The concept of "patient navigation" can be traced back to the United States over 30 years ago when the American Cancer Society held the "National Hearings on Cancer in the Poor" in 1989.1 After these hearings, the American Cancer Society introduced the first patient navigation program in the early 1990s. The original aim of such a program was to reduce mortality by removing barriers to early detection and reducing time from diagnosis to treatment.1 A subsequent milestone in the history of patient navigation is the Patient Navigator and Chronic Disease Prevention Act of 2005.1 After over 30 years of evolution, there are varying definitions of "patient navigation" in practice in the United States today.2-4 It is important to note that, over the same period, there have been a range of programs and roles implemented in countries other than the United States. Indeed, there has been overlap in activities and concepts between "patient navigation," "care coordination," and "case management."5

Despite the plethora of descriptions and overlapping concepts, we would like to promulgate a definition that has been derived through careful examination of empirical data on implementation and evaluation of patient navigation. A recent extensive review of the literature5 concluded that patient navigation in cancer care is:

an individualized intervention that aims to address barriers and facilitate timely access to healthcare services, diagnosis, and treatments and care, with the following common characteristics: (1) Identifies barriers to accessing care experienced by individuals; (2) Overcomes barriers (eg, healthcare system, literacy, language, cultural, social, financial, and logistical) experienced by individuals; (3) Addresses disparities from contextual barriers (eg, geographical, racial/ethnic, financial, socioeconomic); (4) Can occur anywhere along the cancer care continuum (from early detection to end-of-life); (5) Can be delivered by various personnel or through digitalized systems, with or without other facilitators (eg, artificial intelligence). Navigators may come from clinical (nurses and oncology social workers) or non-clinical backgrounds (case managers, outreach workers, community health workers/aides/representatives/volunteers, counselors, educators, health coaches, peers, cancer survivors, and lay personnel). Patient navigation in cancer care may include support for individuals, families, and caregivers to navigate the health system, and address holistic, emotional, educational/informational, and carer needs. Navigation can also be delivered at an individual level or targeted at a community level, or a combination of both.5

The American Cancer Society "National Navigation Roundtable," established in 2017, has led a number of initiatives and meetings to advance navigation efforts in the United States. This national coalition published a suite of valuable articles in Cancer in 2022,4 which address a range of topics relating to progress of the coalition, barriers and opportunities to measuring the impacts of navigation, and implementation concerns and learnings (eg, sustainability, clinical vs nonclinical navigators, role retention, COVID-19 implications). It is important that the international community gathers the wisdom and learnings from our colleagues in the United States who share generously with the global community, but to critically consider implications for their respective countries or settings.

Here, we propose some research or service planning questions for consideration by the international community:

1. For countries or settings that do not yet have any form of navigation, what would be the ideal design of "patient navigation"? What key contextual factors should inform the conceptualization and implementation of "patient navigation" in their specific settings?

2. For countries or settings that already have dedicated programs or roles relevant to "patient navigation," what is the potential to establish new resources or adapt existing resources to enable consistency with the definition outlined previously? Is there an opportunity to introduce new navigation programs or roles that can better reduce barriers and facilitate access to care?

We believe that most countries or settings would already have some form of navigation, whether it be delivered by dedicated navigators or by primary care providers/community health workers. However, we suggest that there are enormous opportunities for shared learnings and innovations across the world. In June 2023, the Multinational Association for Supportive Care in Cancer, Flinders University Caring Future Institute, and Novartis launched the GINO initiative: "A Global Initiative to Advance Cancer Navigation for Better Outcomes." This 3-year initiative will develop an international position statement and practice framework for patient navigation, develop and test a core set of quality and efficiency indicators for international benchmarking (with consideration of resource levels), and develop implementation guidance and a global community of practice to facilitate further collaborative learning at a global level. We encourage the global academic community to engage in research that will advance patient navigation on an international scale, ultimately improving experiences and outcomes for people affected by cancer across the care continuum.

Raymond Javan Chan, PhD, MAppSc(Research), BN, RN,

GAICD, FACN, FAAN

Fiona Crawford-Williams, PhD, BHlthSc(Honors Psych)

Caring Futures Institute, College of Nursing and Health Sciences,

Flinders University, Adelaide, Australia

References