The identification of barriers to care was a primary focus of patient navigation instituted in the 1990s by Harold P. Freeman, MD, to help explain delays in diagnosis as well as incomplete care for underserved women with breast cancer.1 This same premise was the goal of nursing utilization review in the 1970s that evolved into utilization management, case management, and care coordination.2 With this evolution, the process of a team approach with open communication was developed to address psychosocial distresses and financial concerns of patients as well as coordinate care needs. Nurse navigation cultivated the bidimensional care concept—patient centered and health system oriented—as oncology care moved to an outpatient setting.3
Navigators possess insight of a patient’s comprehensive care needs (physical, social, emotional, cultural, and spiritual), provide education and advocacy for the patient, link the patient to networks of professional and community resources, and act as a contact to enhance psychosocial care. By taking the time to observe the care process of patients, performing community needs assessments, and utilizing critical thinking and problem-solving skills, navigators are able to identify barriers to care, ineffective processes, and communication gaps. Navigation is integral to facilitate effective interprofessional collaboration and promote patient satisfaction and care quality, as well as the efficient use of healthcare resources to decrease costs across oncology patient populations and healthcare settings. Functioning as members of the multidisciplinary team and being knowledgeable in the cancer care continuum, navigators provide patient-centered education; assist with communication among the patient, family, and healthcare team; reinforce to patients and their families the significance of adherence to treatment and follow-up; as well as promote healthy lifestyle choices and empower patients with self-care strategies. Navigators may have additional responsibilities, including performance improvement projects, program development and planning within the healthcare system and community, quality improvement and program evaluation, reporting to their cancer committee and administration, health promotion and disease prevention education in the community, and building community partnerships.
It is essential for navigators to commit to lifelong learning and evidence-based practice, and to pursue ongoing continuing education. Navigators must remain knowledgeable about practice changes and current advances in treatments and symptom management. There are opportunities through the Academy of Oncology Nurse & Patient Navigators (AONN+) for navigators to be involved in a professional organization, presentations, publications, and research.
The guiding principles of navigation are to ensure that quality, confidentiality, and professionalism are threaded throughout all aspects of care and programming while demonstrating respect, compassion, and safe, culturally competent care. Common responsibilities of a navigator may include:
- Providing tailored, culturally appropriate education and support/empowerment to the patient and family
- Identifying special needs of the patient and delegating to appropriate support staff
- Enhancing understanding of treatment options available
- Facilitating patient care plan recommendations by physician
- Coordinating multidisciplinary care from time of diagnosis throughout treatment
- Improving timeliness of appointments
- Serving as a resource for the community on health issues, prevention, screening, treatment, and research
Skills such as advocacy, problem solving, time management, critical thinking, multitasking, collaboration, and communication were identified in the Oncology Nursing Society oncology nurse navigator role delineation study.4 AONN+ also recognizes the additional skills of leadership and systems management.
AONN+ Competencies for the Domain of Professional Roles and Responsibilities
- Critical thinking
- Problem solving
- Team building
- History/evolution of navigation
- Definition of navigation and types of navigation
- Tracking workload
- Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer. 2011;117(suppl):3539-3542.
- Shockney LD. Evolution of patient navigation. Clin J Oncol Nurs. 2010;14:405-407.
- Fillion L, Cook S, Veillette AM, et al. Professional navigation framework: elaboration and validation in a Canadian context. Oncol Nurs Forum. 2012;39:E58-E69.
- 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.