Social Prescribing as Part of Effective Navigation Support for People Living With Cancer and Beyond Cancer

Globally, there are varying levels of shortcomings in cancer care delivery and unmet supportive care needs irrespective of the patient population and cancer type.1 Patient navigation in healthcare delivery is critically important to overcome barriers to accessing care, improve outcomes, facilitate timely access to quality care, and navigate people through complex healthcare systems from screening through to end of life.2,3 Cancer patient navigation programs are multidimensional, delivered by healthcare professionals and/or trained community support staff or peer navigators who can provide a wide range of supports.3 However, navigators are often based in health systems and may not have access to the most up-to-date knowledge of the social capital and community support available to address the broader determinants of health for people living with cancer.4 The integration of social prescribing within a cancer care navigation program may help to address some of these needs. Like patient navigation, social prescribing is a nonclinical multicomponent intervention that aims to improve healthcare outcomes and can be delivered by various trained professionals or lay workers.5 Social prescribing extends beyond the medical model and addresses the social determinants of health (income level and educational attainment, employment status, occupation, working conditions, housing, early childhood development, and social inclusion6) by connecting people with nonclinical support and services in the community7 and facilitating a wider range of patient-centered choices.8,9 Programs are typically delivered in general practice or the community setting, but referrals may also originate from primary, secondary, or tertiary care services to a community navigator or link person.5 Not-for-profit cancer organizations may also deliver social prescribing models.5 With its emphasis on partnering with primary care to facilitate connections to nonclinical community services, social prescribing programs have a greater likelihood of improving the health and well-being of cancer survivors4 and have been shown to significantly improve health-related quality of life for colorectal cancer survivors over patient navigation alone.10 By addressing the “causes of the causes” of health outcomes,11 social prescribing programs can contribute to reducing the burden on the healthcare system and addressing health inequities in a more sustainable way and over a longer term.8 Although harmonizing cancer patient navigation with social prescribing can bring significant benefits, caution must be taken in its application, especially around the following 3 areas. First, there is a risk of oversimplifying social prescribing and the skills, training, and expertise required of a link worker or similar navigator roles. There is an emerging trend to train people with past lived experience of the same condition as link workers, but this requires significant mentorship, support, and resourcing.12 Second, there is a risk of positioning social prescribing as a cheaper alternative to patient navigation. Although some patient traffic could be diverted from healthcare systems to social and community supports, there should then be a reallocation of resources (including those devoted to posttreatment or long-term condition management) to support social and community services delivering social prescribing.13 Without this investment, services will have insufficient resources to meet the needs of increased client flow, potentially leading to what is referred to as the “road to nowhere” problem, as seen in the United States and England.14 This problem is particularly prevalent in rural and remote communities.15 Third, care is needed around the concept of “self-management” to avoid accidental patient blaming. Social determinants of health have both components—“social” and “determinants”—meaning an individual alone has very little control over them. Individuals must be supported by policy actions to address broader social determinants, clearly mapping and communicating the supports available to them, and direct support for individuals to connect with services. This reflects the importance of self-management support across patient, provider, and system levels in long-term condition management, such as the chronic care model.16 Cancer nurses have been prominent leaders in shaping cancer patient navigation and will be best placed to exercise thought leadership to guide program planning, implementation, and evaluation.17 The next steps for global patient navigation suggest that there are opportunities to consider new, multilayered, cross-sector navigation interventions, roles, and programs that better address barriers to accessing care and support holistic, person-centered care.17 Embedding social prescribing programs into cancer patient navigation models is a logical step forward to improving holistic patient-centered care cancer care across the continuum. Carla Thamm, PhD, RNFiona Crawford-Williams, PhDMatthew Wallen, PhD, AEP, AESCarolyn Ee, PhD, FRACGPCatherine Paterson, PhD, RNSvetlana Bogomolova, PhDCandice Oster, PhDRaymond J. Chan, PhD, RNAuthor Affiliations: Caring Futures Institute, College of Nursing and Health Services, Flinders University, Adelaide South Australia (Drs Thamm, Crawford-Williams, Wallen, Oster, Ee, Paterson, and Chan); NICM Health Research Institute, Western Sydney University, Penrith (Dr Ee); and Supportive Care and Integrative Oncology Department, Chris O’Brien Lifehouse, Camperdown (Dr Ee), New South Wales; and Central Adelaide Local Health Network (Dr Paterson); and Centre for Social Impact, College of Business, Government & Law, Flinders University (Dr Bogomolova), Adelaide, South Australia