Describing and evaluating cancer patient navigation: Lessons learned from programs at four health centers in Hawaii

Cancer patient navigation (CPN) is designed to help people access and complete recommended cancer screening and treatment, but there is limited agreement on how to best target CPN services. Evaluation to definitively quantify outcomes has proven elusive. This paper describes patient navigation in four healthcare facilities in Hawai‘i and presents findings from evaluation. Descriptive data were gathered through interviews with CPN personnel. De-identified program and evaluation data were provided by each of the facilities. Study waivers were obtained from the IRBs affiliated with each program. All four facilities navigated clients through cancer diagnosis and treatment, and one also navigated patients to cancer screening. Cancer screening navigation was offered to rural-dwelling people and evaluated by randomized control trial, which demonstrated that navigation significantly increased compliance with recommended cancer screening tests. The programs providing navigation to treatment were more difficult to evaluate because navigators assisted a large variety of patients with a variety of cancers at a variety of stages, each with individualized treatment plans. However, data suggest that navigation services were provided to patients with the greatest needs for information, reassurance, transportation, financing, appointment scheduling, and service coordination. Case study methods and client satisfaction surveys also helped to document program impact. CPN services can reduce disparities in cancer screening, are appreciated by clients, and can be successfully targeted to individuals at greatest need for assistance. More work is needed to develop evaluation methods to test navigation's ability to help cancer patients efficiently complete individualized treatment.