Abstract
Background: Social prescribing initiatives require continuous innovation and evaluation to best adapt to local healthcare contexts. Health Navigator (HN) interventions are one pathway of identifying patients’ individual-level social needs (e.g. financial instability and isolation) and providing tailored referrals to appropriate organisations. Although early results are promising, evidence is of varied quality. Furthermore, research into HN workflows in hospital settings is limited, particularly in Australia. Our research is the first in Australia to explore the feasibility and acceptability of an HN intervention in an outpatient setting to address the social needs of a disadvantaged population living with cancer.
Approach: Eligible participants were 18 years or older and presenting to an outpatient cancer clinic. A researcher screened participants for social needs using a dedicated screening tool, and conducted other patient-reported measures (Coping with Cancer ability, health-related quality of life and patient-reported quality of care). Participants who reported needs and requested assistance were linked to the HN. The HN assisted participants to prioritise their three most important needs and co-developed a referral action plan to appropriate community and government organisations. The HN provided ongoing referrals and advocacy over a six-month follow-up period. Participants who did not report needs or who did not request assistance were not referred to the HN. Post-intervention, all measures were repeated by both groups (with and without HN assistance). Primary outcomes were intervention feasibility and acceptability, where feasibility was defined using intervention process measures, i.e. 1) recruitment rate, 2) intervention uptake and 3) intervention completion. An 80% attainment for each of these measures indicated the intervention was feasible. Intervention acceptability was explored using participants’ reasons for non-participation and in separate focus groups with participants, their carers and clinicians (n=11 participants, n=2 caregivers and n=2 oncologists). Focus groups were recorded, transcribed and thematically analysed. Secondary outcomes included changes in social needs and patient-reported outcomes pre/post-intervention.
Results: All participants who disclosed social needs (n=55/73) requested assistance from the HN. The most commonly reported social needs were support (85%, n=47/55), financial instability (44%, n=24/55) and difficulties accessing transport (31%, n=17/55). For participants who completed pre- and post-intervention measures (n=29), the prevalence of all needs reduced following intervention, with the greatest reductions reported in support (↓62%). Approximately 75% of participants completed the HN intervention (n=36/47 surviving participants). Participants, carers and clinicians reported the intervention to be highly acceptable but cited service availability as a key barrier to intervention success. Rates of intervention uptake and completion suggest the intervention may be feasible in this population. There were no statistically significant differences between groups for secondary outcome measures.
Implications: Our study is one of the first to explore the feasibility and acceptability of an HN intervention in Australia. Participants and clinicians report the intervention to be appropriate, but further research is required to determine intervention feasibility. These data will inform future studies, in different populations, to further explore HN roles and workflows to achieve our long-term goal of implementation in Australian healthcare settings.