Last month, a patient diagnosed with gastrointestinal cancer walked into the Tata Memorial Hospital (TMH) in Parel, looking lost. With no attendant accompanying him, his registration process had hit a roadblock. That is when Bhagyashree Parkar (24), a freshly-recruited patient navigator at the hospital, took charge.
“The patient had a confirmed diagnosis from a hospital in Pune. He was accompanied by a man who had held on to his bags and files but it turned out that he was a taxi driver who had driven him from his home in Pune to Mumbai,” said Ms. Parkar. She facilitated the registration process by agreeing to be the patient’s temporary attendant, navigated him from the doctor’s consultation to the investigations and put him in touch with a medical social worker who helped him get into a Pune-bound bus that evening. “I was with the patient from 9.30 a.m. to 3 p.m. that day,” she said.
With a daily footfall of over 2,000 patients, the crowded TMH can be overwhelming for patients and their relatives. A group of 13 patient navigators like Ms. Parkar, who have been recruited in the Parel hospital and its Kharghar arm, the Advanced Center for Treatment, Research and Education in Cancer (ACTREC), are working to ease the process for them.
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The patient navigators or
“After the doctor’s consultation, patients and their relatives have many questions. From basic things like ensuring that the patient reaches the right department for tests to answering their queries about the disease, we do everything,” said Shruti Shinde, a 26-year-old patient navigator. “Many times it starts from explaining to patients what chemotherapy or radiation therapy is,” said Ms. Shinde.
Patients who are advised radiation often come to them saying, “
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Stepping up
A patient navigator typically assists 20 to 25 patients in a day, of which four to five require handholding. On average, they get three to four patients without attendants. “We land up playing the role of caregiver for such patients,” said patient navigator Tanzim Sayed (28). Besides the treatment, they also help patients navigate treatment funding, availing of subsidies, and so on.
Dr. Jayita Deodhar from the palliative medicine department of TMH says patient navigators are a unique cadre of trained people. “They cannot be equated with laypeople working as volunteers with NGOs. They are also not like survivor volunteers recruited by many hospitals. While that is an altruistic thought, it is also essential to be objective from a psychological point of view,” said Dr. Deodhar. Empathy and objectiveness set patient navigators apart, said Dr. Deodhar.
The group is trained in a specially designed year-long patient navigation programme called Kevat, named after the boatman who had helped lord Ram, Sita and Lakshman cross the river Ganga.
The programme consists of a clinical oncology module that covers every aspect of four main cancers: head and neck, breast, gastrointestinal and gynaecological. There is a psychosocial module that covers mental health, networking and advocacy, and communication skills.
While the first batch graduated four months ago, the second batch of 30 is under training. Dr. Rajendra Badwe who heads the Tata Memorial Centre hopes to recruit the navigators in all their cancer hospitals in Sangrur, Guwahati, Varanasi and Visakhapatnam.
“We are now in the process of getting their coats finalised. The fellows will wear dark blue coats and the students will wear light blue coats with the boat symbol of Kevat,” said Nishu Singh Goel, who heads the programme. She said the hospital will put up cut-outs to help patients identify the trained task force.
“Doctors at Tata always have a very high patient load. When we divert patients for investigations and treatment, there is a fear that the patient may simply not get there. But with Kevats, there is a relief that the patients will be guided,” said Dr. Shripad Banavali, head of paediatric and medical oncology at TMH.
He said Kevats are the intermediaries who play a vital role in improving treatment outcomes.