It’s been more than 23 years since Harold Freeman pioneered the concept of Patient Navigation (PN). The original idea behind it was to facilitate patients to screening, diagnosis, treatment, and supportive care. Clinical trials were not in the picture at the time. However, with the success of navigation--helping patients to eliminate financial, logistical, system, communication, and psychological barriers--it seems that it might be an effective strategy for clinical trials accrual as well. Many studies continue to examine the effectiveness of PN, hopefully leading to results of how the strategy could be used to increase accrual to clinical trials. At last week’s 2013 American Public Health Association’s annual meeting in Boston, researchers illustrated some key considerations and activities for patient navigators that seemed to make the most impact on care.
In the Redes En Accion 6 Cities Study to facilitate Latinas with breast cancer to treatment, patient navigators across the six cities were asked to log their daily activities to assess how most of their day was spent. Out of ten activities, Spanish-English translation was the most frequently reported at 61.9%. Telephone support came in next with 59.5%, and transportation and appointment scheduling followed at 54.8%. Of these four highest reported activities, translation, transportation, and telephone support were the patient navigation activities that were significantly associated with initiation of treatment within 30 days.
Another study conducted as part of the National Cancer Insitute’s Patient Navigation Research Program investigated the various tasks that PNs conduct and with whom, and which of those tasks and networks improve care. Specific patient-related tasks, such as providing support and coaching, were significant to improving care. In addition, some collaboration tasks with providers and other medical personnel--coordinating care, seeking advice, and finding supports--helped considerably as well. It was also noted that several tasks a PN performs that detract from care. Overarching system maintenance, finding potential patients, and building internal and external networks, as well providing clinic back-up, and other non-navigation tasks, did not help to improve care.
So, not surprisingly, patient navigation tasks targeted at supporting specific patients seem to be the most effective at helping patients find appropriate care, and, in contrast, those tasks associated with general documentation and support are not--a little food for thought as to how patient navigators might also be able to support patient accrual. In February, Eileen Dimond provided some ways that patient navigators are being integrated into research teams. How might the above results lead to the effectiveness of patient navigators to facilitate clinical trial accrual?