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      Health care stakeholder perspectives regarding the role of a patient navigator during transition to adult care

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          Abstract

          Background

          Transition to adult care represents a vulnerable period for young people with special health care needs as they navigate multiple life transitions and developmental issues. Patient navigators are a promising intervention designed to facilitate the transfer from pediatric to adult care. However, consistent definitions, key tasks, roles and responsibilities are lacking in guiding the scope of practice and the implementation of patient navigators.

          Methods

          Fundamental qualitative description was utilized in this study to identify perceptions from health care providers about implementing a patient navigator service for young people with special health care needs in transition to adult care. A purposive sample of health care providers with a variety of backgrounds within pediatric and adult systems in Alberta, Canada were recruited. Semi-structured interviews with participants were analyzed using thematic analysis to inductively identify perceptions regarding the role of patient navigators.

          Results

          A total of 43 health care providers highlighted the need for a patient navigator service to encompass 4 key stages for young people with special health care needs transitioning from pediatric to adult services: (1) identification of young people with special health care needs and families requiring support, (2) preparation for transfer, (3) health system navigation and, (4) post-transfer support.

          Conclusions

          The results of this qualitative study provide guidance for the development of patient navigator interventions for young people with special health care needs, as well as provide support for current transition services offered across Canada.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-019-4227-6) contains supplementary material, which is available to authorized users.

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          Most cited references42

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          Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine.

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            Patient navigation: state of the art or is it science?

            First implemented in 1990, patient navigation interventions are emerging today as an approach to reduce cancer disparities. However, there is lack of consensus about how patient navigation is defined, what patient navigators do, and what their qualifications should be. Little is known about the efficacy and cost-effectiveness of patient navigation. For this review, the authors conducted a qualitative synthesis of published literature on cancer patient navigation. By using the keywords 'navigator' or 'navigation' and 'cancer,' 45 articles were identified in the PubMed database and from reference searches that were published or in press through October 2007. Sixteen studies provided data on the efficacy of navigation in improving timeliness and receipt of cancer screening, diagnostic follow-up care, and treatment. Patient navigation services were defined and differentiated from other outreach services. Overall, there was evidence of some degree of efficacy for patient navigation in increasing participation in cancer screening and adherence to diagnostic follow-up care after the detection of an abnormality. The reported increases in screening ranged from 10.8% to 17.1%, and increases in adherence to diagnostic follow-up care ranged from 21% to 29.2% compared with control patients. There was less evidence regarding the efficacy of patient navigation in reducing either late-stage cancer diagnosis or delays in the initiation of cancer treatment or improving outcomes during cancer survivorship. There were methodological limitations in most studies, such as a lack of control groups, small sample sizes, and contamination with other interventions. Although cancer-related patient navigation interventions are being adopted increasingly across the United States and Canada, further research will be necessary to evaluate their efficacy and cost-effectiveness in improving cancer care. (c) 2008 American Cancer Society.
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              Comparison of convenience sampling and purposive sampling

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                Author and article information

                Contributors
                +1 (403) 220-7332 , gdimit@ucalgary.ca
                eemorgan@ucalgary.ca
                brooke.allemang1@ucalgary.ca
                kyleigh.schraeder@ucalgary.ca
                shannon.scott@ualberta.ca
                jorge.pinzon@albertahealthservices.ca
                gail.andrew@albertahealthservices.ca
                greg.guilcher@albertahealthservices.ca
                lorraine.hamiwka@albertahealthservices.ca
                eddy.Lang@albertahealthservices.ca
                kamcbrie@ucalgary.ca
                alberto.nettel-aguirre@albertahealthservices.ca
                daniele.pacaud@albertahealthservices.ca
                lonnie.zwaigenbaum@albertahealthservices.ca
                andrew.mackie@albertahealthservices.ca
                susan.samuel@albertahealthservices.ca
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                17 June 2019
                17 June 2019
                2019
                : 19
                : 390
                Affiliations
                [1 ]ISNI 0000 0004 1936 7697, GRID grid.22072.35, Faculty of Social Work, Professional Faculties 4212, , University of Calgary, ; 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
                [2 ]ISNI 0000 0004 1936 7697, GRID grid.22072.35, Department of Psychiatry, , University of Calgary, ; Calgary, Alberta Canada
                [3 ]ISNI 0000 0001 0684 7358, GRID grid.413571.5, Alberta Children’s Hospital Research Institute, ; Calgary, Alberta Canada
                [4 ]ISNI 0000 0004 1936 7697, GRID grid.22072.35, University of Calgary, ; Calgary, Alberta Canada
                [5 ]ISNI 0000 0004 1936 7697, GRID grid.22072.35, Department of Pediatrics, , University of Calgary, ; Calgary, Alberta Canada
                [6 ]GRID grid.17089.37, Faculty of Nursing, , University of Alberta, ; Edmonton, Alberta Canada
                [7 ]GRID grid.17089.37, Department of Pediatrics, , University of Alberta, ; Edmonton, Alberta Canada
                [8 ]ISNI 0000 0001 0684 7358, GRID grid.413571.5, Section of Pediatric Oncology and Blood and Marrow Transplant, , Alberta Children’s Hospital, ; Calgary, Alberta Canada
                [9 ]ISNI 0000 0001 0684 7358, GRID grid.413571.5, Section of Nephrology, , Alberta Children’s Hospital, ; Calgary, Alberta Canada
                [10 ]ISNI 0000 0004 1936 7697, GRID grid.22072.35, Department of Emergency Medicine, , University of Calgary, ; Calgary, Alberta Canada
                [11 ]ISNI 0000 0004 1936 7697, GRID grid.22072.35, Department of Community Health Sciences, , University of Calgary, ; Calgary, Alberta Canada
                [12 ]ISNI 0000 0004 1936 7697, GRID grid.22072.35, Department of Family Medicine, , University of Calgary, ; Calgary, Alberta Canada
                [13 ]ISNI 0000 0001 0684 7358, GRID grid.413571.5, Section of Diabetes and Endocrinology, , Alberta Children’s Hospital, ; Calgary, Alberta Canada
                [14 ]ISNI 0000 0004 0633 3703, GRID grid.416656.6, Division of Cardiology, , Stollery Children’s Hospital, ; Edmonton, Alberta Canada
                Author information
                http://orcid.org/0000-0001-9487-0290
                Article
                4227
                10.1186/s12913-019-4227-6
                6580652
                31208417
                d151084e-dfd4-416e-b5e5-f12e019b3bdd
                © The Author(s). 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 January 2019
                : 6 June 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Funded by: Maternal Newborn Child & Youth Strategic Clinical Network
                Funded by: Roy and Vi Baay Chair in Kidney Research
                Funded by: BMO Financial Group Endowed Research Award in Healthy Living
                Funded by: Alberta Children’s Hospital Foundation
                Funded by: FundRef http://dx.doi.org/10.13039/100010322, Stollery Children’s Hospital Foundation;
                Funded by: FundRef http://dx.doi.org/10.13039/100012856, Alberta Children's Hospital Research Institute;
                Funded by: Alberta Health Services
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Health & Social care
                adolescents,young adults,transition age young people,chronic disease,qualitative research,patient navigator (pn),special health care needs (shcn)

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