Krok-Schoen Jessica L, Oliveri Jill M, Paskett Electra D
Comprehensive Cancer Center, The Ohio State University , Columbus, OH , USA.
Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
Front Oncol. 2016 Jan 28;6:2. doi: 10.3389/fonc.2016.00002. eCollection 2016.
Patient navigation (PN) is a patient-centered health-care service delivery model that assists individuals, particularly the medically underserved, in overcoming barriers (e.g., personal, logistical, and system) to care across the cancer care continuum. In 2012, the American College of Surgeons Commission on Cancer (CoC) announced that health-care facilities seeking CoC-accreditation must have PN processes in place starting January 1, 2015. The CoC mandate, in light of the recent findings from centers within the Patient Navigation Research Program and the influx of PN interventions, warrants the present literature review.
PubMed and Medline were searched for studies published from January 2010 to October 2015, particularly those recent articles within the past 2 years, addressing PN for breast and gynecological cancers, and written in English. Search terms included patient navigation, navigation, navigator, cancer screening, clinical trials, cancer patient, cancer survivor, breast cancer, gynecological cancer, ovarian cancer, uterine cancer, vaginal cancer, and vulvar cancer.
Consistent with prior reviews, PN was shown to be effective in helping women who receive cancer screenings, receive more timely diagnostic resolution after a breast and cervical cancer screening abnormality, initiate treatment sooner, receive proper treatment, and improve quality of life after cancer diagnosis. However, several limitations were observed. The majority of PN interventions focused on cancer screening and diagnostic resolution for breast cancer. As observed in prior reviews, methodological rigor (e.g., randomized controlled trial design) was lacking.
Future research opportunities include testing PN interventions in the post-treatment settings and among gynecological cancer patient populations, age-related barriers to effective PN, and collaborative efforts between community health workers and patient navigators as care goes across segments of the cancer control continuum. As PN programs continue to develop and become a standard of care, further research will be required to determine the effectiveness of cancer PN across the cancer care continuum, and in different patient populations.
患者导航（PN）是一种以患者为中心的医疗服务提供模式，可帮助个人，尤其是医疗服务不足的人群，克服在癌症治疗连续过程中获得医疗服务的障碍（如个人、后勤和系统方面的障碍）。2012年，美国外科医师学会癌症委员会（CoC）宣布，寻求CoC认证的医疗机构自2015年1月1日起必须建立PN流程。鉴于患者导航研究项目各中心的最新研究结果以及PN干预措施的大量涌现，CoC的这项要求促使了本次文献综述。
在PubMed和Medline数据库中检索2010年1月至2015年10月发表的研究，特别是过去2年内发表的涉及乳腺癌和妇科癌症患者导航的英文近期文章。检索词包括患者导航、导航、导航员、癌症筛查、临床试验、癌症患者、癌症幸存者、乳腺癌、妇科癌症、卵巢癌、子宫癌、阴道癌和外阴癌。
与之前的综述一致，PN被证明能有效帮助接受癌症筛查的女性，在乳腺癌和宫颈癌筛查异常后更及时地获得诊断结果，更快开始治疗，接受适当治疗，并在癌症诊断后提高生活质量。然而，也观察到了一些局限性。大多数PN干预措施集中在乳腺癌的癌症筛查和诊断结果方面。正如之前综述中所观察到的，缺乏方法学上的严谨性（如随机对照试验设计）。
未来的研究机会包括在治疗后环境以及妇科癌症患者群体中测试PN干预措施，有效PN存在的与年龄相关的障碍，以及随着医疗服务贯穿癌症控制连续过程的各个环节，社区卫生工作者与患者导航员之间的协作努力。随着PN项目不断发展并成为一种护理标准，需要进一步研究以确定癌症PN在整个癌症治疗连续过程以及不同患者群体中的有效性。
