Evidence-based support for patient navigation
Unfortunately, patient navigation is a tough topic to study due to the difficulty of working in a randomized controlled trial setting, the small sample sizes of existing research, and the differences in how navigation is defined across programs. However, there is some evidence to help make the case.
A 2016 systematic review published in the Journal of Clinical Oncology and a 2017 systematic review from the Journal of Oncology Navigation & Survivorship break down the results from recent studies of patient navigation for cancer treatment and survivorship.
Who does patient navigation benefit?
While most patients would benefit from additional support throughout their cancer treatment, the literature suggests that the impact of patient navigation is more profound for disadvantaged or racial minority groups, as well as underinsured or uninsured populations. Studies show:
- More pronounced impact of navigation among racial or cultural minority groups on initiating treatment; and
- Larger decrease in time to treatment amongst un- or underinsured navigated patients compared to privately insured patients.
How can patient navigation improve care?
Patient navigation decreases time from diagnosis to treatment, with an increased likelihood that patients will initiate treatment within 30 and 60 days. Another area with clear findings is survivorship, as measured by adherence to post-treatment surveillance guidelines. Studies show:
- Evidence of significantly decreased time to treatment from diagnosis, up to 26 days earlier than control groups;
- Multiple findings with an absolute decrease in time to treatment, but nonsignificant results;
- Increased likelihood of receiving hormonal therapy amongst breast cancer patients; and
- Consistently higher surveillance mammography rates among navigated patients.
Can patient navigation impact cost and utilization?
University of Alabama Birmingham's Patient Care Connect program has shown a significant decrease in unnecessary resource utilization coupled with substantial cost savings for navigated patients—suggesting that patient navigation can have a big payoff. After three years, the system saw an estimated $54 million savings for all navigated patients with a 31% decrease in ED visits. Key to their success was:
- Targeting navigation to high-risk patients, taking into account a holistic assessment of their risk;
- Providing thorough disease and skill training to non-clinical navigators; and
- Hardwiring the process and using distress screening as a linchpin of the program.
The importance of continued research
Though the evidence listed here positively reinforces the role of patient navigators in cancer care, a volume of studies with nonsignificant or contradictory results makes it difficult to give a definitive answer about value of patient navigation. One crucial area lacking significant results is the impact of patient navigation on treatment adherence.
A fundamental limitation of any study on navigation is that every organization defines navigation differently depending on a host of factors, including physician preference, patient needs, and cancer program workflows.
The strongest case for patient navigation will come from expanded research on patient treatment adherence and outcomes, as well as a closer look at the current heterogeneity of navigation services. Your center can start maximizing patient navigation by identifying the needs of your particular community and tailoring services to those subsets.
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