Patient Navigation Models for Lung Cancer [Internet]

Excerpt

Background: Multiple patient navigation programs have been developed to address barriers to care (e.g., financial, logistical, and communication) across the cancer care continuum, but health systems are unsure which components of patient navigation are important and how to implement them. In addition the effectiveness of patient navigation programs to improve lung cancer outcomes is uncertain.

Purpose: To review recent literature on components of patient navigation programs addressing all types of cancer, the effectiveness of patient navigation programs on lung cancer outcomes, and the variable effectiveness of patient navigation programs on lung cancer outcomes based on patient characteristics. This report was developed to address the diverse research needs of a stakeholder group interested in the needs of people with lung cancer.

Methods: We searched for systematic reviews from 2015 to 2018 in PubMed^®, CINAHL^®, Cochrane Database of Systematic Reviews, Veterans Affairs Evidence-based Synthesis Program, Agency for Healthcare Research and Quality Effective Health Care Program, PubMed Health, and PROSPERO. We also searched for primary studies from 2013 to 2018 in PubMed and CINAHL. We extracted data from systematic reviews and primary studies, and synthesized results.

Findings: We identified four systematic reviews and six primary studies that focused primarily on breast, cervical, prostate, and colorectal cancer. Navigators’ backgrounds varied from lay people to health care professionals, and training ranged from a few to several hundred hours. Navigation programs were both individual and team based, were delivered in diverse health care settings, and had more clearly defined entry criteria than exit criteria. Navigators performed multiple diverse services, including assisting patients to overcome health care system barriers, maintaining resource networks, and promotion of patient engagement. Only two completed studies evaluated the effectiveness of lung cancer patient navigation programs. One randomized clinical trial found that navigated patients were more likely to receive a screening chest computed tomography, and one observational study found that navigation was associated with increased satisfaction with care. No completed studies analyzed the effectiveness of lung cancer patient navigation programs based on patient characteristics.

Implications: Patient navigation programs for all cancer types are quite diverse with regard to navigators’ characteristics and program structure. Future research studies should describe components in sufficient detail to facilitate implementation and determine which program is most effective for which health system. Lung cancer patients face unique challenges in managing their care, so additional studies on which components are important for lung cancer may be warranted.