In 1990, Harold P. Freeman, MD, founded the first patient navigation program as a strategy to improve outcomes in the underrepresented by eliminating barriers to diagnosis and treatment.1
“If people meet barriers in getting through the healthcare system with cancer and other chronic diseases, then maybe we should navigate them. Maybe we should navigate them. The concept of patient navigation came out of that experience,” he said.
In 1990, Harold P. Freeman, MD, founded the first patient navigation program as a strategy to improve outcomes in the underrepresented by eliminating barriers to diagnosis and treatment.
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG, cofounded AONN+ in 20092 and further refined the role of navigation across all disciplines, including nurse navigation, social work navigation, and patient navigation.
The field has now expanded to include financial navigators, genetic counselors, and dietitians, each practicing within their scope yet focusing on the patients, their needs, barriers, and solutions to address health equity.
“Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.”3 Health equity is impacted by long-standing predispositions known as social determinants of health, which influence access to healthcare, education, income, physical environment, and social/community settings.
We’ve heard time and time again that where you live, your zip code, can impact your overall health, life expectancy, and access to care. What we can’t seem to get right is the understanding that every patient deserves to have a navigator on their care team, helping break down barriers, find solutions, and providing personalized care because patient navigation is one of the only evidence-based interventions that has effectively been able to address disparities in cancer care.4
In June 2023, AONN+ published a Call to Action: Navigation Is a Critical Component in a Comprehensive Approach to Dismantling Health Inequities4 for the sustainability and integration of navigation within healthcare teams and systems. Navigators improve the lives of those in need, impact health literacy through education, are sensitive and thoughtful in their approach, and increase awareness of underrepresented populations.
Let’s review 2 of the 19 Oncology Navigation Standards of Professional Practice5 intended to provide guidance that can be applied to a variety of settings where navigators practice. Each standard is designed with health equity in mind.
Standard 4, Cultural and Linguistic Humility, focuses on navigators practicing in a way “that is culturally and linguistically humble and inclusive.” Furthermore, Standard 12, Treatment, Care Planning, and Intervention, notes that navigators identify potential barriers, advocate, provide evidence-based information, and support patients across the continuum of care. Both are key to creating a state where all people with cancer have access, tools, and resources to achieve their highest quality of health.
Imagine your loved one was just diagnosed with late-stage cancer, maybe even metastatic. Should the neighborhood where they live determine the quality of care they receive? Should their income and/or highest form of education limit their ability to access healthcare? If navigation is evidence based, why don’t all people with cancer have access to its services?
Efforts need to be made to integrate navigators into cancer programs, expand access across underserved areas, enhance collaboration with professional and community organizations, as well as policymakers.
“Only through a collective effort can we work towards achieving health equity for all individuals affected by cancer along the care continuum.”4 We must unify our voices, come together, and continue to fight!
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