Describing what navigators do for patients: Patterns of task and network actions performed by navigators to facilitate cancer care

Problem:

Patient navigation programs for cancer have proliferated, but neither the parameters of navigators' roles nor variation in what they actually do have been well described.

Methods:

We observed 34 navigators working with patients screened for breast, cervical, colorectal or prostate cancer in 8 sites of the Patient Navigation Research Program: 1 to 4 observations per navigator, 2 to 7 hours each (132 observations). A structured protocol recorded 16 types of task and network actions every 15 minutes. Observations were defined by rates of categorized actions. Factor analysis identified summary dimensions of task/network action rates. Cluster analysis defined distinct groups of observation with respect to measured dimensions.

Results:

We identified four dimensions of task/network actions: 1, talking with patients, providers and community supports to facilitate care; 2, exchanging messages with patients, interacting with clinic staff, and documenting actions; 3, maintaining networks with community supports; 4, performing non-navigation tasks. Seven patterns were identified. Four (65% of sessions) differed modestly in their mix task/network actions. Three were more distinct, with activities dominated by (1) messaging patients, interacting with clinic staff and documenting (dimension 2), (2) talking with patients, providers, community supports (dimension 1) or (3) a strong mix on both of these dimensions. Patterns varied by site and number of patients navigated.

Conclusions:

We have identified discrete patterns of navigators' activities in a large national sample. Findings may inform study of the relationships between program settings, actual activities, and the effects of patient navigation.