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An Assessment of Patient Navigator Activities in Breast Cancer Patient Navigation Programs Using a Nine-Principle Framework

Keywords: Patient navigation; breast cancer; patient-centered care; disparities.

Objective: To determine how closely a published model of navigation reflects the practice of navigation in breast cancer patient navigation programs.

Data Source: Observational field notes describing patient navigator activities collected from 10 purposefully sampled, foundation-funded breast cancer navigation programs in 2008–2009.

Study Design: An exploratory study evaluated a model framework for patient navigation published by Harold Freeman by using an a priori coding scheme based on model domains.

Data Collection: Field notes were compiled and coded. Inductive codes were added during analysis to characterize activities not included in the original model.

Principal Findings: Programs were consistent with individual-level principles representing tasks focused on individual patients. There was variation with respect to program-level principles that related to program organization and structure. Program characteristics such as the use of volunteer or clinical navigators were identified as contributors to patterns of model concordance.

Conclusions: This research provides a framework for defining the navigator role as focused on eliminating barriers through the provision of individual-level interventions. The diversity observed at the program level in these programs was a reflection of implementation according to target population. Further guidance may be required to assist patient navigation programs to define and tailor goals and measurement to community needs.

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