Refining the Patient Navigation Role in a Colorectal Cancer Screening Program: Results From an Intervention Study

Abstract

Background Oncology patient navigators help individuals overcome barriers to increase access to cancer screening, diagnosis, and timely treatment. This study, part of a randomized intervention trial investigating the efficacy of patient navigation in increasing colonoscopy completion, examined navigators' activities to ameliorate barriers to colonoscopy screening in a medically disadvantaged population. Methods This study was conducted from 2012 through 2014 at Boston Medical Center. We analyzed navigator service delivery and survey data collected on 420 participants who were navigated for colonoscopy screening after randomization to this intervention. Key variables under investigation included barriers to colonoscopy, activities navigators undertook to reduce barriers, time navigators spent on each activity and per contact, and patient satisfaction with navigation services. Descriptive analysis assessed how navigators spent their time and examined what aspects of patient navigation were most valued by patients. Results Navigators spent the most time assessing patient barriers/needs; facilitating appointment scheduling; reminding patients of appointments; educating patients about colorectal cancer, the importance of screening, and the colonoscopy preparation and procedures; and arranging transportation. Navigators spent an average of 44 minutes per patient. Patients valued the navigators, especially for providing emotional/peer support and explaining screening procedures and bowel preparation clearly. Conclusions Our findings help clarify the role of the navigator in colonoscopy screening within a medically disadvantaged community. These findings may help further refine the navigator role in cancer screening and treatment programs as facilities strive to effectively and efficiently integrate navigation into their services.

Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature

“…Boundary spanning to improve performance and uptake of health services was used to increase participation rates in clinical services [ 39 – 42 , 45 , 48 , 49 , 52 , 63 ] or to achieve a change in health behaviours and outcomes [ 27 , 44 , 47 , 51 , 53 , 55 , 58 – 61 ]. In the former, boundary spanners have a stronger organisational orientation, and in the latter, health services use boundary spanners because of their community orientation.…”

“…Lived experience mattered in some cases. Two of the four navigator programs selected navigators with some prior health experience [ 42 , 52 ], one deliberately recruited lay navigators [ 62 ] and it was not stated in the fourth example [ 41 ]. This demonstrates a varied application of a type that was initially designed for helping disadvantaged patients to use cancer screening and treatment.…”

“…Outcomes for marginalised individuals were described in 26 articles. Outcomes were positive and related to health [ 38 , 40 , 44 , 49 , 51 , 53 , 55 , 58 , 59 , 61 , 63 , 64 ], social benefits [ 42 , 52 – 59 , 65 ], reduced barriers to accessing services [ 52 , 62 , 67 ] and increased participation [ 27 , 39 , 41 , 45 , 48 , 60 ]. The majority of health outcomes were not clinical but related to health knowledge and behaviours.…”

An Exploration of Patient Navigation and Community Health Worker Activities Across National Comprehensive Cancer Control Programs

“…40 Action plans described PNs and CHWs most often in relation to addressing barriers and providing patient education, which is also consistent with the literature. 8 Additional evidence is needed for assessing the efficacy of engaging PNs and CHWs in screening for lung cancer or increasing uptake of HPV vaccination. Since lung cancer screening is complex 41,42 and HPV vaccination rates remain low in the United States, 43,44 there may be a role for PNs and or CHWs in one or both of these arenas as well.…”

“…4–6 Barriers to cancer prevention, screening, and care often include fear or distrust of the medical community, lack of or inadequate health insurance coverage, financial hardship, low levels of health literacy and education, and logistical barriers, such as lack of transportation. 7,8 The social determinants of health, that is, the social, economic, cultural, and physical contexts within which people live, are considered important when addressing health disparities. 9–11…”