Navigation programs were created by healthcare systems to address internal barriers that may contribute to well described inequities in cancer care that generally impact minorities, low-income communities, and recent immigrants in the United States. Since the first program was started in New York City in the 1990s, the concept has been adopted in other healthcare settings around the country. Recently, the federal government and national agencies have demonstrated interest in this model and committed millions of dollars in research monies to establish and evaluate navigation programs. Understanding how existing programs define and organize navigation services and the effectiveness of extant programs is important for future programs and research.
In this new study Daniel Dohan, Ph.D. of the University of California, San Francisco and Deborah Schrag, M.D., M.P.H. of the Memorial Sloan-Kettering Cancer Center reviewed the literature on navigation systems and described care processes in clinics with and without navigation programs. The authors found a dearth of research literature on navigation programs in general and noted that program efficacy had yet to be evaluated using rigorous methodologies such as randomization. Although there is no standard definition of a navigation program in the literature, the authors suggest that navigation programs are distinct in that they specifically addresses barriers to care encountered by individual, disadvantaged patients. Programs have been developed to address these barriers at a broad range of levels of cancer care, from prevention to survival.
The authors also found that while navigation programs often used similar strategies to those of social workers and community outreach workers, navigators were distinguished by being reactive to the needs of particular patients rather than standardized. However, there is no published research as to the efficacy and cost-effectiveness of these programs to redress barriers like patient mistrust, language, culture and education.
Given the increasing use of navigation programs, the authors conclude that "the navigator role must be defined more fully, and appropriate metrics developed to measure the services provided by navigators."
Article: "Using Navigators to Improve Care of Underserved Patients: Current Practices and Approaches," Daniel Dohan, Deborah Schrag, CANCER; Published Online: July 11, 2005 (DOI: 10.1002/cncr.21214); Print Issue Date: August 15, 2005.
Journal
Cancer