The evolving role and impact of patient navigators in serious illness care: a narrative review

In today's increasingly complex and fragmented healthcare system, patient navigation has emerged as a strategy to improve access to palliative care and reduce health inequities among historically marginalized populations. This narrative review aims to examine the evolution of patient navigation and its implementation across care settings to identify key themes and opportunities to optimize outcomes and reduce disparities in patients with serious illnesses.

A literature search was conducted in PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) Ultimate, and Google Scholar by three independent investigators on articles related to patient navigation in palliative care and patients with serious illnesses. A total of 49 academic articles and 5 additional articles were included.

A review of the literature revealed a number of diverse models of care navigation and implementation strategies. Navigation models involved varying degrees of community-based personnel and healthcare professionals from a range of disciplines. Through culturally informed support, education, and empowerment, many of these programs demonstrated improved patient outcomes such as reduced symptom burden, increased advance care planning, improved hospice referrals, more goal-concordant care at the end of life, reduced end-of-life cost expenditure, hospitalizations and emergency room visits. Integration of navigation across both medical and community settings also helped to reduce health disparities by addressing barriers across multiple levels of influence. However, in order for such models to be successful, understanding and integration of cultural values, trusted community figures, and strategies for addressing language barriers are essential.

While a variety of approaches to patient navigation can help improve care for seriously ill patients, common themes of effective interventions include social connection, engagement in what is most meaningful to the patient, identification of patient needs, access to culturally grounded resources, patient advocacy and empowerment, incorporation of navigators embedded within the local community, and support from key stakeholders.