In 2008, the NCBC recognized the need for a standardization of the Breast Patient Navigator's role. Just as the breast care/cancer diagnosis and treatment process may differ from facility to facility, so do the definitions, activities, knowledge and job descriptions of a breast patient navigator. These disparities can adversely affect the breast care/cancer treatment provided to women across the nation and around the world. NCBC created this certification program to better define the role and function of breast health navigators and to promote equitable and consistent care across the continuum for breast patients.
A peer committee was formed to develop a certification program designed to validate the skill sets of breast patient navigators. The first certification program was offered at the NCBC's 21st Annual National Interdisciplinary Breast Center Conference in Las Vegas, NV. More than 900 breast healthcare professionals received their designations as certified Breast Patient Navigators.
Purpose of Certification:
The Breast Patient Navigator Certification Program is a certification that has been developed by a peer review team of the National Consortium of Breast Centers (NCBC). The Navigator program identifies the purpose of certification as a means to: [1] set standards of achievement and the navigator’s role; [2] enhance patient safety, quality of care and delivery of services through recognition and resolution of barriers to care; and [3] recognize professionals who advance beyond basic knowledge in a specialty field.
Reviewing and assessing a candidate for certification in Navigation is dependent on individual professional licensure. Assessment of Navigational knowledge and skills is a specialized assessment, not in combination with current professional licensure.
In 2012 (for enactment in 2015) the Commission on Cancer report (CoC) identified some core requirements for breast centers of excellence to include community outreach, prevention program, screening program, and a patient navigation process. The professional Navigator often serve in all of these capacities, but at minimum needs to have a knowledge of all four requirements. Subsets of navigational duties include:
- Outreach (entering communities/neighborhoods, health fair, community needs assessments)
- Screening (education and promotion of mammographic standards of care)
- Diagnostics (imaging, tissue sampling, MRI)
- Treatment (oncologic: surgical, medical, radiation, adjuvant, supportive, complementary, alternative)
- Recurrence
- Survivorship (care plans)
- End of Life care
Navigators renegotiate the flow of patient care to continually assess for barriers to care and effective ways to reduce or eliminate the impact.
Barriers are defined as anything that stops or delays decisions for diagnosis or treatment for breast cancer. Barriers include (not an exclusive list):
- Financial (cost of living, working, insurance, treatment costs)
- Emotional (lack of emotional resources to effectively cope with a cancer diagnosis, effects of treatment, lack of trust in medical professionals, prospect of disability or death from disease)
- Cultural/language disparities
- Educational (lack of or misunderstanding of diagnosis, treatment, prognosis)
- Transportation (getting to/from numerous and complex appointments)
- Physical (co-morbid conditions prior to or developing from treatment)
- Spiritual (reflection of crossing spiritual with physical illness, loss or lack of)
- Sexual (complexity of physical changes due to cancer and treatment effect on partners)
NAPBC Standard 3.1 Patient Navigation Process
Patient navigation refers to individualized assistance offered to patients, families, and caregivers to help overcome health care system barriers and facilitate timely access to quality health and psychosocial care throughout the continuum of care. Breast disease patient navigation can and should take on different forms in different communities as dictated by the needs of the patient, his or her family, and the community. The patient navigation process includes consistent care coordination throughout the continuum of care and an assessment of the physical, psychological, and social needs of the patient. The anticipated results are enhanced patient outcomes, increased satisfaction, and reduced costs of care. This process may involve different individuals at each point of care.
Examples of patient navigation include, but are not limited to:
- Providing education, support, and coordination to assist patients in securing appointments
- Providing educational resources on breast health, breast cancer, and breast care
- Connecting patients and families to resources and support services
- Promoting communication between the patient and health care providers
- Coordinating services throughout the continuum of care
Benefits of patient navigation include:
- Enhancing the patient’s quality of life, sense of autonomy, and self-determination for managing his/her own health
- Reinforcing the physician-patient relationship
- Expediting care