Using Navigators to Improve Care of Underserved Patients

Institute for Health Policy Studies and Department of Anthropology, History, and Social Medicine, University of California-San Francisco, CA 94118, USA.
Cancer (Impact Factor: 4.89). 09/2005; 104(4):848-55. DOI: 10.1002/cncr.21214
Source: PubMed


Logistic, cultural, educational, and other barriers can impede the delivery of high-quality cancer care to underserved patients. Patient navigation services represent one innovation for addressing perceived barriers to care encountered by disadvantaged patients. In this report, the authors have 1) defined patient navigation, distinguishing it from other cancer support services; 2) described how programs are organized; and 3) discussed the need for research on program effectiveness.
Information was examined on navigation programs published in the scientific literature and on line. Qualitative research also was conducted, consisting of direct observation of patient care in cancer clinics with and without navigators in northern California, in-person interviews with personnel and patients in the clinics observed, and telephone interviews with navigators at four sites across the United States.
The authors found that navigation services have been implemented at all stages of cancer care: prevention, screening, treatment, and survival. Navigators differ from other cancer support personnel in their orientation toward flexible problem solving to overcome perceived barriers to care rather than the provision of a predefined set of services. There are no rigorous demonstrations of the effects and effectiveness of navigation, although such studies are underway.
Currently, patient navigation is understudied, and literature documenting its effects and effectiveness is scant. Rigorous studies are needed of the navigator role and program costs and benefits. Such studies will facilitate an assessment of program effectiveness, feasibility across a range of health care settings, and performance relative to alternative approaches for addressing barriers to care among the underserved.

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    • "Cancer patient navigation (PN) is a process that provides individualized assistance to cancer patients, families, and caregivers to help overcome health-care system barriers and facilitate timely access to quality health and psychosocial care from pre-diagnosis through all phases of the cancer experience[27]. Patient navigators (PNs) assist patients in overcoming barriers to cancer screening and treatment, offer peer counseling , provide linkages to financial and community resources, and provide culturally competent patient education, particularly among (but not limited to) the underserved282930. PNs are increasingly being considered an important component to cancer care, and as such, the Commission on Cancer (CoC) is requiring CoC-accredited hospitals to include PN programs[31]. "
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    • "Three patient navigators were interviewed. These were M¯ aori and worked for M¯ aori organizations (a patient navigator is someone who assists the patients and their family surmount barriers while negotiating the health system) (Dohan & Schrag, 2005). Navigators are being trialed in a number of places in New Zealand (Walker, Signal, Russell , Smiler, & Tuhiwai-Ruru, 2008). "
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