Implementation of evidence-based patient navigation programs

Abstract

Background: Patient navigation refers to a direct patient care role that links patients with clinical providers and their support system and provides individualized support during cancer care, ensuring that patients have access to the knowledge and resources necessary to complete recommended treatment. While most reports have studied the role of patient navigators during the cancer screening or diagnostic process, emerging evidence indicates the benefits of patient navigation during active cancer treatment. Discussion: Reports in the literature are conflicting on the impact of patient navigation during cancer care and on the benefits to timely or quality care in all populations. Recent sub-analyses of the Patient Navigation Research Program data demonstrated specifically the benefits of targeting patient navigation to the most vulnerable populations, including those with low educational attainment, low income and unstable housing, less social support, multiple comorbidities, and minority race/ethnicity. Conclusion: The implications of the Patient Navigation Research Program are that this resource is best utilized when directed to support the care of patients at locations with known challenges to timely care and for specific patients with risk factors for delays in care, including comorbidities, low educational attainment and low income. Implementation of patient navigation programs requires the following processes: needs assessment, selection of a navigator to meet the community and care needs, supervision and integration of the navigator into clinical processes, and systems support to facilitate the identification and tracking of those patients requiring patient navigation. There is a need for ongoing research on methods to fund and sustain patient navigation programs.

Mammography facilities serving vulnerable women have longer follow‐up times

“…While navigation programs have been successful, this personalized intervention guiding individual women through the complexities of breast cancer diagnosis does not seem to have its impact for at least 3 months after the abnormal mammogram . Navigation's focus on the individual appears to be most successful for the patients at highest risk of nonfollow‐up, yet those patients are also the most challenging to achieve follow‐up for even in the context of a navigation program . Thus, the focus of resource‐intensive navigation programs addressing individual barriers to follow‐up may need to be on the most at‐risk patients.…”

“…48,49 Navigation's focus on the individual appears to be most successful for the patients at highest risk of nonfollow-up, yet those patients are also the most challenging to achieve follow-up for even in the context of a navigation program. 50,51 Thus, the focus of resource-intensive navigation programs addressing individual barriers to follow-up may need to be on the most at-risk patients. However, there remains a need for system-level solutions that can reach more women.…”

Nurse Navigator: development of a program for Brazil

“…It was observed during planning and implantation that patients had different difficulties and deficiencies, regardless of their socioeconomic status. Psychosocial, economic and cultural aspects represent factors of great impact on the population's access to recommended cancer treatment and timely care (29) . The format and scope of the NP, together with the roles and responsibilities of its navigators, must reflect the needs of patients, the community and the health institution, for which it is designed, and the service conditions and service functioning must be adapted (28,(33)(34) .…”

“…The consulted literature suggests that NP is more effective, when directed at patients with barriers to care, and can be identified through an assessment of the social determinants of health (29) . Therefore, it is recommended that the services analyze their populations to determine which patients need navigation before implementing a program (29)(30)(31) .…”

“…The consulted literature suggests that NP is more effective, when directed at patients with barriers to care, and can be identified through an assessment of the social determinants of health (29) . Therefore, it is recommended that the services analyze their populations to determine which patients need navigation before implementing a program (29)(30)(31) . is outlined by the type of navigator active, when the assistance will start and end the process and structured, according to the population to be assisted, being able to be directed to only one type of cancer or not, be adaptable to different social, cultural and economic realities of the service (7,28) .…”