A good news percolating down from Mumbai is that Tata Memorial Centre (TMC) has signed a Partnership Agreement of Cancer Patient Navigation Program to improve cancer care in Indonesia on the World Health Day this year.

This was on  April 7, 2022. The MoU was signed with Dharmais National Cancer Hospital and PT Roche Indonesia.  

Two successful batches of students, consisting of thirty students in each batch, have graduated from the program with 100% placement under the Cancer Patient Navigation Program (CPN). 

It is part of the international expansion of TMC’s Kevat program. Currently the third batch is under training with thirty-seven students from Indonesia. 

Tata Memorial Centre established Kevat- a new vertical in paramedical care, by launching India’s first accredited postgraduate diploma in patient navigation in oncology and subsequently offering employment to the trained students. 

Kevat program is India’s first accredited postgraduate diploma in patient navigation in oncology, with TISS- Tata Institute of Social Sciences and with support from Tata Trusts. The navigators form an effective network that provides patients and caregivers with seamless support throughout the continuum of cancer care.

Over the last three years, around 4 lakh patients were under different domains of care by the Kevats. During the pandemic the Kevats were a critical workforce, and contributed towards screening of more than a lakh and forty thousand patients on entry into the Hospital. 

Other initiatives such as running pharmacy support services and patient management for around 70,000 patients, training of administrative staff and triaging patients, facilitating tele-consultations, which enabled 100% functionality of the hospital, 60% for cancer patients and 40% for COVID patients with cancer.

The 36 credit diploma course consists of six months of didactic training and observer ship in clinical and psychosocial aspects of oncology care, followed by a six-month paid internship at different hospitals under the TMC banner. 

Mode of assessment is periodic (module based), mid-term and end term exams.  All those with qualifying grades are awarded a diploma on the completion of the course. Diploma holders are absorbed Pan-India, in private hospitals, government institutes and non-government organizations to support patient care. 

TMC also offers a one-year fellowship to students based on merit. On the successful completion of the fellowship, exemplary candidates are employed by TMC in permanent positions. This program has been started since the signing of the MoU in April 2022 and now as many as 25 healthcare professionals consisting of nurses and doctors have been selected to participate in a series of the cancer patient navigation training programs for a year.

The navigation program was built to address the unmet needs of patient care with the overhang of cultural, social, economic and educational diversity.  Some of the identified concerns are language barriers, lack of awareness, comprehension of health information, resource provision, timely diagnosis and intervention, and adherence to goals of care.

Outcomes of the program include creation of a well trained workforce to support patient care, reduce the burden of clinicians and nurses, offer better delivery and quality of care, maintain compliance to treatment and follow-up, reduce attrition rates, improve survivorship outcomes of care and develop and execute patient navigation programs across cancer hospitals or hospitals offering specialized cancer care services.

Roles of the navigators include screening and early detection activities, assisting  patients with documentation and registration, identifying vulnerable patients, triaging patients, assessing patient understanding of diagnosis, explaining diagnosis and procedures, facilitating communication with the treatment team, preparing patients for procedures, identifying financial resources for patients, reminding patients of follow-up visits, providing psychosocial support, counselling patients and families, aiding in care transitions, rehabilitation assistance , bereavement and end of life processes. Kevats (navigators) follow a centralized reporting system and receive monitoring, audits, and assessments performed by Fellows, Staff, and Supervisors at regular intervals. 

They are given clinical guides and champions who chart their progress and review their activities.  They periodically meet with clinical teams and administrative teams to discuss specific cases and patient related problems. 

They maintain a robust system of patient feedback, based on which make suggestions for improvisations and changes in systems. Their focus areas remain timely diagnosis and treatment, and reduction in waiting time for clinical interventions.

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Through this collaboration with Indonesian health care providers, professional training is provided to define the role of CPN and embed patient navigation in the hospital service system, transfer of knowledge through technical assistance to develop local curricula and the establishment of a local training centre for CPN with national accreditation. Participants will receive professional training to define the role of CPN and implement the patient navigation role in the hospital care system where they are located. 

By using the blended learning method, participants will receive virtual training for 2 months and live training at TMC Mumbai for 3 months, Expert Visit Training in Indonesia for 2 months and undergo on the-job training in each hospital for 6 months with intense assistance from TMC. The program also targets the transfer of knowledge through technical assistance to develop local curricula and the establishment of local training centres for CPNs with national accreditation.

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