Key considerations in designing a patient navigation program for colorectal cancer screening

Introduction - Colorectal cancer is the second leading cause of cancer deaths among cancers affecting both men and women. Screening reduces mortality by detecting cancer early and removing precancerous polyps when found. Only 58.6% of adults are currently up-to-date with colorectal cancer screening. Patient navigation shows promise in increasing adherence to colorectal cancer screening; however, it is a complex intervention that is operationalized differently across institutions. Methods – We conducted a review of the literature from 1995-2012 and identified 12 efficacy studies of patient navigation for colorectal cancer screening. An abstraction form was used to assess specified criteria. We also conducted an environmental scan of existing navigation programs including a search of grey literature and interviews with 11 practitioners and researchers from established navigation programs. Results – Based on the literature review and environmental scan, we identified ten key considerations in designing a patient navigation intervention for colorectal cancer screening including: (1) identifying a theoretical framework and setting program goals, (2) considering community characteristics, (3) establishing the point(s) of intervention within the cancer continuum, (4) determining the setting in which navigation services are provided, (5) identifying the range of services offered and patient navigator responsibilities, (6) determining the staffing background and qualifications for navigators, (7) selecting the method of communications between patients and navigators, (8) designing the training for navigators, (9) defining the oversight and supervision for the navigators, and (10) evaluating patient navigation. Conclusions - Public health practitioners can benefit from these practical results for designing patient navigation programs.