Measuring what navigators do for patients: Development of an instrument to assess tasks and use of social networks

Problem:

Patient navigation—the process of linking patients to complex cancer services, circumventing barriers, organizing services, and tracking patients through treatment—holds promise for reducing disparities in cancer outcomes. Navigation programs have proliferated, but the parameters of navigators' roles are not well defined, limiting understanding of how their performances vary and how specific components contribute to optimal patient outcomes. We developed an instrument for measuring navigators' work.

Methods:

Navigators in the nine participating sites of the NCI-funded Patient Navigator Research Program (PNRP) support the care of patients with abnormal screening tests for breast, cervical, colorectal, or prostate cancer. We chose three representative sites for close, qualitative study, shadowing and interviewing navigators as they worked. Detailed field notes were aggregated and compared across all navigators, sites, and cancers to develop a taxonomy of navigator activities.

Results:

The taxonomy defines two dimensions: tasks and network contacts. Tasks include scheduling tests and appointments, speaking to physicians to support care, identifying community supports, and arranging for services. Network contacts include the parties involved in accomplishing and supporting care, such as patients, providers, administrative staff, and social service agencies. The taxonomy informed a structured, comprehensive instrument for observing the work of navigators.

Conclusions:

We have developed an instrument to be applied in the remaining PNRP sites and Avon Foundation-supported programs that serve women with breast cancer. It should prove to be sensitive to the diverse settings in which navigators work and enable systematic description of variation in what navigators do for use in outcomes studies.