Oncology patient navigators appear to play a vital role in improving access to colonoscopy screening in a medically disadvantaged community, according to a study published in the Journal of the National Comprehensive Cancer Network.1
As of 2015, all Commission on Cancer-accredited programs are required to provide patient navigation services. Patient navigators help people overcome barriers to increase access to cancer screening, diagnosis, and treatment in a timely fashion. They may also provide culturally appropriate patient education, offer peer counseling, and provide resources for financial assistance.
As part of a randomized intervention trial investigating the efficacy of patient navigation in increasing colonoscopy completion, researchers sought to examine navigators’ activities to eliminate barriers to colonoscopy screening in a medically disadvantaged community.
For the study, investigators analyzed service delivery and survey data from 420 patients receiving care at Boston Medical Center in Massachusetts between 2012 and 2014 who were navigated for colonoscopy screening.
The intervention was conducted by 2 nonclinical navigators who spoke both English and Spanish, had experience in health care or community health settings, and were familiar with the local community. The navigators worked with patients to identify, reduce, and remove personal, cultural, structural, and health care system barriers to screening colonoscopy and to support patients through completion of the procedure.
Most patients were either non-Hispanic black or Hispanic, and about 56% of the 420 patients spoke English as their primary language. Approximately 80% reported incomes less than $50,000 per year and approximately 89% were publicly insured.
The study showed that navigators spent the most time evaluating patient barriers and needs; facilitating appointment scheduling; reminding patients of appointments; educating patients about colorectal cancer, the importance of screening, and the colonoscopy preparation and procedures; and arranging transportation for patients to get to their colonoscopy appointment.
Investigators found that patient navigators spent an average of 44 minutes per patient. Three-quarters received less than 1 hour of navigation services.
The study demonstrated that patients valued the navigators, particularly for providing emotional and peer support, as well as for explaining clearly screening procedures and bowel preparation. Nearly all of the patients rated their experience as good, very good, or excellent, and reported that they would recommend patient navigation services to others.
“[The navigator] explained … the reason for having the procedure done and risks if you don’t get it done,” a patient reported. Another said, “[The navigator] made sure that I was clear when to start taking medication, how to mix, and when to mix everything … made sure I did not eat.”
As facilities strive to effectively and efficiently integrate navigation into their clinical services, these findings may help to further clarify the role of an oncology patient navigator in cancer screening and treatment programs within a medically disadvantaged population. In addition, these results may inform other cancer screening and treatment programs, including publicly funded health programs that support patient navigation services.
Future research is warranted to assess whether the reduction of barriers to health care via patient navigation services impacts clinical outcomes.
1. Rohan EA, Slotman B, DeGroff A, Morrissey KG, Murillo J, Schroy P. Refining the patient navigation role in a colorectal cancer screening program: results from an intervention study. J Natl Compr Cancer Netw. 2016;14(11):1371-1378.