Cancer Patient Navigator

Patient Navigation Resource Center

What is a Cancer Patient Navigator?


A cancer patient navigator is an individual trained to help identify and resolve real and perceived barriers to care, enabling patients to adhere to care recommendations and thus improve their cancer outcomes.

  • According to Harold P. Freeman, the founder of the patient navigation model, “patient navigation is a:
    • Patient‐centric healthcare service delivery model
    • Concentrates on the movement of patients along the continuum of medical care
    • Beginning in the community and continuing on through testing, diagnosis, and survivorship to the end of life.”
    • The goal of patient navigation is to improve outcomes in underserved populations by eliminating barriers to a timely cancer diagnosis and treatment in a culturally sensitive manner.

Examples of competencies from the American Cancer Society’s National Navigation Roundtable Domains for Training and Certification Competencies


I. Ethical, cultural, legal, and professional issues
  • Competency: Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to respecting confidentiality, organizational rules and regulations, ethical principles and diversity in gender, age, culture, race, ethnicity, religion, abilities, sexual orientation and geography.
II. Client and care team interaction and communication skills
  • Competency: Apply insight and understanding concerning human emotional responses to create and maintain positive interpersonal interactions leading to trust and collaboration between patient/client/family and the healthcare team. Patient safety and satisfaction is a priority.
III. Health Knowledge
  • Competency: Demonstrates breadth of health, the cancer continuum, psychosocial and spiritual knowledge, attitudes and behaviors specific to their PN (clinical/licensed or non-medical licensure) role
IV. Patient Care Coordination
  • Competency: Participates in the development of an evidence-based or promising/best practice patient-centered plan of care, which is inclusive of the client’s personal assessment and health provider/system and community resources. The PN acts as liaison among all team members to advocate for patients in order to optimize health and wellness with the overall focus to improve access to services for all patients. PN conducts patient assessments (needs, goals, self- management, behaviors, strategies for improvement) integrating clients’ personal and cultural values
V. Practice-based learning
  • Competency: Optimizes navigator practice through continual professional development and the assimilation of scientific evidence to continuously improve patient care, based on individual PN gaps in knowledge, skills, attitudes and abilities.
VI. Systems-based Practice
  • Competency: Advocate for quality patient care by acknowledging and monitoring needed (desirable) improvements in systems of care for patients from enhancing community relationships and outreach through end-of-life. This includes Enhancing community relationships, developing skills and knowledge to monitor and evaluate patient care and the effectiveness of the program.
VII. Domain: Communication/Interpersonal Skills
  • Competency: Promote effective communication and interactions with patients in shared decision making based on their needs, goals, strengths, barriers, solutions and resources. Resolution of conflict among patients, family members, community partners and members of the oncology care team is demonstrated in professional and culturally acceptable behaviors.

The attachments below list Patient Navigator competencies from different organizations / sources. None fit every Patient Navigation program's needs (i.e., no one size fits everyone) and Patient Navigation programs need to select the competencies that are the best match for their local program.

  1. Colorado community and clinical staff volunteer to create a list of competencies and identified examples of behaviors that relate to each competency.
  2. George Washington University is a nationally recognized leader on Patient Navigation.
  3. The University of Colorado coordinate the Patient Navigator Training Collaborative.
  4. Colorado Public Health and Environment has identified Patient Navigator Competencies with an introduction clarifying the document.
Patient Navigation Resource Center
NACI Care© Provides Metric Reports Recommended for Accreditation

In 1999, the Institute of Medicine recommended that quality care is measured using a core set of metrics.   The Academy of Oncology Nurse and Patient Navigators (AONN+) identified ~36 core competencies in 2017 that subsequently have been supported by national organizations, including but not limited to the:

  • American Cancer Society's National Navigation Roundtable 
  • American College of Surgeons (ACOS),  Commission on Cancer (CoC)
  • American Society of Clinical Oncology (ASCO)'s Quality Oncology Practice Initiative  (QOPI)
  • Center for Medicare and Medicaid's Oncology Care Model (OCM)
  • Merit-based Incentive Payment System / Alternative Payment Models (MIPS/APMs)
  • National Accreditation Program for Breast Centers (NAPBC)
  • Oncology Nursing Society (ONS) 

These metrics are being used to evaluate whether patient navigation can improve outreach throughout end-of-life and overall value in healthcare. They also are being used as criteria for patient navigation accreditation certification and programs.

These reports within NACI Care© are grouped:

Navigation Load

  • Navigation Caseloads
  • Clinical Trials Education
  • Patient education
  • Patient Retention through Navigation

Compliance

  • Treatment Compliance
  • Patient Transition from Point of Entry
  • No show rate

Patient /Participants Characteristics

  • Demographic:  best ways to learn
  • Barrier Report
  • Disparate Population at Screening Event

Referrals

  • Clinical Trial Referrals
  • Referrals to revenue-generating services
  • Referrals to revenue-generating services by PN
  • Cancer Screening
  • Social Support Referrals 
  • Social Support Referrals for survivors who have completed SCP
  • Palliative Care Referral

Diagnosis & Treatments

  • Diagnosis to First Oncology Consult
  • Diagnostic Workup to Diagnosis
  • Cancer Screening Follow-Up to Diagnostic Workup
  • Completion of Diagnostic Workup
  • Treatment Compliance
  • Diagnosis to initial treatment
  • Patient Transition from Point of Entry

Hospital

  • 30-, 60-, 90-Day Readmission Rate
  • Inpatient Oncology Unit Length of Stay
  • Emergency Department Utilization
  • Emergency admissions per Number of Chemotherapy Patients

Surveys

  • Patient Experience / Patient Satisfaction with Care
  • Patient Experience / Patient Satisfaction with Navigation Program
  • Psychosocial Distress Screening
  • Patient goals
  • Survivorship Care Plan
  • Transition from Treatment to Survivorship

PN Characteristics 

  • Navigation Knowledge at Time of Orientation
  • Oncology Navigator Annual Core Competencies Review

Institute of Medicine and National Research Council. Ensuring Quality Cancer Care. Washington, DC:  National Academies Press. 1999.  https://doi.org/10.17226/6467 accessed August 26, 2020

Different Professions that May Include Patient Navigation Roles &/or Functions

The Patient Navigator continues working with the patient from community interactions through the door of the clinical setting and in collaboration with members of the health care team within the clinic.


Community or Lay Patient Navigator

Licensed Nurse or Social Work Navigator

Peer Educator or Advisor

Promotores de Salud

Lay Health Advisor

Community Health Worker

What is Included in Each Phase of the Cancer Continuum?


Patient Navigation Roles During Each Phase of the Cancer Continuum