Characteristics of the original patient navigation programs to reduce disparities in the diagnosis and treatment of breast cancer.
BACKGROUND
Patient navigation is an intervention developed to reduce disparities in cancer care that is being widely replicated and receiving considerable support for demonstration projects and research to test its effectiveness. In the current study, the authors present an in-depth descriptive analysis of the original patient navigation programs to inform current and future program development.


METHODS
A qualitative multistakeholder case study using interviews and site visits of the first patient navigation site and 2 sites subsequently developed by the leadership of the original site were evaluated.


RESULTS
At these sites, patient navigation is a system, as opposed to a person, comprised primarily of navigators and directors that work together to remove barriers and facilitate access in a well-defined course of care; navigators were from the community or were culturally similar to the patient population served but were also paid employees of the clinical care site with detailed knowledge of the clinical course patients must traverse to complete care plans. Directors had administrative authority over the clinical facility and social capital across institutions, and communicated regularly and openly with navigators to implement system level changes to remove barriers to care. Contextual factors such as policies supporting breast cancer care also influenced the implementation of these programs.


CONCLUSIONS
The first patient navigation programs combined community and culturally sensitive care-coordination with aspects of disease management programs to reduce racial, ethnic, and poverty-driven disparities in care. Future efforts to replicate and evaluate patient navigation should take into account these unique aspects of the original patient navigation programs.
Vargas
Roberto B
RB
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024, USA. RBVargas@mednet.ucla.edu
Ryan
Gery W
GW
Jackson
Catherine A
CA
Rodriguez
Rian
R
Freeman
Harold P
HP
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D019090:Case Management / Q000592:standards; D003150:Community Health Workers; D006801:Humans; D011787:Quality of Health Care / Q000592:standards*