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Expanding Patient Navigation Beyond the United States

May 2, 2022 | AONN+ Blog | Membership
Featuring:
Nancy Peña, ONP-CG, CMI, BS
Nancy Peña, ONP-CG, CMI, BS
Director/Founder
Navegación de Pacientes Internacional, Inc./Dana-Farber Cancer Institute
Boston, MA

In 2005, I started working as a patient navigator at the Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC). Back then, patient navigation was a new concept, even for the most sophisticated health centers. Later, I received my first patient navigation certification from Dr. Harold Freeman in New York. After that, Dana-Farber Cancer Institute (DFCI) supported me in earning more patient navigation certifications and attending additional courses to enhance our program.

During these years, our program has been growing, thanks to the support of our champion doctor, Sarah Feldman, who is Medical Director of Ambulatory Gynecologic Oncology at Brigham and Women’s Hospital (BWH). We started out building a patient-centered navigation program and learned that navigation is a 2-way learning process—the navigator works as a cultural broker, understanding patients’ needs, translating providers’ recommendations to patients, and sharing patients’ concerns to providers.

In addition to tools that reduce no-shows, our team has also developed resources to educate patients about human papillomavirus (HPV), HPV vaccine, and cervical cancer prevention, telling patients—among other things—how to understand their results and the importance of keeping their appointments.

I believe that patient navigation needs to expand to other countries, such as my native Guatemala. Since 2007, I have been collecting information and resources to make this vision a reality, and have trained patient navigators in Spanish. Since my first training in Guatemala, 5 volunteer lay patient navigators have supported more than 200 oncology patients to access treatment.

In 2018, I decided to go for the AONN+ certification as a lay navigator at the Midyear Conference in Boston. I also had the opportunity to share my idea of expanding navigation to other countries with Lillie D. Shockney, editor-in-chief of JONS, and co-founder of AONN+, and Sharon Gentry, program director of AONN+.

Upon invitation by AONN+ in 2018, I participated in their nonclinical patient navigation advisory committee to develop questions for the nonclinical certification, where I had the opportunity to learn from and work with AONN+ colleagues from across the nation, which was an experience that helped me prepare an international curriculum for expanded navigation.

In 2019, thanks to the donation from “In Memory of Venry A. Samayoa,” we founded our nonprofit Navegación de Pacientes International (NPI) in conjunction with Rachel Allende, LICSW, and Fern Remedi-Brown MEd, MBA, with the aim of expanding patient navigation. Thanks to the continued support of the Samayoa team, NPI also awarded 60 scholarships in 2020 and 2021 to train navigators in Spanish. In addition, thanks to another key member of the AONN+ leadership team, Mandi Pratt-Chapman, Associate Center Director, Patient-Centered Initiatives and Health Equity at the GW Cancer Center, I implemented and adapted the Patient Navigation Guide to train navigators in Spanish in Central America.

During this year, AONN+ invited me to present at the International Navigation: A Global Perspective, about barriers that patients face in Guatemala. I had the opportunity to meet and present with Rowan Robinson, RN, MSN, from South Africa. Rowan and I learned that our patients and communities face similar obstacles when seeking general healthcare service and cancer treatments.

After my presentation, many people encouraged me to continue with my vision of international navigation expansion. I met Maritza Chicas, RN, a nurse from Pennsylvania, who became a volunteer of NPI, and we later invited her to be a member of our board. As we can see, this is an excellent example of the potential of network expansion within our navigator community.

In 2022, AONN+ invited me to work with the Job Task Force, allowing me to grow in another chapter of my career as a navigator.

Today, in conjunction with medical oncologists Patricia Chacón, Erick Estrada, and Sergio Ralón, NPI is supporting the implementation of patient navigation at General San Juan de Dios Hospital in Guatemala, thanks to the Building Expertise, Advocacy, and Capacity for Oncology Navigation (BEACON) initiative through the American Cancer Society. NPI also continues to train patient navigators in Guatemala and El Salvador, Nicaragua, Colombia, Perú, and Argentina.

AONN+ offers both local and international networking and is now the most respected organization in terms of clinical and nonclinical patient navigation. AONN+ also gives all of its members the opportunity to participate in different advisory committees where they can grow professionally.

With the help of AONN+, NPI is able to carry out the missions of Dr. Freeman and AONN+ to “better manage the complexities of the cancer care treatment continuum for their patients” in Central and South America.

As a Latina and a minority woman, I always feel welcomed, included, and validated by AONN+, and AONN+ has also opened many fantastic opportunities for me to keep growing personally and professionally to serve other communities in need, both here in the US and globally.

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