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- Title
Spanning Boundaries: System Dynamics, Externalities, and Patient Navigation.
- Authors
Louis, Christopher; Clark, Jonathan; Holmes, Katelyn; Aumiller, Betsy; Lengerich, Eugene J.
- Abstract
Background: Patient navigation (PN) has emerged as a possible strategy to bridge gaps, overcome barriers, reduce delays, and improve outcomes across the cancer care continuum. However, we lack an explicit theoretical lens through which to view the emergence of patient navigators and the resulting roles they play. Purpose: To view PN through the lens of systems theory and the related theoretical themes of boundary spanning and social networks, and, drawing on these perspectives, to evaluate their usefulness for explaining observed patterns of behavior and to present a framework for understanding PN. Methodology/Approach: Nonprobability discriminative snowball sampling was used to identify 29 key informants in 6 contiguous Appalachian states. Our final sample consisted of 3 groups of informants: health system informants, community-based organization informants, and university-affiliated informants. We used directed content analysis to examine the extent to which patient navigator roles reflect the use of boundary spanning and social networking. Findings: Each group of informants discussed similar themes and characteristics with relative frequency. Patient navigators were found to be spanning boundaries and using their social networks to overcome negative externalities resulting from a variety of sources. We elaborate on these findings in our theoretical framework. Practice Implications: Our findings suggest that cancer patient navigators should build and use their social networks to span boundaries and overcome the negative externalities in the system. Our framework suggests that the need for these capabilities among navigators derives from 4 primary sources–the nature of patient problems, external influences, organizational boundaries, and individual behavior–and how they interact. Addressing the negative externalities associated with these issues reflects an ability to understand and respond to both macro- and micro level issues across the cancer care continuum. These findings provide insights both for managers attempting to address underlying health system issues and for patient navigators who desire to be more effective.
- Subjects
PENNSYLVANIA; ACADEMIC medical centers; CANCER patients; CAREGIVERS; HEALTH services accessibility; SOCIAL networks; STATISTICS; T-test (Statistics)
- Publication
Journal of Oncology Navigation & Survivorship, 2013, Vol 4, Issue 3, p13
- ISSN
2166-0999
- Publication type
Article