Tools to Address Barriers to Care

Navigation programs were created by healthcare systems to address internal barriers that may contribute to well described inequities in cancer care that generally impact minorities, low-income communities, and recent immigrants in the United States. Since the first program was started in New York City in the 1990s, the concept has been adopted in other healthcare settings around the country.

Recently, the federal government and national agencies have demonstrated interest in this model and committed millions of dollars in research monies to establish and evaluate navigation programs. Understanding how existing programs define and organize navigation services and the effectiveness of extant programs is important for future programs and research.

In this new study Daniel Dohan, Ph.D. of the University of California, San Francisco and Deborah Schrag, M.D., M.P.H. of the Memorial Sloan-Kettering Cancer Center reviewed the literature on navigation systems and described care processes in clinics with and without navigation programs. The authors found a dearth of research literature on navigation programs in general and noted that program efficacy had yet to be evaluated using rigorous methodologies such as randomization.

The authors also found that while navigation programs often used similar strategies to those of social workers and community outreach workers, navigators were distinguished by being reactive to the needs of particular patients rather than standardized. Given the increasing use of navigation programs, the authors conclude that "the navigator role must be defined more fully, and appropriate metrics developed to measure the services provided by navigators."; Source: John Wiley & Sons, Inc.