Key Considerations in Designing a Patient Navigation Program for Colorectal Cancer Screening

Abstract

Colorectal cancer is the second leading cause of cancer mortality among those cancers affecting both men and women. Screening is known to reduce mortality by detecting cancer early and through colonoscopy, removing precancerous polyps. Only 58.6% of adults are currently up-to-date with colorectal cancer screening by any method. Patient navigation shows promise in increasing adherence to colorectal cancer screening and reducing health disparities; however, it is a complex intervention that is operationalized differently across institutions. This article describes 10 key considerations in designing a patient navigation intervention for colorectal cancer screening based on a literature review and environmental scan. Factors include (1) identifying a theoretical framework and setting program goals, (2) specifying community characteristics, (3) establishing the point(s) of intervention within the cancer continuum, (4) determining the setting in which navigation services are provided, (5) identifying the range of services offered and patient navigator responsibilities, (6) determining the background and qualifications of navigators, (7) selecting the method of communications between patients and navigators, (8) designing the navigator training, (9) defining oversight and supervision for the navigators, and (10) evaluating patient navigation. Public health practitioners can benefit from the practical perspective offered here for designing patient navigation programs.

Training in Patient Navigation

“…While accreditation standards, health care legislation, and multiple organizations all emphasize the importance of trained patient navigators, no nationally-established certifications or standards for PN training exist, and little is known about the optimal delivery and content of training (DeGroff, Coa, Morrissey, Rohan, & Slotman, 2014; Shelton et al, 2011). Two established PN training programs exist in the United States: the Harold P. Freeman Patient Navigation Institute and the Colorado Patient Navigator Training Program, which provide training to navigators regardless of program affiliation.…”

Characteristics of Effective Colorectal Cancer Screening Navigation Programs in Federally Qualified Health Centers: A Systematic Review

“…In an investigation of CRC protocol and screening prevalence at 49 FQHCs in the Midwest, Daly et al 26 similarly found a significant correlation between the number of protocols employed and the percentage of patients that were screening compliant. In addition to protocol changes, DeGroff et al 27 proposed 10 key features to establish a successful CRC screening navigation program: 1) define the patient population and its unique barriers, 2) apply a theoretical framework, 3) establish entry and exit points for navigation services, 4) determine a location where navigation services will be performed, 5) provide communication training, 6) identify the navigation services offered and navigator responsibilities, 7) determine qualifications for the navigator, 8) design navigator training, 9) identify navigation supervision, and 10) evaluate navigation services.…”

Toward the Elimination of Colorectal Cancer Disparities Among African Americans

“…In primary care, tailored interventions for patients are especially likely to be effective in increasing colorectal cancer screening in primary care [29–31]. The use of lay or nurse cancer screening navigators is also likely to be helpful [32–35]. Horne et al [36] examined the effect of patient navigation on increasing colorectal cancer screening among older African Americans.…”