A systematic approach for optimizing patient navigator-related breast cancer screening, diagnosis, and care delivery tasks for the individual patient, as well as the broader population of medically underserved patients, was described in this article published in JCO Oncology Practice.1

Although survival for patients with breast cancer has increased across racial/ethnic groups in the United States over the last 20 years, substantially lower declines in breast cancer-related mortality have been observed in the non-Hispanic Black, Asian/Pacific Islander, and Hispanic populations compared with non-Hispanic White patients.

Patient navigation has been shown to remove barriers to the provision of timely, patient-centered interventions in the setting of breast cancer prevention and treatment, but it is traditionally focused on improving care for the individual patient.

In this context, these researchers state that “[patient navigation] does not aim to leverage important information gained by individual patient navigation encounters to change processes of cancer care delivery. Indeed, patient navigation has yet to be systematized in implementation models to improve processes of care at scale rather than remain as the current reactive or band-aid approach.”

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Proposed in this article was the application of the 4R approach, based on providing the right information and the right treatment to the right patient at the right time, to facilitate the timely and ordered implementation of appropriate tasks by the care team.2

Specifically, use of the 4R approach to create care sequence templates that can be iteratively modified based on the prior experiences of patient navigators and their patients was proposed as a means of incorporating lessons learned from previous patients.

“To the extent that a learning health care system uses data from every patient in its cycle of process improvement, it may help advance health equity through focus on health disparities,” the researchers posited.

For example, the care sequence templates were used to identify barriers to care delivery, such as issues related to communication and insurance, as well as the need for timely implementation of culturally sensitive care involving genetic counseling, dental care, family planning, and other interventions by a lay navigator into a patient’s care plan.

The authors conclude that the use of 4R care sequence templates “to actionize facilitators to breast cancer screening and care identified in underserved populations by lay navigators may reduce breast cancer health disparities by systematically promoting patient engagement and access to care while in real time improving the processes and sequence of care as a learning health system.”


1. Simon MA, Trosman JR, Rapkin B, et al. Systematic patient navigation strategies to scale breast cancer disparity reduction by improved cancer prevention and care delivery processes [published June 23, 2020]. JCO Oncol Pract. doi: 10.1200/JOP.19.00314

2. Weldon CB, Friedewald SM, Kulkarni SA, et al. Radiology as the point of cancer patient and care team engagement: applying the 4R model at a patient’s breast cancer care initiation.J Am Coll Radiol. 2016;13(12 Pt B):1579–1589.