ORLANDO, Fla.—What is patient navigation and how do we make it work for our community? Patient navigation ensures patients with cancer achieve diagnostic resolution in a timely manner, leading to optimal outcomes for both patients and the community. A path to achieving a successful navigation program was presented by Jean B. Sellers, RN, MSN, of the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina, in an oral presentation at the 2nd Annual Oncology Nurse Advisor Navigation Summit.
Navigation is a community care model developed by Harold Freeman, MD, of the Harlem Hospital in New York City, in 1990. Freeman’s goal was to overcome the barriers to breast cancer care faced by the racial/ethnic minority community Harlem Hospital served, including financial barriers such as low income, inadequate or no health insurance; communication barriers such as language, cultural differences, and a poor understanding of preventive care practices; and medical system barriers such as fear and distrust.
From its inception in 1990 to 2001, navigation had a significant impact on the Harlem Hospital community. Navigation-based outreach improved the percentage of women who presented with breast cancer at earlier, thereby more treatable, stages of disease (6% vs 41% with stage 1 at initial presentation in 1990 vs 2001, respectively, and 49% vs 21% with stage 3 or 4 at initial presentation in 1990 vs 2001, respectively), and 5-year survival (39% in 1990 vs 70% in 2001).
The Commission on Cancer (CoC) defined the role of patient navigation in cancer care as specialized assistance for patients and their caregivers with overcoming barriers to care that facilitates timely access to clinical services and resources from before diagnosis through all phases of the cancer care continuum. Services provided reflect community needs based on type, severity, and/or complexity of identified barriers.
The successful navigation program is driven by a Community Needs Assessment. This report identifies the community and local patient population and its specific health disparities including barriers to care, available resources, and gaps in those resources. It also describes the navigation process put in effect; provides documentation of activities related to the navigation program and their outcomes; and discusses areas for improvement, enhancement, and future directions. Triennal reports document the effectiveness of the program, identifies gaps in community needs, and plans growth and adaption to continually meet the community’s needs.