Despite gains in cancer screening, diagnosis, and treatment, certain populations continue to suffer poor outcomes and higher mortality.3, 77
A number of health system and individual barriers exist for underserved populations in accessing and completing recommended cancer care.6, 7
Although originally designed to overcome barriers experienced by underserved patients who received a screening abnormality, patient navigation service programs are now widespread throughout the United States and Canada and target a number of different cancer-related outcomes in many populations.
Sixteen published articles provided data on the efficacy of patient navigation. Some published articles indicate patient navigation is associated with improvements in breast, prostate, and colorectal cancer screening, as well as improvements in adherence to follow up visits following an abnormality and reduction in time from abnormal screening to diagnostic resolution for breast, cervical, prostate, and colorectal cancer.27,29,32-34,37,45,48,51,57-58,65
However, published studies have limitations that preclude drawing definitive conclusions about the efficacy of patient navigation, such as lack of control groups, lack of randomization to treatment or comparison groups, low sample size, no single definition of patient navigation, and combining patient navigation services with other interventions. Thus, information about the efficacy of patient navigation programs is limited, and there is no information about cost-effectiveness of patient navigation.
The PNRP is a collaborative effort designed to overcome limitations in the research literature by evaluating efficacy and cost effectiveness of various models of patient navigation in cancer in a standardized rigorous process. The PNRP is collecting standardized data across nine sites to determine characteristics of successful and cost-effective navigation programs and which patients benefit from patient navigation. Until more information is available regarding the efficacy of patient navigation programs, institutions considering implementing such interventions should be aware of the paucity of data regarding such benefits.
To date, there are no formal recognized certification programs for patient navigators, nor is there evidence indicating which characteristics of navigators are most efficacious in improving cancer outcomes. Patient navigators have a variety of backgrounds and levels of formal education, and there is little information regarding training of navigators.21,73
The PNRP program has provided centralized standardized training to patient navigators from all nine sites and is collecting data to determine characteristics of navigators that predict better outcomes in abnormal screening tests as well as cancer diagnosis and treatment. If patient navigation is found to be effective, it will be important to agree upon a standardized navigator training program and evaluate appropriateness of a formal certification process for patient navigators. Without such formal certification, it will be difficult to obtain reimbursement from insurance companies or the federal government for patient navigation services.
In conclusion, patient navigation is an intervention designed to reduce health disparities by addressing specific barriers to obtaining timely, quality health care. This intervention is used in many different settings to target various cancer outcomes in many different populations. Although published research indicates that patient navigation may be associated with improvements in screening and diagnostic resolution following screening in certain populations, the research limitations preclude drawing generalizable conclusions regarding efficacy of patient navigation. A thorough evaluation of PNRP and other scientifically rigorous future programs is necessary to ensure that navigator programs are effective and cost-effective prior to continued dissemination.