title: Patterns of task and network actions performed by navigators to facilitate cancer care.
abstract: BACKGROUND
  Patient navigation is a widely implemented intervention to facilitate access to care and reduce disparities in cancer care, but the activities of navigators are not well characterized.
  
  
  OBJECTIVE
  The aim of this study is to describe what patient navigators actually do and explore patterns of activity that clarify the roles they perform in facilitating cancer care.
  
  
  METHODS
  We conducted field observations of nine patient navigation programs operating in diverse health settings of the national patient navigation research program, including 34 patient navigators, each observed an average of four times. Trained observers used a structured observation protocol to code as they recorded navigator actions and write qualitative field notes capturing all activities in 15-minute intervals during observations ranging from 2 to 7 hours; yielding a total of 133 observations. Rates of coded activity were analyzed using numerical cluster analysis of identified patterns, informed by qualitative analysis of field notes.
  
  
  RESULTS
  Six distinct patterns of navigator activity were identified, which differed most relative to how much time navigators spent directly interacting with patients and how much time they spent dealing with medical records and documentation tasks. Navigator actions reveal a complex set of roles in which navigators both provide the direct help to patients denoted by their title and also carry out a variety of actions that function to keep the health system operating smoothly.
  
  
  CONCLUSIONS
  Working to navigate patients through complex health services entails working to repair the persistent challenges of health services that can render them inhospitable to patients. The organizations that deploy navigators might learn from navigators' efforts and explore alternative approaches, structures, or systems of care in addressing both the barriers patients face and the complex solutions navigators create in helping patients.
authors.affiliation: Jack A. Clark, PhD, is Medical Sociologist, Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, and Associate Professor, Health Policy and Management, Boston University School of Public Health, Massachusetts. E-mail: jaclark@bu.edu. Victoria A. Parker, DBA, is Associate Professor, Health Policy and Management, Boston University School of Public Health, Massachusetts. E-mail: vaparker@bu.edu. Tracy A. Battaglia, MD, is Assistant Professor, General Internal Medicine, Boston University School of Medicine, Massachusetts. E-mail: trbattag@bu.edu. Karen M. Freund, MD, is Professor, Medicine, Tufts University Medical School, Boston, Massachusetts. E-mail:karen.freund@tufts.edu.This research was supported by grants from the Avon Foundation.
authors.forename: Jack A
authors.initials: JA
authors.lastname: Clark
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Parker
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
authors.forename: Karen M
authors.initials: KM
authors.lastname: Freund
mesh_terms: D003142:Communication; D003695:Delivery of Health Care / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D062526:Patient Navigation / Q000379:methods* / Q000458:organization & administration; D011369:Professional-Patient Relations; D036301:Qualitative Research