freelisting and open-ended responses, participants reported barriers and facilitators related to patient, provider, administrative, and health system factors. Key barriers included language and cultural barriers, patient engagement, and limited workforce. Facilitators included organizational leadership support, standardized navigator operating procedures, and coordination within the health system. Participants suggested several interventions to improve patient navigation, including patient support groups, language support, integration of social support services, and establishment of shadowing opportunities during the navigator onboarding process.
Preprofessional navigators can expand the workforce and provide critical experiences with underinsured populations for future health professionals. Surgical patient navigation was impacted by four disparity domains including patient, provider, administrative, and health system factors. Standardized procedures for navigators and the complexity of the insurance application impact the success of navigation toward surgical health equity. Broad institutional, state, and national support for patient navigation may be associated with increase reductions in disparities for marginalized patient populations.
•Preprofessional navigator experiences are similar to those of professionals.•Standardized leadership and protocols are strong facilitators of navigation.•Language and culture function as both a barrier and facilitator of navigation.•Complexity of insurance securement processes hindered successful patient navigation. Patients without adequate insurance often face barriers to surgical care, resulting in disparities in health outcomes. Patient navigation programs, often reliant on trained health professionals, have been successful in addressing these barriers in oncology, but few exist for patients with benign surgical disease. This study aims to identify the barriers to and facilitators of a novel surgical preprofessional patient navigation program for underinsured patients. A semistructured qualitative interview study was performed from February 7, 2023, to November 2, 2023, at a single center using freelisting and open-ended responses. Preprofessional navigators included volunteer medical students, postbaccalaureate students, and research personnel. Navigators with an active or prior affiliation with the navigation program and who had navigated at least two patients, were selected using purposeful sampling. The primary outcomes were navigator perceptions of barriers to and facilitators of patient navigation and suggested interventions to improve the navigation experience. Interview responses were analyzed using salience indices and a modified grounded theory approach. Among 22 navigators interviewed (14 women [63.6%], 14 medical students [63.6%]), the average navigation experience was 1.3 y. In freelisting and open-ended responses, participants reported barriers and facilitators related to patient, provider, administrative, and health system factors. Key barriers included language and cultural barriers, patient engagement, and limited workforce. Facilitators included organizational leadership support, standardized navigator operating procedures, and coordination within the health system. Participants suggested several interventions to improve patient navigation, including patient support groups, language support, integration of social support services, and establishment of shadowing opportunities during the navigator onboarding process. Preprofessional navigators can expand the workforce and provide critical experiences with underinsured populations for future health professionals. Surgical patient navigation was impacted by four disparity domains including patient, provider, administrative, and health system factors. Standardized procedures for navigators and the complexity of the insurance application impact the success of navigation toward surgical health equity. Broad institutional, state, and national support for patient navigation may be associated with increase reductions in disparities for marginalized patient populations. Patients without adequate insurance often face barriers to surgical care, resulting in disparities in health outcomes. Patient navigation programs, often reliant on trained health professionals, have been successful in addressing these barriers in oncology, but few exist for patients with benign surgical disease. This study aims to identify the barriers to and facilitators of a novel surgical preprofessional patient navigation program for underinsured patients.INTRODUCTIONPatients without adequate insurance often face barriers to surgical care, resulting in disparities in health outcomes. Patient navigation programs, often reliant on trained health professionals, have been successful in addressing these barriers in oncology, but few exist for patients with benign surgical disease. This study aims to identify the barriers to and facilitators of a novel surgical preprofessional patient navigation program for underinsured patients.A semistructured qualitative interview study was performed from February 7, 2023, to November 2, 2023, at a single center using freelisting and open-ended responses. Preprofessional navigators included volunteer medical students, postbaccalaureate students, and research personnel. Navigators with an active or prior affiliation with the navigation program and who had navigated at least two patients, were selected using purposeful sampling. The primary outcomes were navigator perceptions of barriers to and facilitators of patient navigation and suggested interventions to improve the navigation experience. Interview responses were analyzed using salience indices and a modified grounded theory approach.METHODSA semistructured qualitative interview study was performed from February 7, 2023, to November 2, 2023, at a single center using freelisting and open-ended responses. Preprofessional navigators included volunteer medical students, postbaccalaureate students, and research personnel. Navigators with an active or prior affiliation with the navigation program and who had navigated at least two patients, were selected using purposeful sampling. The primary outcomes were navigator perceptions of barriers to and facilitators of patient navigation and suggested interventions to improve the navigation experience. Interview responses were analyzed using salience indices and a modified grounded theory approach.Among 22 navigators interviewed (14 women [63.6%], 14 medical students [63.6%]), the average navigation experience was 1.3 y. In freelisting and open-ended responses, participants reported barriers and facilitators related to patient, provider, administrative, and health system factors. Key barriers included language and cultural barriers, patient engagement, and limited workforce. Facilitators included organizational leadership support, standardized navigator operating procedures, and coordination within the health system. Participants suggested several interventions to improve patient navigation, including patient support groups, language support, integration of social support services, and establishment of shadowing opportunities during the navigator onboarding process.RESULTSAmong 22 navigators interviewed (14 women [63.6%], 14 medical students [63.6%]), the average navigation experience was 1.3 y. In freelisting and open-ended responses, participants reported barriers and facilitators related to patient, provider, administrative, and health system factors. Key barriers included language and cultural barriers, patient engagement, and limited workforce. Facilitators included organizational leadership support, standardized navigator operating procedures, and coordination within the health system. Participants suggested several interventions to improve patient navigation, including patient support groups, language support, integration of social support services, and establishment of shadowing opportunities during the navigator onboarding process.Preprofessional navigators can expand the workforce and provide critical experiences with underinsured populations for future health professionals. Surgical patient navigation was impacted by four disparity domains including patient, provider, administrative, and health system factors. Standardized procedures for navigators and the complexity of the insurance application impact the success of navigation toward surgical health equity. Broad institutional, state, and national support for patient navigation may be associated with increase reductions in disparities for marginalized patient populations.CONCLUSIONSPreprofessional navigators can expand the workforce and provide critical experiences with underinsured populations for future health professionals. Surgical patient navigation was impacted by four disparity domains including patient, provider, administrative, and health system factors. Standardized procedures for navigators and the complexity of the insurance application impact the success of navigation toward surgical health equity. Broad institutional, state, and national support for patient navigation may be associated with increase reductions in disparities for marginalized patient populations. |
| Author | Kelz, Rachel R. Keddem, Shimrit Schapira, Marilyn M. Morris, Jon B. Morales, Carrie Goldshore, Mathew Bakillah, Emna Chen, Angela T. Moneme, Adora N. Syvyk, Solomiya |
| Author_xml | – sequence: 1 givenname: Adora N. orcidid: 0000-0002-3426-0842 surname: Moneme fullname: Moneme, Adora N. organization: Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 2 givenname: Solomiya surname: Syvyk fullname: Syvyk, Solomiya organization: Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 3 givenname: Emna surname: Bakillah fullname: Bakillah, Emna organization: Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 4 givenname: Shimrit surname: Keddem fullname: Keddem, Shimrit organization: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 5 givenname: Marilyn M. surname: Schapira fullname: Schapira, Marilyn M. organization: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 6 givenname: Angela T. surname: Chen fullname: Chen, Angela T. organization: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 7 givenname: Carrie surname: Morales fullname: Morales, Carrie organization: Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 8 givenname: Mathew surname: Goldshore fullname: Goldshore, Mathew organization: Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 9 givenname: Jon B. surname: Morris fullname: Morris, Jon B. organization: Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 10 givenname: Rachel R. surname: Kelz fullname: Kelz, Rachel R. email: rachel.kelz@pennmedicine.upenn.edu organization: Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania |
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| Keywords | Preprofessional students Surgical health disparities Freelisting Patient navigation Underinsured |
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| SubjectTerms | Adult Attitude of Health Personnel Female Freelisting Health Services Accessibility - organization & administration Health Services Accessibility - statistics & numerical data Healthcare Disparities - statistics & numerical data Humans Interviews as Topic Male Middle Aged Patient navigation Patient Navigation - organization & administration Patient Navigation - statistics & numerical data Preprofessional students Qualitative Research Students, Medical - statistics & numerical data Surgical health disparities Surgical Procedures, Operative Underinsured |
| Title | Barriers to and Facilitators of a Novel Preprofessional Patient Navigation Program in Surgery |
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