Cancer patient navigation (PN) programs have been shown to increase access to and utilization of cancer care for poor and underserved individuals. Despite mounting evidence of its value, cancer patient navigation is not universally understood or provided. We describe five PN programs and the range of tasks their navigators provide across the cancer care continuum (education and outreach, screening, diagnosis and staging, treatment, survivorship, and end-of-life). Tasks are organized by their potential to make cancer services understandable, available, accessible, affordable, appropriate, and accountable. Although navigators perform similar tasks across the five programs, their specific approaches reflect differences in community culture, context, program setting, and funding. Task lists can inform the development of programs, job descriptions, training, and evaluation. They also may be useful in the move to certify navigators and establish mechanisms for reimbursement for navigation services.

Significant racial disparities in cancer mortality are seen between Medicare beneficiaries. A randomized controlled trial tested the use of lay navigators (care managers) to increase cancer screening of Asian and Pacific Islander Medicare beneficiaries. The study setting was Moloka‘i General Hospital on the island of Moloka‘i, Hawai‘i, which was one of six sites participating in the Cancer Prevention and Treatment Demonstration sponsored by the Centers for Medicare and Medicaid Services. Between 2006 and 2009, 488 Medicare beneficiaries (45% Hawaiian, 35% Filipino, 11% Japanese, 8% other) were randomized to have a navigator help them access cancer screening services (experimental condition, n = 242) or cancer education (control condition, n = 246). Self-reported data on screening participation were collected at baseline and exit from the study, and differences were tested using chi-square. Groups were similar in demographic characteristics and baseline screening prevalence of breast, cervical, prostate, and colorectal cancers. At study exit, 57.0% of women in the experimental arm and 36.4% of controls had had a Papanicolaou test in the past 24 months (P = .001), 61.7% of women in the experimental arm and 42.4% of controls had had a mammogram in the past 12 months (P = .003), 54.4% of men in the experimental arm and 36.0% of controls had had a prostate-specific antigen test in the past 12 months (P = .008), and 43.0% of both sexes in the experimental arm and 27.2% of controls had had a flexible sigmoidoscopy or colonoscopy in the past 5 years (P < .001). Findings suggest that navigation services can increase cancer screening in Medicare beneficiaries in groups with significant disparities.

Objectives To examine how the National Cancer Institute-funded Community Network Program (CNP) operationalized principles of community-based participatory research (CBPR). Methods Based on our review of the literature and extant CBPR measurement tools, scientists from nine of 25 CNPs developed a 27-item questionnaire to self-assess CNP operationalization of nine CBPR principles. Results Of 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles to recognize community as a unit of identity, build on community strengths, facilitate co-learning, embrace iterative processes in developing community capacity, and achieve a balance between data generation and intervention. CNPs varied in extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging community in research dissemination, and striving for sustainability. Conclusions Although tool development in this field is in its infancy, findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.

Native Hawaiians, representing 20% of Hawai'i's population, have higher mortality rates and lower life expectancy than all other ethnic groups in Hawai'i and most ethnic groups in the United States. Although research is needed to reduce health disparities, past research abuses have led to feelings of distrust among many Native Hawaiians toward traditionally conducted research. 'Imi Hale-Native Hawaiian Cancer Awareness, Research and Training Network was established in 2000, one of 18 Special Population Networks funded by the National Cancer Institute (NCI), to build a sustainable infrastructure for cancer prevention and control based on principles of community-based participatory research (CBPR). These principles give community members a voice in directing research and provide opportunities for community members to gain from research projects. This paper describes the major structures and mechanisms established by 'Imi Hale to assure community involvement and benefit. We also provide examples of how Native Hawaiians have impacted the design and conduct of specific research projects and how individuals and communities have benefited. 'Imi Hale advisors regularly complete a survey to gauge adherence to CBPR principles, and results from the 2002 survey are presented. The findings suggest that adhering to CBPR principles presents challenges to researchers, but that this approach is well received by the Native Hawaiians involved with 'Imi Hale, many of whom have seen positive benefits for themselves and their communities.

BackgroundIn 2005, approximately 26% of Micronesian women aged 40 or older in Hawai'i used mammography for breast cancer screening. We describe an 18-month project to increase screening participation in this population by tailoring educational materials and using a lay educator approach.