In 1990, Harold P. Freeman, MD, noticed that African American women in the Harlem community had a higher incidence of breast cancer mortality.1 He observed delays in follow-up care after abnormal findings or cancer diagnoses, and proposed that patient navigators from the community could help address and bridge the gaps between this patient population and the healthcare system. The scope of navigation, including nurse and patient navigation, has evolved, and can now span the entire continuum of care, including community outreach and prevention.
In its 2012 standards, the American College of Surgeons Commission on Cancer (CoC) incorporated navigation as a standard of care for cancer programs seeking accreditation beginning in 2015.2 The CoC Standard 3.1: Patient Navigation Process states that cancer programs must complete a community needs assessment to define the patient population being served, identify the needs of this population, identify gaps in resources, and determine how navigation can address these needs.
A national survey conducted by the Oncology Nursing Society in 2012 indicated that the navigator role varies from setting to setting, but there are some common tasks performed by all navigators, including patient education, coordination of care, referral to resources, and psychosocial support.3 Furthermore, oncology navigation takes place in many care and community settings for patients with different cancer types, and who are at any stage of the cancer continuum.
Because early detection is key to achieving better outcomes, this inaugural article focuses on the role of the navigator in the area of community outreach, needs assessments, and approaches to related quality improvement activity. Competencies of the navigator with regard to community outreach and prevention include:
- Finding community resources
- Community needs assessments
- Identifying barriers to care
- Interventions to remove barriers to care
- Community education on prevention and screening
- Population health
- Risk assessment
- Cultural awareness
- Behavior modification
The role of the nurse navigator is to assist patients in scheduling and completing computed tomography screening tests, help coordinate multiple medical services for follow-up care, provide behavioral and psychosocial education with provision of evidence-based smoking cessation information, monitor smoking cessation, address barriers that may interfere with successful adherence to the lung cancer screening protocol, and document metrics to demonstrate outcomes for facility program goals (ie, community needs assessment, cancer committee, and national presentation).
As an Academy of Oncology Nurse & Patient Navigators member, you have access to the Evidence into Practice Committee to help you in the undertaking of a quality improvement project in community outreach,
or any of the other key domains that are relevant to navigators.
- Freeman HP. Patient navigation: a community based strategy to reduce cancer disparities. J Urban Health. 2006;83:139-141.
- Commission on Cancer. Cancer program standards 2012: ensuring patient-centered care, vol. 1.2.1. www.facs.org/~/media/files/quality%20programs/cancer/coc/programstandards2012.ashx. Accessed December 18, 2015.
- Brown CG, Cantril C, McMullen L, et al. Oncology nurse navigator role delineation study: an oncology nursing society report. Clin J Oncol Nurs. 2012;16:581-585.