Nav-CARE (Navigation – Connecting, Accessing, Resourcing, Engaging)
Navigating life and aging with chronic illness
What is Nav-CARE?
The overall goal of the Nav-CARE program is to improve the quality of life of adults living at home with serious illness. Community organizations across Canada are project partners. View the Nav-CARE brochure.
This project builds upon five years of collaborative work with knowledge partners in which we developed the conceptual and theoretical foundations; created, tested, and refined curriculum for volunteer navigators; and conducted three incremental pilots to determine the feasibility and acceptability of the Nav-CARE model.
Why is Nav-CARE important?
Adults living at home with serious illness, particularly those who do not yet qualify for home-based nursing care, often live with unmet needs and heavy symptom burden resulting in poor quality of life. Many do not know the services that are available to assist them. Our previous research (see below) has demonstrated the value of using trained navigators to visit in the home to provide psychosocial support, education, guidance on advance care planning and connection to community and health resources. These navigators engage older adults to identify the services and resources available and to connect them to those resources using a best-fit, client-centred approach.
What is navigation?
Navigation is defined as:“working in collaboration with patients, families, and communities to:
- negotiate the ‘best fit’ for the needs of older persons, their families and communities and resources;
- improve access to needed services and resources at the end of life (including death) and bereavement; and,
- promote quality of life, foster independence, and facilitate community connections utilizing a culturally safe, palliative approach”.
Volunteer navigators have baseline competency in palliative care and/or supporting older adults (either in a volunteer or health care provider capacity). Training in navigation consists of a two-day workshop that addresses five basic competencies: screening, advocating, facilitating community connection, coordinating access to services and resources and promoting active engagement. Curriculum for volunteers and coordinators, based upon navigation competences developed by a group of international experts in palliative care, has been prepared and piloted.
How does Nav-CARE fit with the palliative care system?
Nav-CARE volunteers are “upstream” volunteers who connect with clients and families early in the palliative trajectory. Indeed, these clients may not yet see themselves as palliative. Prognosis is less important than a perceived need for support. In this latest research, volunteers are supported by a nurse navigator coach, a volunteer coordinator, and a local health care provider who has also received training in navigation. This navigation partnership provides services to a currently underserved population while at the same time increasing the capacity of volunteers and health care providers through collaboration.
What does the intervention look like?
Volunteers and their coordinators receive a 2-day training workshop in navigation. Healthcare Partners attend the first day of training. Volunteers are assigned to care for two older adults and family. The older adults are visited in the home by the volunteer every 2-3 weeks over the project period. Volunteers fill out structured visit logs that outline the services provided and experiences with the volunteer role including challenges encountered. Research data is also collected on quality of life, volunteer self-efficacy, program satisfaction, and older adult engagement. Volunteer Navigators meet monthly as a group with the nurse navigator coach to share their experiences. Community partners also meet regularly with the research team to share experiences with implementation.
What were the findings from the pilot research?
Nav-CARE pilot research was funded by Canadian Patient Safety Institute 2014-2015; Vancouver Foundation 2014-2015; TVN 2014-2016; Canadian Frailty Network 2014-2015; Peter Wall Institute for Advanced Studies 2014-2015; University of Alberta 2014-2015; Canada Research Chairs Program 2014-2017. The following was the impact of Nav-CARE on both volunteers and older adults:
- Volunteers found the role satisfying and meaningful
- Volunteers would do the role again and recommend it to others
- Volunteers reported that continuing education and support were essential
- Nav-CARE clients described volunteers as good listeners, caring,
personable, outgoing, friendly, patient, positive, capable, conscientious, kind, non-intrusive, and diligent in finding out what they did not know
- Nav-CARE clients rated the service as highly important to their care
Nav-CARE clients described 4 primary benefits of being a part of the Nav-CARE program:
- Making good decisions for both now and future
- Having a surrogate safety net
- Supporting engagement with life
- “Making life more livable” in the presence of illness”
See Nav-CARE: Volunteer / Healthcare Provider Navigation Summary Report 2016 for more details.
Where are we at now with the project?
With funding from the Max Bell Foundation 2017-2020; CIHR 2016-2019; Canadian Cancer Society Research Institute 2016-2018; BC Centre for Palliative Care 2016; Covenant Health 2015-2017, the program is being adapted and tailored across diverse social and geographic contexts across Canada with volunteers primarily based within hospice who are connected to primary care services. The goal is to create a sustainable program that can be implemented widely in the Canadian context.
An evidence-informed Nav-CARE toolkit containing the following knowledge products has been developed to support Nav-CARE program delivery: an Implementation Toolkit (including: invitation letter template for prospective advisory committee members, advisory committee terms of reference template, community presentation, program sustainability guide), Nav-CARE Volunteer Learning Manual based on navigation competencies, and a Train the Trainers’ Toolkit (facilitator’s guide, training agenda, training PowerPoints, training case studies, community resource guide template, client visit form, evaluation tools).
How will the scale-out be evaluated?
Evaluation data will be gathered from adults, families, volunteers, and other stakeholders. At project conclusion, an Nav-CARE toolkit will be available to enable organizations across Canada to tailor and implement an Nav-CARE program in their community. Policy recommendations for Nav-CARE model use in Canadian healthcare will also be developed. Anticipated contributions to Canadian healthcare are significant: older adults will have better quality of life, volunteers will have enhanced roles that build hospice capacity, and supportive care will be implemented early for those living with serious illness.
Interested in how your community organization can get involved? Contact us for more information! Our current project partners include:
- Bulkley Valley Hospice Society, Smithers BC
- Cranbrook Kimberley Hospice Society, Cranbrook BC
- Desert Valley Hospice Society, Osoyoos BC
- Central Okanagan Hospice Society, Kelowna BC
- Kalein Centre, Nelson BC
- North Okanagan Hospice Society, Vernon BC
- Old and District Hospice Society, Olds AB
- Covenant Health Camrose & Killam, AB
- Colchester East Hants Hospice Society, Truro NS
- Shuswap Hospice Society, Salmon Arm BC
- Abbotsford Hospice Society, Abbotsford BC
- Chilliwack Hospice Society, Chilliwack, BC
- Mission Hospice Society, Mission BC
- Comox Valley Hospice Society, Comox BC
- Quesnel & District Hospice Palliative Care Association, Quesnel BC
- Kerby Centre, Calgary AB
- Vulcan & Region Family and Community Support Services, Vulcan AB
- Dr. Tom Ward, Victoria BC
- Prairie Hospice Society, Saskatoon SK
- McNally House Hospice, Grimsby ON
- Hospice Niagara, St. Catharines ON
- Stedman Hospice, Brantford ON
- Dr. Aaron McKim, Portugal Cove – St. Phillip’s NF