The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials

Patient Education and Counseling

Volumn 100, Issue 3, 2017, Pages 436-448

  Ali Faisal, Sobia F ^a   Colella, Tracey J F ^b,c   Medina Jaudes, Naomi ^a   Benz Scott, Lisa ^a,d  

^a Stony Brook Medicine   (United States)

^b UNIVERSITY OF TORONTO   (Canada)

^c UNIVERSITY HEALTH NETWORK   (Canada)

^d STONY BROOK UNIVERSITY   (United States)

Author keywords

Cancer care; Healthcare utilization outcomes; Meta analysis; Patient navigation

Indexed keywords

CANCER DIAGNOSIS; CANCER SCREENING; CANCER THERAPY; CLINICAL EFFECTIVENESS; ETHNIC DIFFERENCE; FOLLOW UP; HEALTH CARE ACCESS; HEALTH CARE DELIVERY; HEALTH CARE UTILIZATION; HEART REHABILITATION; HUMAN; MEDICAL PRACTICE; META ANALYSIS; PATIENT CARE; PROTOCOL COMPLIANCE; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SEX DIFFERENCE; THERAPY EFFECT; NEOPLASM; PATIENT ATTITUDE; PATIENT COMPLIANCE;

HUMANS; NEOPLASMS; PATIENT ACCEPTANCE OF HEALTH CARE; PATIENT COMPLIANCE; PATIENT NAVIGATION; RANDOMIZED CONTROLLED TRIALS AS TOPIC;

EID: 85008970474     PISSN: 07383991     EISSN: 18735134     Source Type: Journal    
DOI: 10.1016/j.pec.2016.10.014     Document Type: Review

References (84)

1. [1] Freeman, H.P., Patient navigation: a community based strategy to reduce cancer disparities. J. Urban Health 83 (2006), 139–141, 10.1007/s11524-006-9030-0.
2. [2] Freeman, H.P., Rodriguez, R.L., History and principles of patient navigation. Cancer 117 (2011), 3539–3542, 10.1002/cncr.26262.
3. [3] Lorhan, S., Cleghorn, L., Fitch, M., Pang, K., McAndrew, A., Applin-Poole, J., et al. Moving the agenda forward for cancer patient navigation: understanding volunteer and peer navigation approaches. J. Cancer Educ. 28 (2013), 84–91, 10.1007/s13187-012-0424-2.
4. [4] Bandura, A., Social Learning Theory. 1977, Prentice Hall, Englewood Cliffs, NJ, 10.1111/j.1460-2466.1978.tb01621.x.
5. [5] Bandura, A., Social cognitive theory in cultural context. Appl. Psychol. 51 (2002), 269–290, 10.1111/1464-0597.00092.
6. [6] Dennis, C., Peer support within a health care context: a concept analysis. Int. J. Nurs. Stud. 40 (2003), 321–332, 10.1016/S0020-7489(02)00092-5.
7. [7] Freeman, H.P., Muth, B., Kerner, J., Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract. 3 (1995), 19–30.
8. [8] Freeman, H.P., The history, principles, and future of patient navigation: commentary. Semin. Oncol. Nurs. 29 (2013), 72–75, 10.1016/j.soncn.2013.02.002.
9. [9] Freeman, H.P., Wasfie, T.J., Cancer of the breast in poor black women. Cancer 63 (1989), 2562–2569 http://www.ncbi.nlm.nih.gov/pubmed/2720605.
10. [10] Oluwole, S.F., Ali, A.O., Adu, A., Blane, B.P., Barlow, B., Oropeza, R., et al. Impact of a cancer screening program on breast cancer stage at diagnosis in a medically underserved urban community. J. Am. Coll. Surg. 196 (2003), 180–188, 10.1016/S1072-7515(02)01765-9.
11. [11] Bradford, J.B., Coleman, S., Cunningham, W., HIV System Navigation: an emerging model to improve HIV care access. Aids Patient Care STDS 21 (2007), S49–58, 10.1089/apc.2007.9987.
12. [12] Benz Scott, L., Gravely, S., Sexton, T.R., Brzostek, S., Brown, D.L., Examining the effect of a patient navigation intervention on outpatient cardiac rehabilitation awareness and enrollment. J. Cardiopulm. Rehabil. Prev. 33 (2013), 281–291, 10.1097/HCR.0b013e3182972dd6.
13. [13] Connolly, C., King-Shier, K., The Calgary cardiac navigation clinic experience. Can. J. Cardiol., 28, 2012, S426, 10.1016/j.cjca.2012.07.767.
14. [14] Van Walleghem, N., MacDonald, C.A., Dean, H.J., The Maestro Project: a patient navigator for the transition of care for youth with type 1 diabetes. Diabetes Spectr. 24 (2011), 9–13, 10.2337/diaspect.24.1.9.
15. [15] Sullivan, C., Leon, J.B., Sayre, S.S., Marbury, M., Ivers, M., Pencak, J.A., et al. Impact of navigators on completion of steps in the kidney transplant process: a randomized, controlled trial. Clin. J. Am. Soc. Nephrol. 7 (2012), 1639–1645, 10.2215/CJN.11731111.
16. [16] Szilagyi, P.G., Humiston, S.G., Gallivan, S., Albertin, C., Sandler, M., Blumkin, A., Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates. Arch. Pediatr. Adolesc. Med. 165 (2011), 547–553, 10.1001/archpediatrics.2011.73.
17. [17] Dye, T.D., Bogale, S., Hobden, C., Tilahun, Y., Hechter, V., Deressa, T., et al. Complex care systems in developing countries: breast cancer patient navigation in Ethiopia. Cancer 116 (2010), 577–585, 10.1002/cncr.24776.
18. [18] Walsh, J., Young, J.M., Harrison, J.D., Butow, P.N., Solomon, M.J., Masya, L., et al. What is important in cancer care coordination? A qualitative investigation. Eur. J. Cancer Care (Engl.) 20 (2011), 220–227, 10.1111/j.1365-2354.2010.01187.x.
19. [19] Eschiti, V., Burhansstipanov, L., Watanabe-Galloway, S., Native cancer navigation: the state of the science. Clin. J. Oncol. Nurs. 16 (2011), 73–82, 10.1002/0471743941.
20. [20] Genoff, M.C., Zaballa, A., Gany, F., Gonzalez, J., Ramirez, J., Jewell, S.T., et al. Navigating language barriers: a systematic review of patient navigators’ impact on cancer screening for limited English proficient patients. J. Gen. Intern. Med. 31 (2016), 426–434, 10.1007/s11606-015-3572-3.
21. [21] Glick, S.B., Clarke, A.R., Blanchard, A., Whitaker, A.K., Cervical cancer screening, diagnosis and treatment interventions for racial and ethnic minorities: a systematic review. J. Gen. Intern. Med. 27 (2012), 1016–1032, 10.1007/s11606-012-2052-2.
22. [22] Manderson, B., McMurray, J., Piraino, E., Stolee, P., Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature. Health Soc. Care Commun. 20 (2012), 113–127, 10.1111/j.1365-2524.2011.01032.x.
23. [23] Naylor, K., Ward, J., Polite, B.N., Interventions to improve care related to colorectal cancer among racial and ethnic minorities: a systematic review. J. Gen. Intern. Med. 27 (2012), 1033–1046, 10.1007/s11606-012-2044-2.
24. [24] Parker, V., Lemak, C., Navigating patient navigation: crossing health services research and clinical boundaries. Adv. Health Care Manag. 11 (2011), 149–183.
25. [25] Paskett, E.D., Harrop, J.P., Wells, K.J., Patient navigation: an update on the state of the science. CA Cancer J. Clin. 61 (2011), 237–249, 10.3322/caac.20111.
26. [26] Robinson-White, S., Conroy, B., Slavish, K.H., Rosenzweig, M., Patient navigation in breast cancer: a systematic review. Cancer Nurs. 33 (2010), 127–140, 10.1097/NCC.0b013e3181c40401.
27. [27] Tan, C., Wilson, S., McConigley, R., Experiences of cancer patients in a patient navigation program: a qualitative systematic review. JBI Database Syst. Rev. Implement. Rep. 13 (2015), 136–168.
28. [28] Wells, K.J., Battaglia, T.A., Dudley, D.J., Garcia, R., Greene, A., Calhoun, E., et al. Patient navigation: state of the art or is it science?. Cancer 113 (2008), 1999–2010, 10.1002/cncr.23815.
29. [29] Whop, L.J., Valery, P.C., Beesley, V.L., Moore, S.P., Lokuge, K., Jacka, C., et al. Navigating the cancer journey: a review of patient navigator programs for Indigenous cancer patients. Asia Pac. J. Clin. Oncol. 8 (2012), 89–96, 10.1111/j.1743-7563.2012.01532.x.
30. [30] Craig, P., Dieppe, P., Macintyre, S., Nazareth, I., Petticrew, M., Developing and evaluating complex interventions: the new Medical Research Council guidance. Br. Med. J. 337 (2008), 979–983, 10.1136/bmj.a1655.
31. [31] Haidich, A.B., Meta-analysis in medical research. Hippokratia 14 (2010), 29–37, 10.5005/jp/books/10519.
32. [32] Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med. 6 (2009), 1–6, 10.1371/journal.pmed.1000097.
33. [33] Downs, S.H., Black, N., The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J. Epidemiol. Commun. Health 52 (1998), 377–384.
34. [34] Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cohrane Collaboration, 2014.
35. [35] Hedges, L.V., Vevea, J.L., Fixed- and random-effects models in meta-analysis. Psychol. Methods 3 (1998), 486–504, 10.1037/1082-989X.3.4.486.
36. [36] Deeks, J., Higgins, J., Altman, D., Analysing data and undertaking meta-analyses. Higgins, J., Green, S., (eds.) Cochrane Handb. Syst. Rev. Interv. Cochrane Collab., 2008, John Wiley and Sons Ltd., Chichester, West Sussex (p. 278).
37. [37] Egger, M., Davey Smith, G., Schneider, M., Minder, C., Bias in meta-analysis detected by a simple, graphical test. Br. Med. J. 315 (1997), 629–634, 10.1136/bmj.316.7129.469.
38. [38] Jandorf, L., Stossel, L.M., Cooperman, J.L., Graff Zivin, J., Ladabaum, U., Hall, D., et al. Cost analysis of a patient navigation system to increase screening colonoscopy adherence among urban minorities. Cancer 119 (2013), 612–620, 10.1002/cncr.27759.
39. [39] Ladabaum, U., Mannalithara, A., Jandorf, L., Itzkowitz, S.H., Cost-effectiveness of patient navigation to increase adherence with screening colonoscopy among minority individuals. Cancer 121 (2015), 1088–1097, 10.1002/cncr.29162.
40. [40] Lairson, D.R., Huo, J., Ball Ricks, K.A., Savas, L., Fernandez, M.E., The cost of implementing a 2-1-1 call center-based cancer control navigator program. Eval. Program Plann. 39 (2013), 51–56, 10.1016/j.evalprogplan.2013.04.001.
41. [41] Lairson, D.R., Dicarlo, M., Deshmuk, A.A., Fagan, H.B., Sifri, R., Katurakes, N., et al. Cost-effectiveness of a standard intervention versus a navigated intervention on colorectal cancer screening use in primary care. Cancer 120 (2014), 1042–1049, 10.1002/cncr.28535.
42. [42] Bensink, M.E., Ramsey, S.D., Battaglia, T., Fiscella, K., Hurd, T.C., McKoy, J.M., et al. Costs and outcomes evaluation of patient navigation after abnormal cancer screening: evidence from the patient navigation research program. Cancer 120 (2014), 570–578, 10.1002/cncr.28438.
43. [43] Binswanger, I.A., Whitley, E., Haffey, P.-R., Mueller, S.R., Min, S.-J., A patient navigation intervention for drug-involved former prison inmates. Subst. Abuse 36 (2015), 34–41, 10.1080/08897077.2014.932320.
44. [44] Ferrante, J.M., Chen, P.H., Kim, S., The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: a randomized controlled trial. J. Urban Health 85 (2008), 114–124, 10.1007/s11524-007-9228-9.
45. [45] Fiscella, K., Whitley, E., Hendren, S., Raich, P., Humiston, S., Winters, P., et al. Patient navigation for breast and colorectal cancer treatment: a randomized trial. Cancer Epidemiol. Biomark. Prev. 21 (2012), 1673–1681, 10.1158/1055-9965.EPI-12-0506.
46. [46] Fischer, S.M., Cervantes, L., Fink, R.M., Kutner, J.S., Apoyo con Cariño: a pilot randomized controlled trial of a patient navigator intervention to improve palliative care outcomes for Latinos with serious illness. J. Pain Symptom Manag. 49 (2015), 657–665, 10.1016/j.jpainsymman.2014.08.011.
47. [47] Griswold, K.S., Pastore, P.A., Homish, G.G., Henke, A., Access to primary care: are mental health peers effective in helping patients after a psychiatric emergency. Prim. Psychiatry 17 (2010), 42–45.
48. [48] Hacking, B., Wallace, L., Scott, S., Kosmala-Anderson, J., Belkora, J., McNeill, A., Testing the feasibility, acceptability and effectiveness of a decision navigation intervention for early stage prostate cancer patients in Scotland—a randomised controlled trial. Psychooncology 22 (2013), 1017–1024, 10.1002/pon.3093.
49. [49] Hendren, S., Griggs, J.J., Epstein, R., Humiston, S., Jean-Pierre, P., Winters, P., et al. Randomized controlled trial of patient navigation for newly diagnosed cancer patients: effects on quality of life. Cancer Epidemiol. Biomark. Prev. 21 (2012), 1682–1690, 10.1158/1055-9965.EPI-12-0537.
50. [50] Kelly, E., Fulginiti, A., Pahwa, R., Tallen, L., Duan, L., Brekke, J.S., A pilot test of a peer navigator intervention for improving the health of individuals with serious mental illness. Commun. Ment. Health J. 50 (2014), 435–446, 10.1007/s10597-013-9616-4.
51. [51] Lee, J.H., Fulp, W., Wells, K.J., Meade, C.D., Calcano, E., Roetzheim, R., Patient navigation and time to diagnostic resolution: results for a cluster randomized trial evaluating the efficacy of patient navigation among patients with breast cancer screening abnormalities, Tampa, FL. PLoS One 8 (2013), 1–9, 10.1371/journal.pone.0074542.
52. [52] Lee, J.H., Fulp, W., Wells, K.J., Meade, C.D., Calcano, E., Roetzheim, R., Effect of patient navigation on time to diagnostic resolution among patients with colorectal cancer-related abnormalities. J. Cancer Educ. 29 (2014), 144–150, 10.1007/s13187-013-0561-2.
53. [53] Paskett, E.D., Katz, M.L., Post, D.M., Pennell, M.L., Young, G.S., Seiber, E.E., et al. The Ohio Patient Navigation Research Program: does the American Cancer Society patient navigation model improve time to resolution in patients with abnormal screening tests?. Cancer Epidemiol. Biomark. Prev. 21 (2012), 1620–1628, 10.1158/1055-9965 (EPI-12-0523).
54. [54] Rahm, A.K., Sukhanova, A., Ellis, J., Mouchawar, J., Increasing utilization of cancer genetic counseling services using a patient navigator model. J. Genet. Couns. 16 (2007), 171–177, 10.1007/s10897-006-9051-6.
55. [55] Wagner, E.H., Ludman, E.J., Aiello Bowles, E.J., Penfold, R., Reid, R.J., Rutter, C.M., et al. Nurse navigators in early cancer care: a randomized, controlled trial. J. Clin. Oncol. 32 (2014), 12–18, 10.1200/JCO.2013.51.7359.
56. [56] Jandorf, L., Cooperman, J.L., Stossel, L.M., Itzkowitz, S., Thompson, H.S., Villagra, C., et al. Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system. Health Educ. Res. 28 (2013), 803–815, 10.1093/her/cyt003.
57. [57] Benz Scott, L., Gravely, S., Effect of patient navigation on enrollment in cardiac rehabilitation. JAMA Intern. Med. 173 (2013), 244–246, 10.1093/aje.
58. [58] Ko, N.Y., Darnell, J.S., Calhoun, E., Freund, K.M., Wells, K.J., Shapiro, C.L., et al. Can patient navigation improve receipt of recommended breast cancer care? Evidence from the National Patient Navigation Research Program. J. Clin. Oncol. 32 (2014), 1–8, 10.1200/JCO.2013.53.6037.
59. [59] Bastani, R., Mojica, C.M., Berman, B.A., Ganz, P.A., Low-income women with abnormal breast findings: results of a randomized trial to increase rates of diagnostic resolution. Cancer Epidemiol. Biomark. Prev. 19 (2010), 1927–1936, 10.1158/1055-9965.EPI-09-0481.
60. [60] Braun, K.L., Thomas, W.L., Domingo, J.L.B., Allison, A.L., Ponce, A., Haunani Kamakana, P., et al. Reducing cancer screening disparities in medicare beneficiaries through cancer patient navigation. J. Am. Geriatr. Soc. 63 (2015), 365–370, 10.1111/jgs.13192.
61. [61] Chen, M.S., Fang, D.M., Stewart, S.L., Ly, M.Y., Lee, S., Dang, J.H.T., et al. Increasing hepatitis b screening for Hmong adults: results from a randomized controlled community-based study. Cancer Epidemiol. Biomark. Prev. 22 (2013), 782–791, 10.1158/1055-9965.EPI-12-1399.
62. [62] Christie, J., Lihau, Nk.I., Jandorf, L., A randomized controlled trial using patient navigation to increase colorectal cancer screening in low-income underrepresented minorities. J. Natl. Med. Assoc. 100 (2008), 278–284.
63. [63] Dietrich, A.J., Tobin, J.N., Cassells, A., Robinson, C.M., Greene, M.A., Sox, C.H., et al. Telephone care management to improve cancer screening among low-income women. Ann. Intern. Med. 144 (2006), 563–571.
64. [64] Dignan, M.B., Burhansstipanov, L., Hariton, J., Harjo, L., Rattler, T., Lee, R., et al. A comparison of two Native American navigator formats: face-to-face and telephone. Cancer Control J. Moffitt Cancer Center 12 (2005), 28–33, 10.1038/nature11130.Reduced.
65. [65] Ell, K., Vourlekis, B., Lee, P.J., Xie, B., Patient navigation and case management following an abnormal mammogram: a randomized clinical trial. Prev. Med. (Baltim.) 44 (2007), 26–33, 10.1016/j.ypmed.2006.08.001.
66. [66] Ell, K., Vourlekis, B., Xie, B., Nedjat-Haiem, F.R., Lee, P.J., Muderspach, L., et al. Cancer treatment adherence among low-income women with breast or gynecologic cancer: a randomized controlled trial of patient navigation. Cancer 115 (2009), 4605–4615, 10.1002/cncr.24500.
67. [67] Ginsburg, O.M., Chowdhury, M., Wu, W., Chowdhury, M.T.I., Pal, B.C., Hasan, R., et al. An mHealth model to increase clinic attendance for breast symptoms in rural Bangladesh: can bridging the digital divide help close the cancer divide?. Oncologist 19 (2014), 177–185, 10.1634/theoncologist.2013-0314.
68. [68] Green, B., Wang, C., Anderson, M., Chubak, J., Meenan, R., Vernon, S.W., et al. An automated intervention with stepped increases in support to increase uptake of colorectal cancer screening. Ann. Intern. Med. 158 (2013), 301–311.
69. [69] Green, B.B., Anderson, M.L., Wang, C.-Y., Vernon, S.W., Chubak, J., Meenan, R.T., et al. Results of nurse navigator follow-up after positive colorectal cancer screening test: a randomized trial. J. Am. Board Fam. Med. 27 (2014), 789–795, 10.3122/jabfm.2014.06.140125.
70. [70] Hilgeman, M.M., Mahaney-Price, A.F., Stanton, M.P., McNeal, S.F., Pettey, K.M., Tabb, K.D., et al. Alabama Veterans Rural Health Initiative: a pilot study of enhanced community outreach in rural areas. J. Rural Health 30 (2014), 153–163, 10.1111/jrh.12054.
71. [71] Jandorf, L., Braschi, C., Ernstoff, E., Wong, C.R., Thelemaque, L., Winkel, G., et al. Culturally targeted patient navigation for increasing African Americans’ adherence to screening colonoscopy: a randomized clinical trial. Cancer Epidemiol. Biomark. Prev. 22 (2013), 1577–1587, 10.1158/1055-9965 (EPI-12-1275).
72. [72] Jandorf, L., Gutierrez, Y., Lopez, J., Christie, J., Itzkowitz, S.H., Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. J. Urban Health 82 (2005), 216–224, 10.1093/jurban/jti046.
73. [73] Lasser, K.E., Murillo, J., Lisboa, S., Casimir, a N., Valley-Shah, L., Emmons, K.M., et al. Colorectal cancer screening among ethnically diverse, low-income patients. Arch. Intern. Med. 171 (2011), 906–912, 10.1001/archinternmed.2011.201.
74. [74] Lasser, K.E., Kenst, K.S., Quintiliani, L.M., Wiener, R.S., Murillo, J., Pbert, L., et al. Patient navigation to promote smoking cessation among low-income primary care patients: a pilot randomized controlled trial. J. Ethn. Subst. Abuse 12 (2013), 374–390, 10.1080/15332640.2013.819311.
75. [75] Maxwell, A.E., Jo, A.M., Crespi, C.M., Sudan, M., Bastani, R., Peer navigation improves diagnostic follow-up after breast cancer screening among Korean American women: results of a randomized trial. Cancer Causes Control 21 (2010), 1931–1940, 10.1007/s10552-010-9621-7.
76. [76] Myers, R.E., Bittner-Fagan, H., Daskalakis, C., Sifri, R., Vernon, S.W., Cocroft, J., et al. A randomized controlled trial of a tailored navigation and a standard intervention in colorectal cancer screening. Cancer Epidemiol. Biomark. Prev. 22 (2013), 109–117, 10.1158/1055-9965.EPI-12-0701.
77. [77] Percac-Lima, S., Grant, R.W., Green, A.R., Ashburner, J.M., Gamba, G., Oo, S., et al. A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial. J. Gen. Intern. Med. 24 (2009), 211–217, 10.1007/s11606-008-0864-x.
78. [78] Phillips, C.E., Rothstein, J.D., Beaver, K., Sherman, B.J., Freund, K.M., Battaglia, T.A., Patient navigation to increase mammography screening among inner city women. J. Gen. Intern. Med. 26 (2011), 123–129, 10.1007/s11606-010-1527-2.
79. [79] Raich, P.C., Whitley, E.M., Thorland, W., Valverde, P., Fairclough, D., Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population. Cancer Epidemiol. Biomark. Prev. 21 (2012), 1629–1638, 10.1158/1055-9965.EPI-12-0513.
80. [80] Ritvo, P.G., Myers, R.E., Paszat, L.F., Tinmouth, J.M., McColeman, J., Mitchell, B., et al. Personal navigation increases colorectal cancer screening uptake. Cancer Epidemiol. Biomark. Prev. 24 (2015), 506–511, 10.1158/1055-9965.EPI-14-0744.
81. [81] Wells, K.J., Lee, J.-H., Calcano, E.R., Meade, C.D., Rivera, M., Fulp, W.J., et al. A cluster randomized trial evaluating the efficacy of patient navigation in improving quality of diagnostic care for patients with breast or colorectal cancer abnormalities. Cancer Epidemiol. Biomark. Prev. 21 (2012), 1664–1672, 10.1158/1055-9965.EPI-12-0448.
82. [82] Lijmer, J.G., Bossuyt, P.M.M., Heisterkamp, S.H., Exploring sources of heterogeneity in systematic reviews of diagnostic tests. Stat. Med. 21 (2002), 1525–1537, 10.1002/sim.1185.
83. [83] Walkinshaw, E., Patient navigators becoming the norm in Canada. Can. Med. Assoc. J. 183 (2011), 1698–1699, 10.1503/cmaj.109-3973.
84. [84] Moy, B., Chabner, B.A., Patient navigator programs, cancer disparities, and the Patient Protection and Affordable Care Act. Oncologist 16 (2011), 926–929, 10.1634/theoncologist.2011-0140.