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THEBASICSOFPATIENTNAVIGATION
Lesson1:TheRoleofthePatientNavigator
LearningObjectives
x Describetheroleofthepatientnavigator
x Compareandcontrastrolesacrosspatientnavigatortypes
KeyTakeaways
x Allnavigatorsaddressbarrierstocare.
x Barrierstocaremaybepractical,personal,systemsbased,providerbasedor
psychosocial.
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THEBASICSOFPATIENTNAVIGATION
LESSON1:THEROLEOFTHEPATIENT
NAVIGATOR
ThePatientNavigatorsRole
SamplePatientNavigatorJobDescription
PossibleBarriers
PatientNavigatorDuties
DayintheLifeofaPatientNavigator
ResourcesforPatientNavigators
ThePatientNavigatorsRole
Patientnavigatordutiesvary,butthemainrolethatallhaveincommonisaddressingbarrierstocare.The
patientnavigatorhelpspatientsidentifyandovercomechallengestogettingmedicalcare.Sometimesthe
navigatordirectlyremovesbarriersforpatients,butoftenthenavigatorhelpsthepatientsremovebarriers
themselves.Therearesomegeneralfunctionalcategoriesthatdescribepatientnavigatorfunctions:
x ProfessionalRolesandResponsibilities x EthicsandProfessionalConduct
x BarrierstoCare/HealthDisparities x CulturalCompetency
x PatientEmpowerment x Outreach
x Communication x CareCoordination
x CommunityResources x PsychosocialSupportServices/Assessment
x Education,PreventionandHealth x Advocacy
Promotion
Source:Willisetal.2013.
Allpatientnavigatorsaddressbarrierstocare,nomatterwheretheyworkinthecancercontinuum:
Survivorship:
Referrals for
Treatment:
wellness/nutrition;
Primary Education,
Screening/Early stress
Prevention: Support,
Detection:Remove management;
Adoptionof coordinationof
barrierstoaccess education;
healthylifestyle, multidisciplinary
toscreening survivorshipcare
diseaseprevention care,resource
plans;support
referrals
groups,retreats
andotherservices
Onthenextpageyouwillfindasamplepatientnavigatorjobdescription,whichisalsoavailableinthe
learningmanagementsystem.
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POSITIONDESCRIPTION:PATIENTNAVIGATOR
BASICFUNCTION
ThePatientNavigatorworksinadynamichealthcareenvironmentwithinoneormoredepartmentsproviding
oneononeassistancetopatients,navigatingthemthroughthehealthcaresystemtoensuretimely
screening,diagnosis,treatmentand/orposttreatmentcancercareandsupportiveservices.S/heworkswith
otherhealthcareprofessionalstoestablishandmaintainaclimateofmutualrespect,dignity,diversity,ethical
integrityandtrustandparticipatesinmultidisciplinaryteamstoprovidepatientcarethatissafe,timely,
efficient,effectiveandequitable.S/heusesknowledgeofone'sroleandtherolesofotherhealthcare
professionalstoappropriatelyassessandaddresstheneedsofpatientsservedtooptimizehealthand
wellness.S/heisexpectedtosetlearningandimprovementgoals;identifyandperformlearningactivitiesthat
addressone'sgapsinknowledge,skills,attitudesandabilities;andrespondtofeedbacktoimprove
professionalperformanceandpatientcare.
CHARACTERISTICDUTIES
Assistpatientsinaccessingcancercareandnavigatinghealthcaresystems.
Assessbarrierstocareandengagepatientsandfamiliesincreatingpotentialsolutionstofinancial,
practicalandsocialchallenges.
Identifyappropriateandcredibleresourcesresponsivetopatientneeds(practical,social,physical,
emotional,spiritual),takingintoconsiderationreadinglevel,healthliteracy,culture,languageandamount
ofinformationdesired.Refertolicensedcliniciansforphysicalconcerns,emotionalneedsorclinical
education.
Educatepatientsandcaregiversonthemultidisciplinarynatureofcancertreatment,therolesofteam
membersandwhattoexpectfromthehealthcaresystem.Providepatientsandcaregiversevidencebased
informationandrefertoclinicalstafftoanswerquestionsaboutclinicalinformation,treatmentchoices
andpotentialoutcomes.
Empowerpatientstocommunicatetheirpreferencesandprioritiesfortreatmenttotheirhealthcare
team;facilitateshareddecisionmakinginthepatient'shealthcare.
Empowerpatientstoparticipateintheirwellnessbyprovidingselfmanagementandhealthpromotion
resourcesandreferrals.
Followupwithpatientstosupportadherencetoagreedupontreatmentplanthroughcontinuednon
clinicalbarrierassessmentandreferralstosupportiveresourcesincollaborationwiththeclinicalteam.
Contributetopatientnavigationprogramdevelopment,implementationandevaluation.
Assesspatientcapacitytoselfadvocate;Helppatientsoptimizetimewiththeirdoctorsandtreatment
team(e.g.prioritizequestions,clarifyinformationwithtreatmentteam).
Encourageactivecommunicationbetweenpatients/familiesandhealthcareproviderstooptimizepatient
outcomes.
RELATEDDUTIES
Performsspecialprojectassignmentsrequiredtosupporttheimplementationandevaluationofpatient
navigation.
Assistswithcarecoordinationofpatients.
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Enhancesprofessionalknowledge/skillsbyidentifyingandparticipatingincontinuingeducation
opportunities.
Performsothernonclinicalworkrelateddutiesasrequested.
SUPERVISIONRECEIVED
Supervisionisreceivedfrom____________.
QUALIFICATIONSANDSKILLSREQUIRED
Basicunderstandingofmedicalterminology,healthcaresystemsandhealthcarefinancingrequired.
Proficiencywithapersonalcomputerisnecessary.DemonstratedfluencyinEnglish/[Insertanylanguage
requirementshere].Inaddition,thepatientnavigatormustbeableto:
Workcooperativelyandcommunicateeffectivelywithawiderangeofindividuals,includingpatientsand
familymembersfromdiversesocioeconomicandculturalbackgrounds,healthcareprofessionalcolleagues
andexternalhealthandservicefocusedorganizations.
Employactivelisteningandremainsolutionsorientedininteractionswithpatients,familiesandmembers
ofthehealthcareteam.
Demonstrateempathy,integrity,honestyandcompassionindifficultconversations.
Applyinsightandunderstandingaboutemotionsandhumanresponsestoemotionstocreateand
maintainpositiveinterpersonalinteractions.
Applyknowledgeofthedifferenceinrolesbetweenclinicallylicensedandnonlicensedprofessionalsand
actwithinprofessionalboundaries.Excellentcommunication,organizational,andinterpersonalskillsare
necessary.
WORKINGCONDITIONS
Theincumbentperformsjobdutiesinanormalbusinessofficeenvironmentand/orinacommunitybased
settingexteriortothenormalbusinessofficeenvironment.Tasksaregenerallycarriedoutinasedentary
formatwithinthebusinessenvironment.Thisinvolvesworkingwhilesittingatadeskforextendedperiodsof
time;exteriorworkingenvironmentsrequirestandingand/orwalkingforextendedperiodsoftime.Typically,
theincumbentwillnotbeexposedtoadverseweatherconditionsorphysicalactivitiesinordertoperformthe
jobotherthanoccasionallyliftingofficesupplyitemsthatmayweighupto20pounds.Theincumbentwillbe
requiredtoattendmeetingsinotheroffices,ordeliverand/orretrieveinformationfromotherofficesaround
campusandwithincommunitybasedsettings.
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PossibleBarriers
Therearegenerallyfivetypesofbarrierstocarethatyoumayneedtoassistwith:
Practical
Treatmentcosts
Transportation
Languagebarriers
Work
Foodinsecurity
Insuranceproblems
Stablehousing
Immigrationstatus
Psychosocial
Anxietyanddepression
Changesinrelationshipsandrolesinfamily
Familyandsocialsupport
Stigma,fear,socialisolation
Mentalhealth
Provider
Biasesinmedicalrecommendations
Poorcommunicationwithpatientswithlowliteracy
PoorcommunicationwithlimitedEnglishproficientpatients
Culturaldissonance
Systems
Lackofinterpreters
Longwaittimes
Lackofappropriateproviders
Inconvenientappointmenttimes
Personal
Lackofknowledge
Healthmyths
Mistrustofproviders
Lowpriorityplacedonhealth
Source:PNTC.
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GeorgeWashingtonUniversity(GW)CancerInstitute2015
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MO ODULE4 4:
Resou
urces
THEBASICSO
OFPATIEENTNAV
VIGATION
PatieentNavigato orDuties
Anottherwayoftthinkingabooutpatientn
navigationdutiesistothhinkaboutw
whatactionsyoutaketohelp
patieents,ortasks,andwhatwaysyouinteractwitthothers,orrhowyounnetwork.
NavigatorTasks
Maintaining
M Doccumenting
Navigating Facilitating O
Other
systems activities
Cooaching Finddingpatients Identifying Charttingtotrack Admin nistrative
Exxplaining Cooordinating entialpatientss
pote navigaation dutiestosupport
Acctivelisteningg team Build
ding activittiesin researcch
commmunication netw
worksand patienntsrecord Filingp
papers
Asskingquestion ns
Inte
egrating referrralroutines orthrrough Collaborating
info
ormation Reviewingcases navigaation withnuurse
thro
ough softw
ware ortools navigattors(if
doccumentation applicaable)
anddsharingwith
h
team
Collaborating
NavigationNetw
workDuties
Patientin
nteractions
Provideriinteractions
Noncliniccalstaff
Supportivveservices
PaperorElectronicMe
edicalRecords
Sourrce:Parkere
etal.2010.
ologyPatientNavigatorTraaining:TheFu
Onco undamentals
GeorrgeWashingto
onUniversityy(GW)CancerrInstitute2015
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ADayintheLifeofaPatientNavigator
Thetablebelowsummarizesadayinthelifeofapatientnavigatorwhoworkswithbreastcancerpatients.
Barrier/Event Action/NextStep
Callfrompatientwhohassurgeryin2days.Patient Mailpatientinformationoncamisole,includinga
wouldliketospeakwithanesthesiologistabout prescriptionandalistofplacesshecangetit;ask
nerveblock.Patientalsoneedsinformationabout doctortotaskanesthesiologisttocallthepatient
bras/garmentssheshouldwearafterthesurgery. beforetheprocedure.
Newlydiagnosedpatient(olderwoman,came Completedistressscreening,assessbarriersto
alone). care,helppatientidentifysupport;nextstep:BSGI
(refertonursetoexplainprocedure).
Patientcallswithquestionsaboutradiation(has Assistpatientwithschedulingappointmentand
notbeeninforherconsultyet). givegeneralinformation.
Newlydiagnosedpatient(mid30s,hasyoung Completedistressscreening,assessbarriersto
children)comesinforfirstappointment. care,helpidentifysupport;assistinfinding
oncologistclosetopatientshome;givebasic
informationaboutbreastcancerand
chemotherapy;refertonursetoexplainMediport
andtestsneededbeforestartingtreatment.
Patientbeginningchemoneedsherdoctortospeak Getdoctorsdirectphonenumber,trackdown
withsurgeonASAPregardingrecommendations. surgeon,askhertocalldoctor.
Otherdoctorisgoingonvacationtomorrow.
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PatientapplyingfordisabilityandMedicaid,needs FaxMedicalExaminationReportformtoPCPs
referraltoinfectiousdisease,psychiatry.Needs office;taskinfectiousdiseaseadministrativestaff
PET/CT. tocallpatientwithappointmenttime;givepatient
numbertoschedulePET/CT;followupon
psychiatryreferral.
Patientplanningmastectomysurgery,wouldliketo Workwithsurgeontoidentifyformerpatient;
speakwithformerpatientwhohadthesame contactformerpatientandaskifshewouldliketo
procedure. participate;contactcurrentpatientwithformer
patientscontactinformation.
Patientlivesfarawayandwouldlikeaconsultwith Assistpatientwithschedulingappointment;call
radiationonthesamedayasherappointmentwith patientbackwithinformation
surgeon.
Referralfrommedicaloncologistforpatienttosee Callpatientandsetuptimetomeetwithdietitian;
dietitian. addpatienttodietitiansschedule.
Patientneedsappointmentwithphysicaltherapist. Discussroleofrehabilitationclinic;schedule
patientappointments.
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ResourcesforPatientNavigators
x AcademyofOncologyNurseandPatientNavigators(AONN+)
AONN+isthelargestprofessionalsocietyforoncologynurseandpatientnavigators.
x AssociationofCommunityCancerCenters(ACCC)PatientNavigationTools
ThissectionoftheACCCwebsiteoffersaprogrampreassessmenttool,descriptionofpatient
navigatorresponsibilitiesandcorefunctions,samplejobdescriptions,sampleprogrampoliciesand
standardoperatingprocedures(SOPs),sampleassessmentandtrackingforms,samplepatient
satisfactionsurveysandanoutcomesmeasuretool.
x CChangesCancerPatientNavigationOverview
Thiswebsiteincludesinformationtopromotepatientnavigationandthedevelopmentofcommunity
basedpatientnavigationprograms.
x KansasCancerPartnershipsCancerPatientNavigationProgramToolkit
Thisguideprovidesavarietyofpatientnavigatortools,includingasamplepatientnavigatorposition
description,sampleintakeformsandtrackingtools,sampleflyers,asamplepatientsatisfactionsurvey
andmore.
x TheBostonMedicalCenterPatientNavigationToolkit
Thistoolkitprovidestoolsfordeterminingyournavigationtasks,sampleinterviewquestions,patient
navigatorintroductiontips,patientnavigatorprotocolsandotherusefultools.
x WillisA,PrattChapmanM,ReedE,HatcherE.BestPracticesinPatientNavigationandCancer
Survivorship:MovingTowardQualityPatientCenteredCare.JournalofOncologyNavigationand
Survivorship.2014.
x WillisA,Reed,PrattChapmanM,KappH,HatcherE,VaitonesV,CollinsS,BiresJ,WashingtonEC.
DevelopmentofaFrameworkforPatientNavigation:DelineatingRolesAcrossNavigatorTypes.Journal
ofOncologyNavigationandSurvivorship.2013.
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Module4,Lesson1:TheRoleoftheOncologyPatientNavigator
References:Presentations
AgencyforHealthcareResearchandQuality.CareCoordinationMeasuresAtlas:Chapter2:WhatisCare
Coordination.2014.Retrievedfrom:http://www.ahrq.gov/professionals/preventionchronic
care/improve/coordination/atlas2014/chapter2.html.
BoneLR,EdingtonK,RosenbergJ,etal.Buildinganavigationsystemtoreducecancerdisparitiesamongurban
blackolderadults.ProgCommunityHealthPartnership.2013;7(2):209218.doi:10.1353/cpr.2013.0018.
CommunityToolbox.Chapter23:ModifyingAccess,Barriers,andOpportunities.Section6:UsingOutreachto
IncreaseAccess.2014.Retrievedfrom:http://ctb.ku.edu/en/tableofcontents/implement/accessbarriers
opportunities/outreachtoincreaseaccess/main.
FioreMC,BaileyWC,CohenSJ,etal.TreatingTobaccoUseandDependence.ClinicalPracticeGuideline.
Rockville,MD:U.S.DepartmentofHealthandHumanServices.PublicHealthService.June2000.
HopkinsJ,MumberMP.Patientnavigationthroughthecancercarecontinuum:Anoverview.JOncolPract.
2009;5(4):150152.doi:10.1200/JOP.0943501.
JohnsHopkinsSchoolofNursing.Communityoutreachprogram.n.d.Retrievedfrom:
http://nursing.jhu.edu/excellence/community/outreach.html.
NationalCancerInstitute.Cancerhealthdisparitiesfactsheet.2008.Retrievedfrom:
http://www.cancer.gov/aboutnci/organization/crchd/cancerhealthdisparitiesfactsheet.
ParkerVA,ClarkJA,LeysonJ,etal.Patientnavigation:Developmentofaprotocolfordescribingwhat
navigatorsdo.HealthServRes.2010;45(2):514531.doi:10.1111/j.14756773.2009.01079.x.
PatientNavigatorTrainingCollaborative.n.d.Retrievedfrom:http://patientnavigatortraining.org/.
TheOfficeofMinorityHealth.WhatisCulturalCompetency.2013.Retrievedfrom:
http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=1&lvlid=6.
WillisA,ReedE,PrattChapmanM,etal.Developmentofaframeworkforpatientnavigation:Delineating
rolesacrossnavigatortypes.JournalofOncologyNavigation&Survivorship.2013;4(6):2026.
References:BriefQuiz
BraunKL,KagawaSingerM,HoldenAE,etal.Cancerpatientnavigatortasksacrossthecancercare
continuum.JHealthCarePoorUnderserved.2012;23(1):398413.doi:10.1353/hpu.2012.0029.
ParkerVA,ClarkJA,LeysonJ,etal.Patientnavigation:Developmentofaprotocolfordescribingwhat
navigatorsdo.HealthServRes.2010;45(2):514531.doi:10.1111/j.14756773.2009.01079.x.
PrattChapmanM,WillisA,MasselinkL.Corecompetenciesforoncologypatientnavigators.Journalof
OncologyNavigationandSurvivorship.April2015.
VargasRB,RyanGW,JacksonCA,RodriguezR,FreemanHP.Characteristicsoftheoriginalpatientnavigation
programstoreducedisparitiesinthediagnosisandtreatmentofbreastcancer.Cancer.2008;113(2):426433.
doi:10.1002/cncr.23547.
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WillisA,ReedE,PrattChapmanM,etal.Developmentofaframeworkforpatientnavigation:Delineating
rolesacrossnavigatortypes.JournalofOncologyNavigation&Survivorship.2013;4(6):2026.
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