Search

Background: The Ohio State University Comprehensive Cancer Center has developed the multidisciplinary Cancer and Aging Resiliency (CARE) Clinic to focus on caring for older adults with cancer. The clinic providers evaluate, educate, and intervene within the following components: physician, pharmacy, audiology, psychosocial, cognitive, physical functioning, case management, and nutrition. Objectives: To reduce healthcare inequalities by utilizing patient navigators to identify older adults with cancer who would benefit from being seen in the CARE Clinic and to improve patient accessibility through increasing referral rates and the completion of CARE Clinic referrals. Methods: Navigators identified new patients coming to the breast and thoracic oncology clinics who were older than 65 years of age. Patient navigators contacted the patient or the patient's representative via phone or in person to perform an initial assessment utilizing the G8 geriatric screening tool. This screening tool is used to identify frailty among older adults and has been validated in older adults with cancer. It includes questions regarding nutrition, weight loss, mobility, cognition, comorbidities, and medications. Based on the formula built in to the G8 screening tool, patient navigators used a cutoff score of <15 to identify patients who may benefit from a referral to the CARE Clinic. The referral recommendation was then sent to the patient's treating oncologist by an in-basket message in EPIC electronic health records. Navigators followed up with providers to ensure referrals were placed and followed up with patients to navigate them to their appointment. Results: From January 2023 to July 2023, 29 older adults with breast cancer were screened; the number of breast cancer patients positive for referral was 8 (27.6%); the number of breast cancer patients referred to the CARE Clinic was 2 (25%), with 2 referrals pending. The number of older adults with thoracic cancer screened was 203; the number of thoracic patients who screened high-risk and recommended a referral was 163 (80.3%); the number of referrals placed to the CARE Clinic was 32 (19.6%), with 37 referrals pending. The number of referrals from the thoracic clinic to the CARE Clinic increased from 5 referrals in December 2022 to 17 referrals in January 2023, with monthly referral averages consistently higher in 2023 versus 2022. To further improve referrals, navigators could place these referrals directly and include G8 results to simplify follow-up and remove delays through the streamlining of provider communications. Conclusions: While there has been an increase in referrals to the CARE Clinic from patient navigation efforts, the potential to increase the referral rate is far greater. One solution would be to allow the patient navigators to place the referral directly. Discussions about the CARE Clinic could happen at other times than the new patient appointment, and navigators could meet with returning patients as well as new patients. Allowing navigators to place the referral directly would become a billable service and a way to promote the benefits of patient navigation to reduce healthcare inequities for older adults with cancer. [ABSTRACT FROM AUTHOR]