Implementation Factors for Patient Navigation Program Success: a Qualitative Study

Overview

Journal Implement Sci Commun

Publisher Biomed Central

Specialty Health Services

Date 2021 Dec 21

PMID 34930503

Citations 8

Authors

Mandi L Pratt-Chapman

Rachel Silber

Jeffrey Tang

Phuong Thao D Le

Affiliations

Soon will be listed here.

Abstract

Background: Patient navigation (PN) is an evidence-based practice that involves assessing and addressing individual barriers to care for patients. While PN has shown effectiveness in numerous studies, designing successful, sustainable PN programs has remained challenging for many healthcare organizations. The purpose of the present study was to examine implementation factors for successful PN programs to optimize the sustainability of PN services across cancer care settings in the USA.

Methods: Data were collected via semi-structured interviews with PN stakeholders (n=17) from diverse cancer care settings. Thematic content analysis was conducted by deductively coding major themes based on constructs from the Exploration-Preparation-Implementation-Sustainability framework and by inductively coding emergent themes.

Results: Facilitators in the outer context included payer guidelines, accreditation requirements, community partnerships, and demonstrated need and demand for services. Inner context factors such as alignment with organizational and leadership priorities, appropriate staff support and workloads, and relative advantage were important to program success. Innovation characteristics such as the presence of innovation champions, clear role and scope of practice, clear protocols, strong communication channels, and innovation fit were facilitators of program success. Community-Academic partnerships and funding stability also emerged as facilitators for program sustainability.

Conclusion: Our qualitative analysis from a diverse sample of PN stakeholders and programs across the USA supports intentional use of implementation theory to design PN programs to optimize implementation success.

Citing Articles

Exploring the role of the JEEViKA swasthya mitra helpdesk in improving healthcare access: a qualitative study in tertiary healthcare facilities in Bihar, India.

Kumar P, Ahmad S, Pradhan N, Chaudhary N, H H, Kumari S BMC Health Serv Res. 2025; 25(1):146.

PMID: 39865243 PMC: 11771127. DOI: 10.1186/s12913-025-12299-3.

Cost and activity analysis for a citywide patient navigation intervention to engage underserved patients in breast cancer treatment: Findings from the Translating Research Into Practice study.

Rajabiun S, Cabral H, Chen C, Lloyd-Travaglini C, Dugas J, Amburgey D Cancer. 2025; 131(1):e35671.

PMID: 39748471 PMC: 11695749. DOI: 10.1002/cncr.35671.

A new model for the diagnostic assessment services trajectory for neurodevelopmental conditions.

Jacques C, Rivard M, Mello C, Abouzeid N, Herault E, Saulnier G Front Rehabil Sci. 2024; 5:1426966.

PMID: 39655185 PMC: 11625808. DOI: 10.3389/fresc.2024.1426966.

Evaluating implementation of a community-focused patient navigation intervention at an NCI-designated cancer center using RE-AIM.

Ver Hoeve E, Calhoun E, Hernandez M, High E, Armin J, Ali-Akbarian L BMC Health Serv Res. 2024; 24(1):550.

PMID: 38685006 PMC: 11059763. DOI: 10.1186/s12913-024-10919-y.

Integrating accompanying patients into clinical oncology teams: limiting and facilitating factors.

Pomey M, Paquette J, Iliescu Nelea M, Vialaron C, Mourad R, Bouchard K BMC Health Serv Res. 2024; 24(1):150.

PMID: 38291443 PMC: 10826234. DOI: 10.1186/s12913-024-10624-w.

References

Simon M, Tom L, Leung I, Wong E, Knightly E, Vicencio D . The Chinatown Patient Navigation Program: Adaptation and Implementation of Breast and Cervical Cancer Patient Navigation in Chicago's Chinatown. Health Serv Insights. 2019; 12:1178632919841376. PMC: 6475834. DOI: 10.1177/1178632919841376. View

Gerves-Pinquie C, Girault A, Phillips S, Raskin S, Pratt-Chapman M . Economic evaluation of patient navigation programs in colorectal cancer care, a systematic review. Health Econ Rev. 2018; 8(1):12. PMC: 6002330. DOI: 10.1186/s13561-018-0196-4. View

Kline R, Muldoon L, Schumacher H, Strawbridge L, York A, Mortimer L . Design Challenges of an Episode-Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model. J Oncol Pract. 2017; 13(7):e632-e645. PMC: 5508445. DOI: 10.1200/JOP.2016.015834. View

Guerra C, Verderame E, Nicholson A, Wan L, Brooks A . A Plan-Do-Study-Act Approach to the Development, Implementation and Evaluation of a Patient Navigation Program to Reduce Breast Cancer Screening Disparities in Un- and Under-Insured, Racially and Ethnically Diverse Urban Women. Front Public Health. 2021; 9:595786. PMC: 7933216. DOI: 10.3389/fpubh.2021.595786. View

Moullin J, Dickson K, Stadnick N, Rabin B, Aarons G . Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implement Sci. 2019; 14(1):1. PMC: 6321673. DOI: 10.1186/s13012-018-0842-6. View

Feldstein A, Glasgow R . A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf. 2008; 34(4):228-43. DOI: 10.1016/s1553-7250(08)34030-6. View

Freund K . Implementation of evidence-based patient navigation programs. Acta Oncol. 2016; 56(2):123-127. DOI: 10.1080/0284186X.2016.1266078. View

Jandorf L, Braschi C, Ernstoff E, Wong C, Thelemaque L, Winkel G . Culturally targeted patient navigation for increasing african americans' adherence to screening colonoscopy: a randomized clinical trial. Cancer Epidemiol Biomarkers Prev. 2013; 22(9):1577-87. PMC: 3769457. DOI: 10.1158/1055-9965.EPI-12-1275. View

Freeman H . The origin, evolution, and principles of patient navigation. Cancer Epidemiol Biomarkers Prev. 2012; 21(10):1614-7. DOI: 10.1158/1055-9965.EPI-12-0982. View

10.

Valaitis R, Carter N, Lam A, Nicholl J, Feather J, Cleghorn L . Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review. BMC Health Serv Res. 2017; 17(1):116. PMC: 5294695. DOI: 10.1186/s12913-017-2046-1. View

11.

Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009; 4:50. PMC: 2736161. DOI: 10.1186/1748-5908-4-50. View

12.

Raich P, Whitley E, Thorland W, Valverde P, Fairclough D . Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population. Cancer Epidemiol Biomarkers Prev. 2012; 21(10):1629-38. PMC: 4053249. DOI: 10.1158/1055-9965.EPI-12-0513. View

13.

Roland K, Milliken E, Rohan E, DeGroff A, White S, Melillo S . Use of Community Health Workers and Patient Navigators to Improve Cancer Outcomes Among Patients Served by Federally Qualified Health Centers: A Systematic Literature Review. Health Equity. 2017; 1(1):61-76. PMC: 5586005. DOI: 10.1089/heq.2017.0001. View

14.

Jean-Pierre P, Cheng Y, Wells K, Freund K, Snyder F, Fiscella K . Satisfaction with cancer care among underserved racial-ethnic minorities and lower-income patients receiving patient navigation. Cancer. 2016; 122(7):1060-7. PMC: 4803516. DOI: 10.1002/cncr.29902. View

15.

Kline R, Rocque G, Rohan E, Blackley K, Cantril C, Pratt-Chapman M . Patient Navigation in Cancer: The Business Case to Support Clinical Needs. J Oncol Pract. 2019; 15(11):585-590. PMC: 8790714. DOI: 10.1200/JOP.19.00230. View

16.

Castaldi M, Safadjou S, Elrafei T, McNelis J . A Multidisciplinary Patient Navigation Program Improves Compliance With Adjuvant Breast Cancer Therapy in a Public Hospital. Am J Med Qual. 2016; 32(4):406-413. DOI: 10.1177/1062860616656250. View

17.

Kline R, Bazell C, Smith E, Schumacher H, Rajkumar R, Conway P . Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care. J Oncol Pract. 2015; 11(2):114-6. DOI: 10.1200/JOP.2014.002337. View

18.

Rocque G, Pisu M, Jackson B, Kvale E, Demark-Wahnefried W, Martin M . Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer. JAMA Oncol. 2017; 3(6):817-825. PMC: 5540048. DOI: 10.1001/jamaoncol.2016.6307. View

19.

Aarons G, Hurlburt M, Horwitz S . Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011; 38(1):4-23. PMC: 3025110. DOI: 10.1007/s10488-010-0327-7. View

20.

Battaglia T, Freund K, Haas J, Casanova N, Bak S, Cabral H . Translating research into practice: Protocol for a community-engaged, stepped wedge randomized trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative. Contemp Clin Trials. 2020; 93:106007. PMC: 7884078. DOI: 10.1016/j.cct.2020.106007. View