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 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.
Wells
Kristen J
KJ
Department of Health Outcomes and Behavior, Division of Cancer Prevention and Control, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA. kristen.wells@moffitt.org
Battaglia
Tracy A
TA
Dudley
Donald J
DJ
Garcia
Roland
R
Greene
Amanda
A
Calhoun
Elizabeth
E
Mandelblatt
Jeanne S
JS
Paskett
Electra D
ED
Raich
Peter C
PC
D019033:Delivery of Health Care, Integrated / Q000639:trends*; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008507:Medically Underserved Area; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*
JAMA. 1992 Dec 9;268(22):3219-23
1433762
JAMA. 1998 Jun 10;279(22):1801-7
9628711
J Cancer Educ. 2006 Spring;21(1 Suppl):S11-4
17020496
Cancer. 1999 Dec 1;86(11):2378-90
10590381
Cancer. 1996 May 15;77(10):2070-6
8640672
Clin J Oncol Nurs. 2007 Feb;11(1):81-5
17441399
Health Qual Life Outcomes. 2003 May 01;1:16
12756054
J Urban Health. 2005 Jun;82(2):216-24
15888638
Ann N Y Acad Sci. 1995 Sep 30;768:281-5
8526367
Med Care. 2002 Sep;40(9):743-51
12218765
J Urban Health. 2008 Jan;85(1):114-24
17906931
J Palliat Med. 2007 Oct;10(5):1023-8
17985954
Med Care. 2000 Jul;38(7):705-18
10901354
J Public Health Manag Pract. 2004 Nov-Dec;10(6):545-55
15643379
J Cancer Educ. 1995 Winter;10(4):213-6
8924397
Cancer Epidemiol Biomarkers Prev. 2007 Jun;16(6):1298-302
17548702
Can Oncol Nurs J. 2006 Spring;16(1):11-7, 5-10
17078346
J Natl Med Assoc. 1999 Apr;91(4):195-200
10333668
Cancer Pract. 1998 May-Jun;6(3):191-4
9652252
CA Cancer J Clin. 2008 Jan-Feb;58(1):9-31
18096863
Psychooncology. 2006 Nov;15(11):1014-22
16555366
Cancer. 2006 Dec 1;107(11):2669-77
17078056
Clin J Oncol Nurs. 2007 Oct;11(5):633-9
17962171
J Health Care Poor Underserved. 2006 May;17(2 Suppl):31-54
16809874
ONS Connect. 2007 Mar;22(3):29
17410751
J Am Coll Surg. 2003 Feb;196(2):180-8
12595043
Cancer Pract. 2002 May-Jun;10(3):130-8
11972567
Prev Med. 2007 Jan;44(1):26-33
16962652
J Cancer Educ. 1998 Winter;13(4):213-9
9883780
Cancer. 2007 Jan 15;109(2 Suppl):359-67
17123275
ONS Connect. 2007 Mar;22(3):12
17410749
Am J Public Health. 2005 Dec;95(12):2129-32
16257946
Cancer. 2005 Aug 15;104(4):848-55
16010658
J Cancer Educ. 2005 Spring;20(1 Suppl):65-70
15916524
Cancer Control. 2005 Nov;12 Suppl 2:28-33
16327748
J Urban Health. 2006 Mar;83(2):139-41
16736361
ONS Connect. 2007 Mar;22(3):5
17410747
Prev Med. 2001 Sep;33(3):190-203
11522160
J Natl Cancer Inst. 2006 Feb 1;98(3):157-9
16449671
Ethn Health. 1996 Sep;1(3):221-8
9395566
Surg Oncol Clin N Am. 2005 Oct;14(4):655-69, v
16226685
Psychooncology. 2008 Apr;17(4):383-91
17628037
Breast Cancer Res Treat. 1996;40(1):25-35
8888150
Health Care Manage Rev. 2004 Jul-Sep;29(3):196-206
15357230
Cancer Pract. 1995 Jan-Feb;3(1):19-30
7704057
J Natl Cancer Inst. 1999 Aug 18;91(16):1409-15
10451447
ONS Connect. 2007 Mar;22(3):8-11
17410748
J Natl Cancer Inst. 2002 Mar 6;94(5):334-57
11880473
J Gen Intern Med. 1997 Aug;12(8):472-7
9276652
J Womens Health Gend Based Med. 2002 Sep;11(7):639-51
12396896
J Community Health. 2005 Aug;30(4):299-307
15989211
Can Assoc Radiol J. 2004 Jun;55(3):145-50
15237774
Cancer Nurs. 1998 Oct;21(5):349-57
9775485
J Genet Couns. 2007 Apr;16(2):171-7
17277995
Can Oncol Nurs J. 2003 Summer;13(3):193
14508910
Am J Surg. 2002 Jun;183(6):659-62
12095596
Cancer. 2006 Oct 15;107(8 Suppl):2043-51
16977600
Med Care. 2005 Feb;43(2):141-8
15655427
PLoS Med. 2006 Jul;3(7):e193
16805649
CA Cancer J Clin. 2007 Jan-Feb;57(1):43-66
17237035
J Urban Health. 2006 Mar;83(2):231-43
16736372