Dr. Kathryn L. Braun is Professor and Director of the Office of Public Health Studies, chair of the DrPH program, and the Barbara Cox Anthony Endowed Co-Chair on Aging at the University of Hawai‘i. She also serves as Co-Principal Investigator of ‘Imi Hale Native Hawaiian Cancer Network, Co-Investigator of Hā Kūpuna National Resource Center for Native Hawaiian Elders, and lead evaluator for the Hawai‘i Healthy Aging Partnership. Dr. Braun is known for her work in community-based participatory research in cancer and gerontology, and she has published more than 200 peer-reviewed journal articles on these topics. She is a past winner of a Board of Regent’s Medal for Excellence in Teaching from the University of Hawai‘i. She is a fellow in the Gerontological Society of America and the Association for Gerontology in Higher Education, and is current President of the Active Aging Consortium Asia-Pacific. She is a former Peace Corps Volunteer (the Philippines), and a former Fulbright Scholar (South Korea). She loves to travel and has been to about 120 countries.
Questions & Answers
This program can easily be adapted to indigenous, minority, immigrant, and other underserved groups with low cancer screening prevalence. A key component is to hire navigators from the community of interest, as they will have the best chance of locating and engaging community members in new health behaviors. A second key component is training. Navigators must be provided basic information about cancer and cancer screening. Training also must include sessions on motivational interviewing, assessing need for and barriers to cancer screening, and helping clients overcome barriers. Navigators need to learn about local services to which to link clients, including services related to cancer, health insurance, and transportation and so forth. Navigators also need to learn how to engage families to help in getting their loved ones to screening; in other words, the navigator should not take the place of family and friends. Navigators need to understand the importance of tracking clients through outreach, education, screening, and follow-up. Finally, training must stress that a cancer patient navigator will never have all the answers; thus, it is essential to provide navigators with resources for additional information, as well as access to supervisors and clinicians.
Depending on the commitment and capacity of the agency/institution (clinic, hospital, community health center, community agency, etc.), the navigation program can be applied to community clients, inpatients, outpatients or all three, can include navigation for cancer treatment and survivorship as well as cancer screening, and can be focused on other chronic diseases as the majority of core competencies (communication skills, data collection and evaluation, relationship building, etc.) are applicable to patients with other chronic conditions.
There are several facilitators to implementation. First, administrative buy-in is critical. Many patient navigations programs are started with grant funds and navigation services are not yet a reimbursable service. Data on patient and clinic impact and patient satisfaction then are needed to convince the agency to sustain the program.
Second, non-navigator staff should be educated on the role of the navigator so there is a clear understanding of how navigators enhance, vs. duplicate what other staff do.
Third, navigators should be hired from the community of interest, and training should be localized so that navigators can meet local providers and learn about local services for people needing cancer screening and cancer care. These navigators should be encouraged to conduct outreach into their communities by promoting the program in culturally appropriate ways, engaging local leaders as supporters, and partnering with local groups, such as churches and social clubs, where clients congregate.
Fourth, there needs to be services and programs available for the navigator to link clients to. For example, navigators may need to have access to financial resources to help cash-limited clients to travel to screening and pay for parking. Navigators need to have the flexibility to help clients as needed, e.g., by transporting them to appointments, negotiating with a family member to provide child care while the parent or grandparent keeps a screening appointment, or even making group mammogram appointments for women who feel safer coming to appointments together and perhaps accompanying the group to provide English translation.
We recommend that the program be evaluated by soliciting feedback from clients, navigators, and providers. For our cancer patient navigation program at an urban hospital, we mailed a postcard to individuals who had been assisted by a navigator, asking these seven questions:
1. About how many times have you seen your Navigator? (circle one)
1 time
2-3 times
4-8 times
9+ times
2. The Navigator helped me get answers to my cancer care questions. (circle one)
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
3. The Navigator helped make sure I missed very few, if any, appointments. (circle one)
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
4. The Navigator provided me support and resources to help me complete my treatment goals. (circle one)
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
5. Overall, I feel that the Navigator helped my family and me through my cancer journey. (circle one)
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
6. I recommend that navigation services be available to all cancer patients. (circle one)
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
7. Please share any comments about your Patient Navigator.
This patient satisfaction tool identified that 90% of patients were very satisfied with the services they received from the navigator and supported the hospital’s cancer program to continue this service.
Administrators should be aware that Dr. Linda Burhansstipinov has a grant from SBIR to develop an electronic database for use by cancer patient navigators (A Tool to Improve Evaluation of Patient Navigation Services in Underserved Populations, PI: Burhansstipanov, 1R43 MD011350-01). Once finished, this product would be an excellent choice for navigator programs, as it will produce reports that can be used for program evaluation.
Currently, we are focusing on feasibility of applying the training curricula and program to train navigators to assist patients with other chronic diseases such as cardiovascular disease, diabetes and asthma.