Mauteen Bisognano and James Conway have written a great book, 10 Powerful Ideas for Improving Patient Care: Book 4. Chicago . Health Administration Press. 2008.

The chapter that I particularly enjoyed was “Use Patient Navigation,” where they cited the work of an oncologic surgeon, Dr. Harold Freeman, with patient navigators at Harlem Hospital.  Patient navigators are knowledgeable healthcare professionals or volunteers who help cancer patients through the entire continuum of care. A trained navigator can:

• prepare patients and identify barriers
• assist with the logistics of care
• facilitate referrals to physicians and community programs
• help to find resources
• provide emotional support

In patients treated for breast cancer at Harlem Hospital, the number of patients with localized disease increased from 51% to 79% after the navigator program, with a dramatic increase in 5-year survival from 39% to 70%.

As a cancer survivor, I wrote in “Chemotherapy from An Insider’s Perspective,” Lancet 1:1006-1009, 1982:  “Surprise spits in the eye. Any event that occurs unpredictably, regardless of the cause, should be expected to produce feelings of helplessness and outrage…. The only times that I considered terminating chemotherapy prematurely were during these surprises, because each one made me feel as though the light at the end of the tunnel represented an oncoming train…. Intermittent desire to stop chemotherapy reflected my inability to cope with the unpredictable side-effects of treatment, not an objective calculation of the amount of medicine necessary for cure.”

I think that we can benefit from well-trained advocates who guide us and provide emotional support. I would appreciate you responding to the following questions:

• Are there other diseases than cancer where navigator programs are up and running
• For those who have set up navigator programs, what lessons have you learned that you can share with our readers
• Do you know of any programs where navigators go beyond working within the present system (or non-system) of fragmented care to improve processes of care

Thanks.