The development and implementation of a volunteer lay navigation competency framework at an outpatient cancer center

Abstract

Purpose

To describe the development and delivery of a competency framework designed to guide the recruitment, training, and competency screening of volunteer lay navigators at an outpatient cancer centre in Victoria, BC.

Methods

Volunteers that passed a screening interview underwent 22 h of training focusing on the scope of the navigator’s role, communication skills, and cancer center processes and resources. Volunteers that passed a post-training interview, by demonstrating a basic level of competency in three domains (Self as Navigator, Communication, and Knowledge/Information), were invited to participate as volunteer lay navigators in a three-step intervention with newly diagnosed lung cancer patients at the British Columbia Cancer Agency-Vancouver Island Centre.

Results

Of the 27 volunteers who attended a screening interview, 20 were invited to participate in training. From the subset of 20, 13 of these participants achieved competency scores high enough to qualify them to practice as volunteer lay navigators.

Conclusions

By incorporating the lessons we have learned from this study, we believe that the lay navigation competency framework serves as a useful model for selecting, training, and supporting competent navigators.

Appendices

Appendices

Appendix A

Screening Tool for Lay Navigation Volunteers

Applicant Name___________________ Interviewer Name(s)__________________

Date of Interview__________________

• 1. You’ve received materials about the role and program, what excites you about the lay navigation position?

• 2. What skills/life experience do you bring to this position that you think would be helpful?

• 3. Reflecting on your previous work/volunteer positions, describe your most positive experience with supervision, and an experience that did not work as well for you.

• 4. How have you managed the challenges of confidentiality—running in to people you know, seeing patients outside the centre, friends/family who inquire about patients

• 5. Scenario: You are on the phone for the first time with a patient. Role play your response to the following:

  Patient: “Since the doctor told me I have cancer I’m having a lot of trouble thinking. I can’t concentrate at work. I just feel numb inside.”

• 6. Scenario: You are meeting with a patient. Role play your response to the following:

  Patient: “Have you had an experience with cancer? What was it like for you?”

• 7. Scenario: You are waiting for a lung cancer patient who is 15 minutes late. He comes in the door smelling of smoke and struggling to catch his breath. Role play your response to the following:

  Patient: “Sorry I’m late, I had to stop and get cigarettes.”

• 8. Scenario: It is your final phone contact with the patient. Role play your response to the following:

  Patient: “I really want to thank you for all of your support. I don’t know how I would have gotten through this without you. I would really like to be able to stay in touch in case there are more questions I have. Can I have your phone number?”

• 9. Often you will be asked to provide information on resources or services that you are not familiar with.

  • Describe the process you would use to respond to the query

  • Upon researching the query, you found an overwhelming amount of information, how would you determine what to share with the patient [you were looking up something like “coping with cancer”]?

• 10. The way this program works is such that when you are agree to take on a patient, you are committing to following through with three contacts with the patient over a 4-week period of time in a way that is convenient for the patient. Describe your ability to respond to the time expectations of this role.

• 11. What do you see as being the most challenging part of this role/most rewarding?

• 12. Do you have any questions or is there anything else you would like us to know?

Appendix B

Screening Scoring Tool

Applicant Name___________________ Interviewer Name(s)__________________

Date of Interview__________________

Scale: 1 = inadequate, 3 = adequate, and 5 = advanced skill

Core Competency	1	2	3	4	5
1. Self as Navigator Self awareness—demonstrates appropriate use of self, limit setting, confidentiality: Questions #6, 7, 8
2. Self as Navigator Responsibility—demonstrates commitment to program, patients, ability to follow through, and willingness to accept direction: Question #1, overall
3. Self as Navigator Personal growth – demonstrates commitment to self directed learning and skill development Question # 2,3
4. Self as Navigator Character—demonstrates integrity, honesty, emotional readiness, respect, and non-judgmental attitude: Questions #4, 6, 7
5. Self as Navigator Empowerment—fosters independence and self-advocacy in the helping relationship: Questions #3, 8
6. Communication Demonstrates calm, caring, and confident presence: Questions #4, 6, 8
7. Communication Demonstrates empathic listening : Questions #4, 6, 8
8. Communication Invites dialogue through use of silence, encourages, non-verbal communication: Questions #4, 6, 8
9. Knowledge Ability to identify needs: Questions #3, 4, 5
10. Knowledge Ability to filter and select relevant information: Questions #3, 4, 5
11. Knowledge Shares information with pace, timing and quantity suited to listener: Questions #4, 5

Score (total of each column):

• Score of 44 (80 %) or higher indicates a strong competency for lay navigation

• Score of 33–43 (60 %–79 %) indicates a basic competency for lay navigation, monitor their progress during training, additional coaching may be necessary

• Score of 32 (59%) or lower indicates the individual does not qualify for the lay navigation training.

• If a volunteer scores less than 3 in any category but scores above 30 overall, they will need additional training and supervision in that area. It is recommended that additional testing of that particular competency area be done before assigning them to a patient.

Appendix C

Final Lay Navigation Competency Interview

Volunteer’s Name___________________ Date___________

Interviewer’s Name

• 1. (a) You are called by project staff to offer you a patient referral, how do you decide if you can take the referral?

  (b) What are your responsibilities, to both the patient and the program, once you have accepted the referral?

• 2. It has been one month since training, and you receive your first referral. It is a newly diagnosed colorectal cancer patient. How do you prepare yourself?

• 3. In your first phone call, the patient tells you that they are new to their community of Port Alberni and they are wondering what supports are available to them at home. What do you do?

• 4. Role Play 2nd Contact–Phone Contact: A patient talks about being very stressed and anxious. The patient asks about your personal experience with cancer and wants to know how you or those you cared for coped with the stress.

• 5. Role Play 2nd Contact–In-person: You are meeting at the centre with a patient and her daughter. The visibly anxious daughter is very vocal about looking for help in any form and asks about complementary medicine. The patient isn’t interested in any information about cancer, healing, or treatment.

• 6. Describe how you would take the mother and daughter (from the above role play) on a tour of the centre.

• 7. Role Play 3rd Contact–Phone Contact: Prior to the 3rd contact you receive news from program staff that the patient (from Question 5) has been told they are terminal. Role play this closure phone call.

• 8. You and your partner are out shopping and you see the daughter (from Question 5) in the store. How do you respond? What if the daughter approaches you and starts talking to you about how her mother is doing—how do you respond?

• 9. Do you have any questions or concerns related to your role as a lay navigator?

Core Competency	1	2	3	4	5
1. Self as Navigator Self awareness—demonstrates appropriate use of self, limit setting, confidentiality: Questions #7, 8, 4
2. Self as Navigator Responsibility—demonstrates commitment to program, patients, ability to follow through, and willingness to accept direction: Question #1, overall
3. Self as Navigator Personal growth—demonstrates commitment to self-directed learning and skill development: Questions #2, 3
4. Self as Navigator Character—demonstrates integrity, honesty, emotional readiness, respect, and non-judgmental attitude: Questions #5, 7, 8
5. Self as Navigator Empowerment—fosters independence and self-advocacy in the helping relationship: Question #3
6. Communication Demonstrates calm, caring, and confident presence: Questions #4, 5, 7
7. Communication Demonstrates empathic listening : Questions #4, 5, 7
8. Communication Invites dialogue through use of silence, encourages, non-verbal communication: Questions #4, 5, 7
9. Knowledge Ability to identify needs: Questions #3, 5, 6
10. Knowledge Ability to filter and select relevant information: Questions #3, 5, 6
11. Knowledge Shares information with pace, timing and quantity suited to listener: Questions #5, 6

Score (total of each column)

• A score of 44 (80%) or higher indicates a strong competency for lay navigation – volunteer qualified as a Lay Navigator and does not require further training or additional supervision.

• A score of 33 – 43 (60%-79%) indicates a basic competency for lay navigation – volunteer qualified as a Lay Navigator but requires close supervision and additional coaching may be necessary.

• A score of 32 (59%) or lower indicates a low competency for lay navigation – volunteer is not qualified as a Lay Navigator.

• If a volunteer scores less than 3 in any category but scores above 30 overall, they will need additional training and supervision in that area. It is recommended that additional testing of that particular competency area be done before assigning them to a patient.