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 patients (Robinson-White 2010*). Most clinic-based navigators serve low income individuals in urban settings and work with pre-existing clients (Hou 2015*).

Expected Beneficial Outcomes (Rated)

  • Increased cancer screening

Other Potential Beneficial Outcomes

  • Improved cancer care

  • Improved prenatal care

  • Increased access to care

Evidence of Effectiveness

There is strong evidence that patient navigator programs increase rates of cancer screening (Genoff 2016*, Muliira 2016*, Hou 2015*), especially for breast cancer (Krok-Schoen 2016, Marshall 2016*, Phillips 2010, Robinson-White 2010*). Additional evidence is needed to confirm effects for programs focused on other health conditions and outcomes.

Patient navigators improve adherence to breast cancer screening recommendations (Genoff 2016*, Marshall 2016*, Krok-Schoen 2016, Whop 2012, Robinson-White 2010*), diagnosis follow-up (Percac-Lima 2015, Krok-Schoen 2016, Robinson-White 2010*), treatment initiation (Krok-Schoen 2016, Robinson-White 2010*) and proper treatment receipt, and improve quality of life after cancer diagnosis (Krok-Schoen 2016). Navigation can also increase screening rates for colorectal cancer (Genoff 2016*, Muliira 2016*, Elkin 2012, Jandorf 2005) and cervical cancer (Genoff 2016*, Glick 2012*), especially when implemented in conjunction with patient education (Glick 2012*, Naylor 2012). Telephone support with patient navigation has been shown to moderately improve cancer care for minority populations (Naylor 2012, Glick 2012*). By increasing screening rates, patient navigator programs have the potential to reduce racial and socio-economic disparities in early detection (Robinson-White 2010*, Phillips 2010, Jandorf 2005).

Patient navigation can eliminate barriers to cancer care (Krok-Schoen 2016) and can be effective for disadvantaged (Percac-Lima 2015) and minority populations (Muliira 2016*), including blacks (Marshall 2016*), Native Americans (Whop 2012), Latinos (Paskett 2016*, Percac-Lima 2014), non-English speakers (Paskett 2016*, Percac-Lima 2014), and those with limited English proficiency (Genoff 2016*). Patient navigation may also decrease disparities in screening rates by improving screening among Latinos and non-English speakers (Percac-Lima 2014) and eliminate disparities in diagnostic resolution delays based on employment, housing, and marital status (Rodday 2015*).

Patient navigators may also increase access to care by improving scheduling and completion of appointments for children with autism spectrum disorder (Mishkind Roth 2016*) and increasing immunization and preventive care for urban adolescents (Szilagyi 2011*). Navigators may benefit older adults transitioning between care settings, and divert some chronically ill patients from higher intensity care (Manderson 2012). Patient navigator programs are suggested strategies to improve prenatal care (CDC-Reach, NACCHO-PNP), 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 assistance (NACCHO-PNP).

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 populations (Donaldson 2012*). 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 navigator (Elkin 2012).

Surveys of patients and providers who have used patient navigators suggest satisfaction with their services (Loskutova 2016*). 

Impact on Disparities

Likely to decrease disparities

Implementation Examples

The American College of Surgeons’ Commission on Cancer (CoC) requires patient navigation processes in order for a facility to achieve CoC accreditation (ACSCOC-Standards 2016). The American Cancer Society’s Navigator program provides one-on-one guidance for cancer patients at many sites around the country (ACS Navigator). Some communities provide perinatal or prenatal navigators for at-risk women. For example, the state of Maryland funds perinatal navigators (MD Annual Report 2013), the CDC REACH US program at Virginia Commonwealth University provides prenatal navigators (CDC-Reach).

Implementation Resources

KCP-CPPNW 2009 - Kansas Cancer Partnership (KCP). Cancer patient navigation program toolkit (CPPNW). Topeka: Kansas Department of Health and Environment (KDHE); 2009.

Citations - Evidence

* Journal subscription may be required for access.

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.

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.

Hou 2015* - Hou S-I, Roberson K. A systematic review on US-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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

CDC-Reach - Centers for Disease Control and Prevention (CDC). Reach US Virginia Commonwealth University.

NACCHO-PNP - National Association of County & City Health Officials (NACCHO). Patient navigator program.

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.

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

ACSCOC-Standards 2016 - Cancer program standards: Ensuring patient-centered care (2016 edition). 2016. American College of Surgeons Commission on Cancer (ACSCOC).

ACS Navigator - American Cancer Society (ACS). American Cancer Society navigator.

MD Annual Report 2013 - Maryland Office of Minority Health and Health Disparities. 2012 Annual Report. Maryland Department of Health and Mental Hygiene. 2013.

CDC-Reach - Centers for Disease Control and Prevention (CDC). Reach US Virginia Commonwealth University.

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