The Role of the Indigenous Patient Navigator: A Scoping Review

Abstract

Background Healthcare systems are complex and as a result patients may experience fragmentation of services. Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations. Patient navigation is known as a patient-centered approach to empower individuals to connect with appropriate services. Literature surrounding the Indigenous Patient Navigator (IPN) remains sparse necessitating this scoping review. Purpose: To map the current state of the role of the IPN internationally within Canada, United States, Australia and New Zealand. Methods Estalished methodological framework by Arksey and O’Malley and the PRISMA extension for scoping reviews was used. Results A total of 820 articles were reviewed from four databases, yielding sixteen articles. Conclusions The absence of published literature surrounding the IPN role in Australia and New Zealand was surprising considering similar histories of colonization. The term navigator was used most often and was typically used when describing lay/peer roles. Professional roles were described using specific role descriptions. Six IPN roles were identified including: (1) social service navigation, (2) wholistic support of Indigenous people, (3) advocacy/building capacity, (4) health assessment, (5) administrative navigation, and (6) outreach. Additionally, barriers and enablers IPNs address are identified. This scoping review will assist to promote and reinforce the IPN role.

Perspectives of Aboriginal People Affected by Cancer on the Need for an Aboriginal Navigator in Cancer Treatment and Support: A Qualitative Study

“…In addition to the problems surrounding timely access, travel, and cultural safety in service delivery, many patients present with co-morbidities and have limited logistical and financial support [8][9][10]. In similar post-colonial settings, a navigator role has shown promise in addressing health disparities in underserved minorities by improving access to services and supporting patients via advocacy and education [11].…”

“…While AHLOs can address some of the needs identified, their numbers are small, and their input is required across many departments and areas of the hospital. Participants had little interaction with AHLOs, yet it has long been known that Aboriginal patients in hospital want Aboriginal people to be involved in their care and that unmet social support needs exacerbate stress and worry [9,11,14]. Issues identified around the coordination of care and frequent references to loneliness and isolation highlight the contribution that an Aboriginal Patient Navigator could make by interfacing with Aboriginal patients directly and linking them with their wider family, providing the anchor that many patients felt that they needed.…”

“…In the United States and Canada, navigator roles exist to assist many underserved minorities who suffer stark inequities in health service delivery. The navigation concept was devised in the 1990s in Harlem, by Dr Harold Freeman, as a "person-centred approach to empower individuals and families to establish a connection with appropriate services" [11] (p. 200). Originally intended to improve marginalized women's access to healthcare services, patient navigator programs evolved to support diverse population groups, and largely focus on cancer care.…”

“…The employment of Indigenous Patient Navigators who work specifically with Indigenous individuals and families has been found to be effective in building bridges between these populations and the Western healthcare system and improving patient satisfaction, although less is known about how they improve health outcomes [11]. Whop and colleagues [15] reviewed research on successful Indigenous Patient Navigator programs in the United States and found that the navigator role provided a culturally competent service to reduce cancer mortality, by means of increased screening and assisting with follow-up care coordination.…”

“…Rankin and colleagues' scoping review of the role of Indigenous Patient Navigators commented on the dearth of literature from Australia and New Zealand surrounding this role, despite their colonial settler histories [11]. However, several small-scale studies in Australia have identified issues that a patient navigator could potentially address.…”