Core Principles of Navigation

Nicole Messier, RN, BSN
Clinical Program Coordinator, Vermont Cancer Center, Fletcher Allen Health Care, Burlington, Vermont

Pamela J. Vlahakis, RN, MSN, CBCN
Clinical Care Coordinator, Hunterdon Regional Breast Care Program, Hunterdon Regional Cancer Center, Flemington, New Jersey

The session leaders defined patient navigation in accord with the National Cancer Institute’s 2005 definition, discussed the 9 core principles of patient navigation, and identified barriers all navigators face when providing care. The speakers also explored the relevance of navigation principles in the context of 2 case studies illustrating issues in their practice settings. Ms Vlahakis began as a navigator for patients with breast cancer and now works with patients with any type of cancer at her community medical center, whereas Ms Messier navigates patients with upper gastrointestinal cancers in an academic setting.

The principles of navigation are:

1. Patient navigation is a patient-centric healthcare service delivery model.
2. Patient navigation serves to virtually integrate a fragmented healthcare system for the individual patient.
3. The core function of patient navigation is the elimination of barriers to timely care across all segments of the healthcare continuum.
4. Delivery of patient navigation services should be costeffective and commensurate with the training and skills necessary to navigate an individual through a particular phase of the care continuum.
5. The determination of who should navigate should be determined by the level of skills required at a given phase of navigation.
6. In a given system of care there is the need to define the point at which navigation begins and the point at which navigation ends.
7. There is a need to navigate patients across disconnected systems of care, such as primary care sites and tertiary care sites.
8. Patient navigation systems require coordination.
9. Patient navigation should be defined with a clear scope of practice that distinguishes the role and responsibilities of the navigator from that of all other providers.

In concluding, Ms Messier described the key points for patient navigation: the staff of each program must revisit and redefine patient navigation specific to their institution and culture; all disease sites are now studied for the benefits navigation provides; and navigation research must continue to document measurable outcomes.