Welcome back to Navigation Refresh, a recurring, informative feature for novice and seasoned patient navigators alike. In this issue, we cover the implementation of an oncology navigation program.
Implementing a program is harder than one might think. Patient navigation can mean so many things that deciding what you are really doing, for whom, for how long, in what context, is critical to clarify in order for patients and clinicians to understand the navigator role.
In 2024, the World Health Organization (WHO) published a technical brief to summarize patient navigation evidence and provide guidance for implementing patient navigation in the context of breast cancer screening, detection, and treatment.1 The Figure shows the key steps for implementing, monitoring, and evaluating a patient navigation program according to WHO.
The WHO framework emphasizes a number of important aspects of program building. First, identify your key stakeholders and engage them in the program development and implementation process. Consider who needs to be at the table for your program to work? This might include clinical champions, patient support staff, navigators, navigator supervisors, and community stakeholders.2,3
The second step is conducting a situation analysis. This could involve identifying your institutional capacity for delivering navigation services, who will supervise the navigation program, and how patients will access services. It might also include whether competing institutions offer patient navigation services and what you need to do to keep up with the competition. Finally, what internal and external resources are available?
As part of your situation analysis, you should also consider the needs you want to address for patients. What are your patients’ greatest needs? Which patients have the greatest needs? Where are the disparities in outcomes? What is getting in the way of patients accessing services and/or completing treatment? Your program cannot do everything for every patient, but understanding your patients’ top needs and how you might address those needs is important. Process mapping can be a helpful tool to target pain points along the patient’s journey and ways that navigators can connect patients to resources or coordinate care to alleviate those pain points.2,4
Deciding who will provide patient navigation services, how they will be trained,5 and what their scope of practice and role delineation will be from other patient support staff will be an important part of process mapping and assessment of human resource capacity for navigation.
Consideration of your financing approach and whether your institution plans to bill for services should be considered. While Medicare now reimburses for patient navigation services,6 implementation of billing has been slow due to documentation requirements, lack of billing infrastructure, and reimbursement rates that do not fully cover program costs. Some programs opt to integrate navigation services with their organizational budget (without billing) and/or rely on philanthropy to support navigation. More work needs to be done to smooth out billing for patient navigation and bolster sustainability of programs.7
Piloting your program to identify where process maps may need to be refined or communication channels need to be reinforced can also help build a solid foundation for your program. You can start with 1 clinic and test out a process map, refine it, and then expand your services when you are confident that the processes you put in place are working as expected.
Adapting to context relates to all of the previous steps, since each program will be different in terms of priority patients, patient needs, institutional context, and community context. Considering program priorities and evaluation metrics that show value in your specific context will improve the fit of your program to address patient needs and show value of your program.
Finally, when considering evaluation and monitoring, AONN+ has identified 35 metrics for patient navigation as well as 10 core metrics that are recommended across programs.8
Core metrics include documenting patient barriers to care, navigation caseload, social support referrals, palliative care referrals, and patient satisfaction. Navigator knowledge, assessment of patient learning style, and days to key milestones (eg, diagnosis to treatment, days to hospital readmission) are also included in the core 10 metrics.8
This edition of Navigation Refresh aligns with Standard 17: Operational Management, and Standard 18: Practice Evaluation and Quality Improvement, of the Professional Oncology Navigation Task Force (PONT).6
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