Patient navigation addresses barriers and facilitates timely access to quality standard care by providing individualized assistance to patients, survivors, and families. Harold P. Freeman, MD, first coined the term “patient navigation” in the 1990s in Harlem, NY, when he found that his black patients often presented with more advanced stages of disease and had poorer health outcomes and higher mortality than his white patients. He then decided to provide free or reduced-cost screenings, coupled with one-on-one navigation services. The result was an increase in 5-year survival from 39% to 70% in patients with breast cancer—94% of whom were black—treated at Harlem Hospital Center, New York, and a drop in late-stage diagnosis from 50% to 20% for his African American patients.1
The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”2 Health is affected by social determinants, which, according to the Healthy People 2020 approach, include economic stability, education, neighborhood and built environment, social and community context, and health and healthcare.3
For example, healthcare disparities may result from low income, unequal access to medical care, not prioritizing healthcare, lack of transportation, not having access to screenings during nonwork hours, or cultural barriers (eg, stigma of cancer). Navigators come from a variety of nonclinical and clinical backgrounds, and, through partnerships with patients, troubleshoot barriers to care to help patients obtain access to cancer care.
Recently, consensus-based core competencies were developed for oncology patient navigators to clarify the knowledge, skills, and abilities required of patient navigators.4 The competency domains are aligned with competency categories for other healthcare professionals and are comprised of patient care, knowledge for practice, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice, interprofessional collaboration, and personal and professional development.4,5
Rosie is a young mother of 4 who lives in the city. Her youngest child is still breast-feeding when Rosie finds a lump in her breast. Rosie decides to ignore the lump, because she is worried about telling her family that she might be sick. She is the primary breadwinner and caregiver for her family, and she does not want to worry them. At the grocery store, Rosie notices a flyer for a free mammography day, and decides to call the number on the flyer. A patient navigator answers Rosie’s call and inquires about the lump she has found; the navigator explains the need for a mammogram. Rosie tells the patient navigator that she cannot take time off from work to get screened; however, the navigator convinces her to come into the clinic for a screening during new weekend hours. Rosie is diagnosed with stage II breast cancer, and is told that she needs surgery and chemotherapy, and must stop breast-feeding. She is worried about the cost of formula if she stops breast-feeding.
Check Your Knowledge
1. Which of the following is a primary barrier to care for Rosie?
a. Housing stability
b. Social cohesion
c. Education level
d. Financial concerns
2. Which of the following overarching competency domains are relevant to the navigator understanding that she must try to convince Rosie to get her diagnostic mammogram?
a. Knowledge for practice, and interpersonal and communication skills
b. Systems-based practice, and personal and professional development
c. Practice-based learning and improvement, and professionalism
d. Patient care, and personal and professional development
3. Why was the first patient navigation program developed in Harlem, NY?
a. To provide cancer support services to a wide variety of patients
b. To increase adherence to pharmacotherapy for patients with human immunodeficiency virus
c. To reduce the stage of disease and mortality of black patients
d. To address concerns of patients about receiving unequal cancer care
4. What is the primary purpose of patient navigation?
a. To remove healthcare bias
b. To reduce barriers to quality care
c. To facilitate group social support
d. To find copay assistance for patients
5. True or False: Patient navigators are always volunteers.
1, D; 2, A; 3, C; 4, B; 5, False.
- Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer. 2011;117(Suppl 15):3539-3542.
- World Health Organization. WHO definition of health. www.who.int/about/definition/en/print.html. Accessed March 8, 2016.
- US Department of Health & Human Services. Social determinants of health. www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health. Accessed March 8, 2016.
- Pratt-Chapman M, Willis A, Masselink L. Core competencies for oncology patient navigators. Journal of Oncology Navigation & Survivorship. 2015;6:16-21.
- Englander R, Cameron T, Ballard AJ, et al. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013;88:1088-1094.