Patient navigators
Patient navigators, sometimes called systems navigators, provide culturally sensitive assistance and care coordination, determining individual barriers and guiding patients through available medical, insurance, and social support systems. Navigators are usually employed by hospitals or clinics, and may be fully integrated into a primary care team. Hospitals and clinics generally try to hire navigators that come from the same communities as their patients. Navigators are most commonly employed in cancer care, often serving low income or disadvantaged patients1. Most clinic-based navigators serve low income individuals in urban settings and work with pre-existing clients2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased cancer screening
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved cancer care
Improved prenatal care
Increased access to care
What does the research say about effectiveness?
There is strong evidence that patient navigator programs increase rates of cancer screening2, 3, 4, especially for breast cancer1, 5, 6, 7. Additional evidence is needed to confirm effects for programs focused on other health conditions and outcomes.
Patient navigators improve adherence to breast cancer screening recommendations1, 3, 5, 6, 8, diagnosis follow-up1, 5, 9, treatment initiation1, 5 and proper treatment receipt, and improve quality of life after cancer diagnosis5. Navigation can also increase screening rates for colorectal cancer3, 4, 10, 11 and cervical cancer3, 12, especially when implemented in conjunction with patient education12, 13. Telephone support with patient navigation has been shown to moderately improve cancer care for minority populations12, 13. By increasing screening rates, patient navigator programs have the potential to reduce racial and socio-economic disparities in early detection1, 7, 11.
Patient navigation can eliminate barriers to cancer care5 and can be effective for disadvantaged9 and minority populations4, including blacks6, Native Americans8, Latinos14, 15, non-English speakers14, 15, and those with limited English proficiency3. Patient navigation may also decrease disparities in screening rates by improving screening among Latinos and non-English speakers15 and eliminate disparities in diagnostic resolution delays based on employment, housing, and marital status16.
Patient navigators may also increase access to care by improving scheduling and completion of appointments for children with autism spectrum disorder17 and increasing immunization and preventive care for urban adolescents18. Navigators may benefit older adults transitioning between care settings, and divert some chronically ill patients from higher intensity care19. Patient navigator programs are suggested strategies to improve prenatal care20, 21, but, overall, have not been rigorously evaluated in this context. Such programs may help women navigate the Medicaid system, find managed care and a provider, and obtain other services such as food and transportation assistance21.
A study of three implementations of navigation programs indicates that patient navigation for breast and colorectal cancer can be cost-effective in community hospitals that serve low income populations22. A patient navigator program focused on increasing screening colonoscopies at three public hospitals in urban areas had an average cost of $50-$300 per patient referred to a navigator10.
Surveys of patients and providers who have used patient navigators suggest satisfaction with their services23.
Implementation Examples
The American Cancer Society’s Navigator program provides one-on-one guidance for cancer patients at many sites around the country24. Some communities provide perinatal or prenatal navigators for at-risk women. For example, the state of Maryland funds perinatal navigators25, the CDC REACH U.S. program at Virginia Commonwealth University provides prenatal navigators20.
Implementation Resources
KCP-CPPNW 2009 - Kansas Cancer Partnership (KCP). Cancer patient navigation program toolkit (CPPNW). Topeka: Kansas Department of Health and Environment (KDHE); 2009.
Footnotes
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1 Robinson-White 2010 - Robinson-White S, Conroy B, Slavish KH, Rosenzweig M. Patient navigation in breast cancer: A systematic review. Cancer Nursing. 2010;33(2):127-40.
2 Hou 2015 - Hou S-I, Roberson K. A systematic review on U.S.-based community health navigator (CHN) interventions for cancer screening promotion - Comparing community-versus clinic-based navigator models. Journal of Cancer Education. 2015;30(1):173-186.
3 Genoff 2016 - Genoff MC, Zaballa A, Gany F, et al. Navigating language barriers: A systematic review of patient navigators’ impact on cancer screening for limited English proficient patients. Journal of General Internal Medicine. 2016;31(4):426-434.
4 Muliira 2016 - Muliira JK, D’Souza MS. Effectiveness of patient navigator interventions on uptake of colorectal cancer screening in primary care settings. Japan Journal of Nursing Science. 2016;13(2):205-219.
5 Krok-Schoen 2016 - Krok-Schoen JL, Oliveri JM, Paskett ED. Cancer care delivery and women’s health: The role of patient navigation. Frontiers in Oncology. 2016;6(2):1-10.
6 Marshall 2016 - Marshall JK, Mbah OM, Ford JG, et al. Effect of patient navigation on breast cancer screening among African American Medicare beneficiaries: A randomized controlled trial. Journal of General Internal Medicine. 2016;31(1):68-76.
7 Phillips 2010 - Phillips CE, Rothstein JD, Beaver K, et al. Patient navigation to increase mammography screening among inner city women. Journal of General Internal Medicine. 2010;26(2):123-9.
8 Whop 2012 - Whop LJ, Valery PC, Beesley VL, et al. Navigating the cancer journey: A review of patient navigator programs for Indigenous cancer patients. Asia-Pacific Journal of Clinical Oncology. 2012;8(4):e89-e96.
9 Percac-Lima 2015 - Percac-Lima S, Ashburner JM, McCarthy AM, Piawah S, Atlas SJ. Patient navigation to improve follow-up of abnormal mammograms among disadvantaged women. Journal of Women’s Health. 2015;24(2):138-143.
10 Elkin 2012 - Elkin EB, Shapiro E, Snow JG, Zauber AG, Krauskopf MS. The economic impact of a patient navigator program to increase screening colonoscopy. Cancer. 2012;118(23):5982-5988.
11 Jandorf 2005 - Jandorf L, Gutierrez Y, Lopez J, Christie J, Itzkowitz SH. Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. Journal of Urban Health. 2005;82(2):216-24.
12 Glick 2012 - Glick SB, Clarke AR, Blanchard A, Whitaker AK. Cervical cancer screening, diagnosis and treatment interventions for racial and ethnic minorities: A systematic review. Journal of General Internal Medicine. 2012;27(8):1016-32.
13 Naylor 2012 - Naylor K, Ward J, Polite BN. Interventions to improve care related to colorectal cancer among racial and ethnic minorities: A systematic review. Journal of General Internal Medicine. 2012;27(8):1033-46.
14 Paskett 2016 - Paskett ED, Dudley D, Young GS, et al. Impact of patient navigation interventions on timely diagnostic follow up for abnormal cervical screening. Journal of Women’s Health. 2016;25(1):15–21.
15 Percac-Lima 2014 - Percac-Lima S, López L, Ashburner JM, Green AR, Atlas SJ. The longitudinal impact of patient navigation on equity in colorectal cancer screening in a large primary care network. Cancer. 2014;120(13):2025-2031.
16 Rodday 2015 - Rodday AM, Parsons SK, Snyder F, et al. Impact of patient navigation in eliminating economic disparities in cancer care. Cancer. 2015;121(22):4025-4034.
17 Mishkind Roth 2016 - Roth BM, Kralovic S, Roizen NJ, et al. Impact of autism navigator on access to services. Journal of Developmental & Behavioral Pediatrics. 2016;37(3):188–195.
18 Szilagyi 2011 - Szilagyi PG, Humiston SG, Gallivan S, et al. Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates. Archives of Pediatrics & Adolescent Medicine. 2011;165(6):547-553.
19 Manderson 2012 - Manderson B, Mcmurray J, Piraino E, Stolee P. Navigation roles support chronically ill older adults through healthcare transitions: A systematic review of the literature. Health & Social Care in the Community. 2012;20(2):113-127.
20 CDC-Reach - Centers for Disease Control and Prevention (CDC). Reach U.S. Virginia Commonwealth University.
21 NACCHO-PNP - National Association of County & City Health Officials (NACCHO). Patient navigator program.
22 Donaldson 2012 - Donaldson EA, Holtgrave DR, Duffin RA, et al. Patient navigation for breast and colorectal cancer in 3 community hospital settings: An economic evaluation. Cancer. 2012;118(19):4851-9.
23 Loskutova 2016 - Loskutova NY, Tsai AG, Fisher EB, et al. Patient navigators connecting patients to community resources to improve diabetes outcomes. Journal of the American Board of Family Medicine. 2016;29(1):78-89.
24 ACS Navigator - American Cancer Society (ACS). American Cancer Society navigator.
25 MD Annual Report 2013 - Maryland Office of Minority Health and Health Disparities. 2012 Annual Report. Maryland Department of Health and Mental Hygiene. 2013.
Related What Works for Health Strategies
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