Do existing programs for breast cancer patient navigation align with a framework of existing principles?

Background: Patient navigators address barriers to care, organize care needs, and track patients to improve outcomes in complex care situations. A current challenge is to define navigation across varied settings. This research aims to determine the extent to which a group of foundation-funded navigation programs are consistent with the dominant model of principles for patient navigation. Study Design: A qualitative observational study generated narrative field notes describing navigator activities. Four researchers participated in observations of 10 self-defined navigation programs funded by a single foundation. Programs were diverse in organization, geographic distribution, and scope of activities. Data were analyzed using a priori codes derived from the nine principles of navigation outlined in the model. The coding scheme was modified after pilot coding a sub-sample of cases. Results: Nine of ten sites broadly aligned with six of the nine principles. Navigators were 1)highly integrated within clinics; 2)used several strategies to coordinate care across disjointed systems; 3)implemented navigators to provide patient-centric care; 4)eliminated multiple barriers; 5)defined the scope of the navigator role; 6)defined a specific skills level required for navigators. Additionally, navigators were integral in improving systems not directly related to patient care. Conclusions: We established that most self-defined navigation programs were broadly consistent with the goals of navigation outlined in the framework. The lack of a gold-standard for designing and implementing patient navigation programs has cultivated a diversity of practices. For the impact of navigation to be adequately measured, consensus criteria that define the practice of navigation are warranted.