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Charting a course
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I’m participating in a class about cancer health care quality in the School of Public Health. Though I’m not taking the class for credit (I already have an MPH), the professor is terrific, and I’m enjoying the opportunity to catch up on a few years of literature about cancer quality. The other day, one of the class participants e-mailed a copy of an article from Cancer in 2008 about patient navigators (Wells KJ et al. Cancer. 2008;113(8):1999-2010).
If your center is anything like mine, I’m sure you’ve come to appreciate how ubiquitous patient navigators are becoming in the delivery of academic cancer care. I see patients in a hematologic malignancy clinic, and our hematologic malignancy nurse navigator has markedly improved the experience — from the patient perspective and certainly from mine as well. She has transformed the care delivery in that clinic into a team approach, and her close and constant communication with my patients provides both my patients and me with an added layer of security.
As I look around my center, though, I can see that different navigators are fulfilling different roles in other disease areas. Some are functioning more as administrators, others as care providers, others as case managers and some as combinations of the three. What exactly is the job description of a patient navigator, and how are navigators evaluated on performance? Does the evaluation include clinical outcomes of patients with cancer?
As the Cancer article points out, the answers to these questions are far from clear across the country. Though the concept of a patient navigator isn’t brand new, the implementation of this role in different centers is evolving rapidly. This role can be filled by individuals with a variety of backgrounds, with usually little training in patient navigation — in part because of the variable definitions of the term. Whether the driving force behind patient navigation is administrative, theoretical or part of a planned project in cancer quality improvement is also not always clear.
Does your center have patient navigator(s)? If so, what do they do? I think the potential for patient navigators to play a central role in quality improvement is tremendous, but centers that envision the job in this way will need to define the job as such and measure outcomes accordingly.