Cancer patient navigation: program development in a large multisite cancer institute (2010-2023)

This paper outlines the 13-year development of a comprehensive, multisite patient navigation (PN) programme at Atrium Health Levine Cancer Institute (LCI), aiming to inform institutions seeking to establish or expand navigation services.

Between 2010 and 2023, LCI's PN programme evolved through three distinct phases: initiation, structured development and system-wide consolidation. Key components included appointing a programme director, introducing the Acuity Grading Scale for patient prioritisation, integrating PN documentation into the electronic medical record and developing operational policies aligned with Commission on Cancer standards. Both generalist and tumour-specific nurse navigators were employed across urban and rural settings, supplemented by virtual navigation services.

The programme demonstrated improved care coordination, timely treatment initiation and equitable access, particularly among racial and ethnic minorities. Virtual navigation proved effective during the COVID-19 pandemic. Challenges included securing clinician buy-in, standardising services across cancer types and sustaining funding amid limited reimbursement models. A navigator academy and ongoing competency evaluations supported workforce development.

LCI's experience offers a replicable model for building PN programmes grounded in standardisation, community needs and workforce training. While promising, broader adoption will require further evidence-based standards, financial modelling and strategies to navigate system integration challenges.