Experiences of lay community health worker navigators in diagnostic breast imaging at a safety-net hospital

Recently, breast health navigation has become mainstream in clinical settings. Although the roles of navigators remain loosely defined, the goals are to improve follow-up, decrease times between services and eliminate barriers to making appointments. Utilizing the expertise of lay community health workers, extensively trained in breast health to act as a bridge between patients and providers, navigation begins when an abnormal mammogram is identified and ends when a recommendation for annual screening or treatment starts. Navigators schedule appointments, obtain referrals and prior films, make reminder calls, and among many other activities provide social support during a time of uncertainty.  Patient encounter data are tracked in a database and patient interactions are qualitatively described for reporting purposes.  During our 10 years of operation at a safety-net hospital, we have encountered patients with many distinct barriers ranging from: fear of positive results, financial concerns, language barriers, or lack of information.  In addition, we have fully become integrated in a high-volume radiology department at a safety-net hospital.   With a discussion (oral or roundtable) led by our senior lay patient navigator we will describe patient encounters at various stages of the diagnostic process, discuss how we became fully integrated into the health system, and describe success and challenges of being a navigator in a clinical setting.