Patient navigation and care coordination have been a focus in healthcare for several years because of the fragmentation that commonly occurs among access, diagnosis, and treatment. This strong national movement has evidence-based research to support the need, which has led cancer program–accrediting bodies to add patient navigation as a required standard. The National Accreditation Programs for Breast Centers has had a patient navigation standard in place since it was instituted in 2009, and the American College of Surgeons Commission on Cancer will be adding patient navigation as standard 3.1 in the revised standards that will go live January 1, 2012.
Evidence shows that in addition to unequal access to healthcare, racial and ethnic minorities as well as underserved populations do not always receive timely, appropriate advice and care when faced with a cancer diagnosis.1 Care coordination/patient-centered care takes patient navigation to a higher level, one that ensures not only guidance for access, screening, diagnosis, and treatment but also psychosocial care.
The Institute of Medicine report entitled Cancer Care for the Whole Patient stresses the need that all cancer care should ensure the provision of appropriate psychosocial health services, facilitate effective communication, identify each patient’s psychosocial needs, design and implement a plan that links the patient with needed psychosocial care, coordinate biomedical and psychosocial care, engage and support patients in managing illness, and systematically follow up on evaluating and adjusting the plan.2
The National Quality Forum, through the National Priorities Partnership (NPP), developed a portfolio for care coordination, in which the members of NPP envision a healthcare system that guides patients and families through their healthcare experience, while respecting patient choice, offering physical and psychological supports, and encouraging strong relationships between patients and the healthcare professionals accountable for their care.3
The New Standard
The Commission on Cancer’s new standard 3.1 focuses on health disparities and finding a patient navigation process that addresses the needs of the community. This new standard requires each program or institution to be responsible for evaluating the needs of its cancer patient population as well as those of the community it serves. Each program will need to establish a navigation process that suits its needs and to determine appropriate staffing.
To meet the standard, it is important to remember that patient navigation is a process, not a person. Many questions have arisen regarding what type of navigators will be acceptable to be in compliance with this standard. The Commission on Cancer is allowing each program to determine this depending on the gaps in care identified through its needs assessment. Some institutions will have non-clinical navigators, whereas others may need both nonclinical and clinical navigators to provide care through the continuum. Another question relates to offering patient navigation onsite versus by referral and how that may be interpreted by the commission. As the final standards are disseminated this summer, the rationale for this option should be clearly defined.
What This Means for Navigation Programs
Navigation programs currently in place as well as new programs will need to perform a full assessment reviewing health disparities and barriers to care identified and reviewing populations served. The needs assessment will then be used to create or revise processes. This standard will require documentation of the needs assessment process as well as outcome metrics to prove the value of the program. Each program will need to track areas for quality improvement and create action plans to enhance the navigation process.
This new standard will be phased in over a 3-year period by all accredited cancer programs. To help programs meet the new standard, the Commission on Cancer will be providing a webinar series this fall to provide a framework for compliance. Topics will include:
- How to conduct a community needs assessment
- How to operationalize a plan and evaluate it
- A best practice repository of tools to assist with each aspect of program planning.
- Freeman HP, Vydelingum NA. The role of the Special Populations Networks program in eliminating cancer health disparities. Cancer. 2006;107(8 suppl):1933-1935.
- Institute of Medicine. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: National Academies Press; 2007.
- National Priorities Partnership. Vision. 2008. www.nationalprioritiespartnership.org/PriorityDetails.aspx?id=606. Accessed April 21, 2001.
This article was adapted
with permission from the
PA Patient Navigator
Sein E. Patient Navigation as a New Standard for Cancer Program Accreditation.
March 18, 2011. http://pubweb.fccc.edu/panavnet/?p=443.