Cancer

In March 2010, the American Cancer Society hosted the National Patient Navigation Leadership Summit. The Summit organizers invited cancer clinicians, researchers, practicing public health experts, funders, and patient navigators to develop a national consensus on common outcomes of patient navigation. The goal of the Summit was to develop and propose core metrics for navigation programs to measure the impact on individuals and populations across the disease continuum. This article describes the Summit and outlines the need for such an endeavor in the effort to support the growth and sustainability of patient navigation.

Patient navigation is a patient-centric health care service delivery intervention, the principal purpose of which is to eliminate barriers, which may occur across the health care continuum, to timely diagnosis and treatment of cancer and other chronic diseases. This intervention, which was pioneered in Harlem, NY, is being widely replicated nationally and is receiving considerable support for demonstration projects and research to test its effectiveness. This article reviews the history of the development of patient navigation and outlines the basic principles of this intervention based on two decades of experience.

Patient Navigators can play an integral role in the changing healthcare environment by facilitating access; addressing language, culture, literacy, communication and other barriers; and helping to deliver better quality and more efficient care contributing to the elimination of existing health disparities.

The lack of comparable metrics to evaluate prevention and early detection patient navigation programs impeded the ability to identify best practices. The Prevention and Early Detection Workgroup of the Patient Navigation Leadership Summit conducted a synthesis of the literature to characterize variability in reported clinical metrics and create recommendations for researchers and program evaluators to consider adopting when measuring the impact of their navigation programs.

Patient navigation during diagnosis and treatment of cancer is an emerging health care delivery innovation designed to facilitate care for patients who experience health access barriers. Core metrics are proposed to shape a policy-relevant research agenda for assessing the role of patient navigation in improving quality of cancer-care delivery during diagnosis and treatment of cancer.

Survivorship navigation may improve appropriate health care utilization through education and care coordination, potentially improving health outcomes and quality of life of cancer survivors while reducing cost to the health care system.

Patient navigation represents an opportunity to further the integration of palliative care with standard cancer care. This article defines palliative and hospice care and describes some of the current challenges of integrating palliative care into other forms of care. It also considers outcomes that navigation might be expected to improve for patients receiving palliative care or enrolled in hospice, including symptom relief; communication efficacy; transitions of care; and access to palliative care, hospice, and bereavement care for families.

This article proposes strengthening patient navigation services by partnering with key persons from a patient's social support and network. The Partnership Approach recognizes the benefits of allowing members of the patient's social network to help in the care of the patient. This novel approach maximizes the family's role and efforts in helping to achieve a positive outcome for their loved one.

The Patient-Reported Outcomes Working Group developed a series of measures relevant to patient navigation for cancer-related care. These measures should prove useful for evaluation of patient navigation research and programs.

Evaluation of the costs of interventions and programs involving patient navigator services is important yet lacking in the literature. Common cost metrics are proposed to demonstrate the economic impact of patient navigation to facilitate decision making regarding sustainability.