What makes patient navigation most effective: Defining most useful tasks and activities

Introduction: To explore the association between patient navigators' activities and time to diagnostic resolution for abnormal cancer screening tests.

Method: We observed 34 patient navigators in 2-7 hour sessions as they worked in 9 sites of the national Patient Navigation Research Program (PNRP). We used a previously developed observational tool to record the frequency (per hour) of five tasks performed by trained navigators: A. Navigating with specific patients B. Facilitating for specific patients C. Maintaining system for all patients D. Documenting/Reviewing E. Other activities ( provide clinic back-up, do non-navigation tasks) Clinical data from patients enrolled in the navigated and control arm of the PNRP were used to assess outcomes; the proportion of subjects who completed diagnostic evaluation of a cancer screening abnormality within one year. We calculated the correlation (R2) between frequency of the task with the rate ratio of improved diagnostic resolution to assess which tasks had the greatest impact on the patient outcome.

Results: Sites with the highest rates of navigators directly navigating or facilitating with patients had the highest ratios of diagnostic resolution relative to controls (R2=0.40 and 0.28, respectively). Sites with navigators working with medical records documentation, with no direct patient contact, were associated with a longer time for diagnostic evaluation for abnormal cancer screening test.

Conclusion: Sites where navigators spend the most time directly working with patients, and have limited documentation time, appear to be most effective in facilitating timely cancer care.