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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
to help low-income patients participate in screening for the detection of cancer and aid those with suspicious screening findings in gaining access to diagnostic and treatment services. Initially, patient navigators tended to be local community residents without professional credentials, but more recently some have proposed that nurses, social workers, and other health workers play a navigator role. This variation in the background of the navigator relates to differences in role expectations. While all navigator programs focus on helping patients overcome barriers to receiving effective services, some also include patient education and patient advocacy roles (Dohan and Schrag, 2005).
Evidence to date for the effectiveness of patient navigator programs is confined largely to their effectiveness in getting patients screened for the detection of cancer. One of the few randomized trials of this type of patient navigation (Jandorf et al., 2005) found that patient navigators increased the prevalence of screening for colorectal cancer. Results of other quasi- and nonexperimental evaluations suggest that such programs increase screening rates and may modestly increase the proportion of patients detected with early-stage disease (Dohan and Schrag, 2005). Some qualitative evidence suggests that navigators help patients overcome barriers, both logistical (e.g., transportation) and attitudinal, although their role in helping patients once diagnosed has received little study. However, a recent randomized trial evaluating the impact of a patient navigation program on follow-through with diagnosis among women with abnormal mammograms found that the intervention significantly increased the percentage of women achieving diagnostic resolution (Ell et al., 2007).
In summary, patient navigator programs appear to help low-income patients participate in cancer screening and perhaps diagnosis. Whether such programs can also be effective in linking a diverse patient population to appropriate psychosocial services and how they differ from case management functions described above remains uncertain, however. The American Cancer Society (ACS) and NCI have both launched major initiatives to implement and evaluate patient navigator programs. The ACS program involves placing trained ACS staff in strategically selected health care facilities with oncology treatment services to provide adult cancer patients and families with personalized and reliable information about the disease, referral to ACS resources, and timely follow-up. NCI has launched a Patient Navigation Research Program to address unequal access to standard oncology care by developing interventions designed to reduce the time to delivery of standard cancer services, cancer diagnosis, and treatment after an abnormal finding. Patient navigators in this program will assist patients and their families throughout the period of care by, for example, arranging various forms of financial support, scheduling transportation to appointments, and organizing child care during appointments. ACS is working