History & Goals
The history of the Patient Navigation approach to cancer care begins with the realization that fragmentation of the health care system directly contributes to disparities in cancer treatment and survival. The Patient Navigation model developed in response to this problem. Due to these findings, the first “Patient Navigation” program was conceived and initiated in 1990 at Harlem Hospital Center and funded by the American Cancer Society. This ground-breaking project was directed by Dr. Harold Freeman, and found that Patient Navigation worked well for minority populations in an urban hospital setting. The project focused on navigating medically underserved women through breast cancer screening, diagnosis and treatment. Studies of the Harlem Hospital Center Breast Cancer Screening and Patient Navigation Program found that five-year survival rates rose from 39% prior to the program to 70% after its implementation .
In 1995-1996, another innovative Patient Navigator program was developed by Linda Burhansstipanov, M.S.P.H., Dr.P.H., at the AMC Cancer Research Center in Denver, CO and funded through the Robert Wood Johnson Foundation. The program, titled Native American Women’s Wellness through Awareness (NAWWA) was a culturally competent model aimed at increasing participation in breast cancer screening and included Patient Navigation as a component. Evaluation of the program found that Navigators were effective in increasing screening rates.
Interest in Patient Navigation began to grow following these encouraging results. In 2002 the President’s Cancer Panel, directed by Dr. Freeman, was invited to visit the Yakama Nation and discuss the burden of cancer among American Indian and Alaska Native people of the Northwest. Out of these conversations, the Northwest Tribal Cancer Navigator Program (NTCNP) Pilot Project was developed and began work in two clinics with funding from the Center to Reduce Cancer Health Disparities. The pilot project was completed in 2006 and the final report will be available on the NPAIHB website soon.
In 2005 the National Cancer Institute, with support from the American Cancer Society, awarded grants to nine research institutions to establish the Patient Navigator Research Program (PNRP). These institutions are charged with developing innovative patient navigator interventions to reduce or eliminate cancer health disparities and test their efficacy and cost-effectiveness. As a selected site, the Northwest Portland Area Indian Health Board (NPAIHB) expanded the Navigator Pilot Project to include four Navigation sites.
The NTCNP is a community-based intervention addressing barriers to timely, quality cancer diagnosis and care for American Indians. The overall aim of the NTCNP is to reduce delays of cancer diagnosis and care. Special emphasis of the NTCNP will be describing the unique cultural approach to cancer navigation.
Freeman M.D., Harold P. A model patient navigation program. Oncology Issues, September/October 2004, p. 45.
Goals
The purpose of the Northwest Tribal Cancer Navigator Program is to complete a comprehensive evaluation of the effectiveness of the Navigator model in Northwest tribal communities. The long-term goal is to ensure American Indian and Alaska Native patients have access to the same cancer care and services that are available to other groups. “Navigators” - nurses or lay health workers - will help patients overcome barriers to appropriate diagnosis and treatment for cancer.
If proven effective, the evaluation findings of NTCNP will provide policy-makers solid evidence on which to base funding decisions regarding use of this method of reducing the burden of cancer among American Indians and Alaska Natives.
