Patient navigation: State of the art or is it science?
First implemented in 1990, patient navigation interventions are emerging today as an approach to reduce cancer disparities. However, there is lack of consensus about how patient navigation is defined, what patient navigators do, and what their qualifications should be. Little is known about the effi...
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| Published in | Cancer Vol. 113; no. 8; pp. 1999 - 2010 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hoboken
Wiley Subscription Services, Inc., A Wiley Company
15.10.2008
Wiley-Liss |
| Subjects | |
| Online Access | Get full text |
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| Summary: | First implemented in 1990, patient navigation interventions are emerging today as an approach to reduce cancer disparities. However, there is lack of consensus about how patient navigation is defined, what patient navigators do, and what their qualifications should be. Little is known about the efficacy and cost‐effectiveness of patient navigation. For this review, the authors conducted a qualitative synthesis of published literature on cancer patient navigation. By using the keywords ‘navigator’ or ‘navigation’ and ‘cancer,’ 45 articles were identified in the PubMed database and from reference searches that were published or in press through October 2007. Sixteen studies provided data on the efficacy of navigation in improving timeliness and receipt of cancer screening, diagnostic follow‐up care, and treatment. Patient navigation services were defined and differentiated from other outreach services. Overall, there was evidence of some degree of efficacy for patient navigation in increasing participation in cancer screening and adherence to diagnostic follow‐up care after the detection of an abnormality. The reported increases in screening ranged from 10.8% to 17.1%, and increases in adherence to diagnostic follow‐up care ranged from 21% to 29.2% compared with control patients. There was less evidence regarding the efficacy of patient navigation in reducing either late‐stage cancer diagnosis or delays in the initiation of cancer treatment or improving outcomes during cancer survivorship. There were methodological limitations in most studies, such as a lack of control groups, small sample sizes, and contamination with other interventions. Although cancer‐related patient navigation interventions are being adopted increasingly across the United States and Canada, further research will be necessary to evaluate their efficacy and cost‐effectiveness in improving cancer care. Cancer 2008. © 2008 American Cancer Society.
A qualitative synthesis was conducted to evaluate cancer patient navigation in which patient navigation services were defined and differentiated from other outreach services. Overall, there was evidence for some degree of efficacy for patient navigation in increasing participation in cancer screening and adherence to diagnostic follow‐up care after the detection of an abnormality. |
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| Bibliography: | Study findings are the result of the collaborative efforts of the following sites and principal investigators: Boston University Medical Center (Karen M. Freund, MD, MPH and Tracy A. Battaglia, MD, MPH); Chicago Patient Navigation Research Program (Charles Bennett, MD, PhD, MPP and Elizabeth Calhoun, PhD); Denver Health and Hospitals Authority (Peter C. Raich, MD, FACP and Elizabeth Whitley, PhD, RN); George Washington University Cancer Institute, District of Columbia City‐wide Patient Navigation Research Program (Steven R. Patierno, PhD); H. Lee Moffitt Cancer Center and Research Institute (Richard G. Roetzheim, MD, MSPH); Northwest Tribal Cancer Navigator Program (Victoria Warren‐Mears, PhD); Ohio State University Comprehensive Cancer Center (Electra D. Paskett, PhD); University of Rochester, Department of Family Medicine Randomized Controlled Trial of Primary Care‐based Patient Navigation‐Activation (Kevin Fiscella, MD, MPH); and University of Texas Health Science Center at San Antonio (Donald J. Dudley, MD) in conjunction with NOVA Research Company (Paul A. Young, MBA, MPH), the ACS, and the NCI Center to Reduce Cancer Health Disparities (Roland Garcia, PhD and Mary Ann Van Duyn, PhD, MPH, RD, Program Directors). The following authors contributed substantially to the preparation of this article but were not included in the author listing because of the journal's limitation on the number of authors: Steven R. Patierno, PhD, George Washington Cancer Institute, George Washington School of Medicine and Health Sciences, George Washington School of Public Health and Health Services, Washington, DC; Richard G. Roetzheim, MD, MSPH, University of South Florida, Tampa, Fla; and Paul A. Young, MBA, MPH, NOVA Research Company, Bethesda, Md. Dr. Wells' contribution to this article was funded by a grant from the NCI (R25 CA090314; Paul B. Jacobsen, PhD, principal investigator). Fax: (813) 745‐5525 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 The following authors contributed substantially to the preparation of this manuscript but were not included in the author listing due to the journal’s limitation on the number of authors: Steven R. Patierno, Ph.D., The GW Cancer Institute, GW School of Medicine and Health Sciences, The GW School of Public Health and Health Services; Richard G. Roetzheim, M.D., M.S.P.H., University of South Florida; and Paul A. Young, M.B.A., M.P.H., NOVA Research Company. |
| ISSN: | 0008-543X 1097-0142 |
| DOI: | 10.1002/cncr.23815 |