Job descriptions by oncology patient navigator experience

Abstract

The American Cancer Society National Navigation Roundtable (ACS NNRT) was established in 2017.¹ The ACS NNRT is a national coalition of 100+ member organizations to advance navigation efforts that eliminate barriers to quality care, reduce disparities, and foster ongoing health equity across the cancer continuum. The ACS provides organizational leadership and expert staff support to the ACS NNRT. In 2024, the ACS NNRT Workforce Development Task Group (WFD) published an article that described job roles of patient navigators (PN) based on their level of expertise.² The purpose of the current article is to illustrate how the table (https://navigationroundtable.org/resource/patient-navigation-job-roles-by-levels-of-experience-workforce-development-task-group-national-navigation-roundtable/) from the published article can be used to generate job descriptions that align with roles and responsibilities of navigators. The current article is the work of the NNRT WFD and highlights insights and guidance from experts in the field. The 2024 table can provide a resource for navigators looking to advance careers and administrators creating job descriptions for navigators at different levels of proficiency. The table applies to clinical and oncology patient navigators across diverse settings and organizations (community, academic, and clinic-based).

Oncology patient navigation as an occupation and a health delivery support strategy has rapidly expanded over the last 3 decades with this care concept’s importance becoming widely accepted. Through the evolution of this profession, the role of the navigator has been updated to meet the needs of the community or health care system.³ The profession has matured with evidence-based practices and peer-reviewed publications to support navigation titles, standards, training, qualifications, and validation of their contribution to value-based care. Efforts have also been made to standardize patient navigation roles to inform job descriptions.² There remains a gap in standardized language to create job descriptions that patient navigation programs can use.

The origin of this profession started with Dr. Harold P. Freeman’s patient navigation goal to improve outcomes in populations that are medically underserved by eliminating barriers to timely cancer diagnosis and treatment in a culturally sensitive manner.⁴ He described “lay navigators (now defined as oncology patient navigators) as the principal navigators in our system,” but recognizes the need for other professional navigators such as social workers and nurses, to be integrated at more complex points of care.⁵ He acknowledges that patient navigators (now defined as “oncology patient navigators”) and clinical navigators (nurse and/or social worker) should possess specific knowledge and skill set based on patient needs. Oncology patient and clinical navigators work with patients throughout and at any point within the cancer continuum. For example, an oncology patient navigator based in a community setting may work with patients at the prevention, education, and screening portion of the cancer continuum, whereas an oncology patient navigator in the clinic starts working once a patient is diagnosed with cancer. Oncology patient navigators also may cross the threshold of the clinic and continue working with their patients throughout diagnosis, treatment, survivorship, and end of life.

Documentation and reimbursement systems in the clinical setting led to the evolution of nurse navigation, and later case management. From 2013 to 2017, the Oncology Nursing Society, Academy of Oncology Nurse & Patient Navigators (AONN+) and George Washington University contributed to work to delineate navigation roles, core competencies, knowledge domains, and standard metrics to measure the impact of navigation.

Because of the multiple competency resources resulting from this foundational work, in 2019, the American Cancer Society National Navigation Roundtable (ACS NNRT) Workforce Development group used the basis of these competencies along with others from the Patient Navigator Training Collaborative and the Colorado Department of Public Health and Environment Health Navigation Workforce Development Initiative to come to a consensus about shared domains for competency-based patient navigation training.⁶

To unify the profession on standardization of definitions, scopes, and roles for the various types of navigators, a patient navigation working group composed of leaders from professional oncology groups was created in a cross-disciplinary partnership that included nursing, social work, and oncology patient navigators that originated from the Biden Cancer Initiative in 2017.⁷ The group transitioned into the Professional Oncology Navigation Task Force and in March 2022, standards of professional practice were published.⁸

With standardization of definitions, roles, shared domains for competency-based patient navigation training, and metrics to support the profession, another unifying piece of professional navigation practice was the creation of job descriptions with specific scopes of practice around levels of expertise. In 2022–2023, the ACS NNRT Workforce Development Group, using the training competencies from 2019 and agreed on definitions of entry, intermediate, and advance to define navigation experience or equivalent as well as skills including knowledge and comprehension for that level of expertise, created job descriptions that are applicable to all oncology navigators.^{2, 9} The tool can be used in creating job descriptions as well as a guide for navigators as they advance their careers. Dissemination and implementation of these foundational standards has been a challenge. It is critical to the growth of the patient navigation profession and provision of high quality and consistent services that the standards are widely adopted in practice. The Community Guide recognizes patient navigation as an evidence-based practice.¹⁰

This article illustrates how the patient navigator job roles table can be used to generate job descriptions for three distinct levels of proficiency—entry, intermediate, and advanced (Figure 1). It is a resource for administrators to create standard-aligned job descriptions to a specific level of expertise and it is a resource for navigators to see how one may advance over time to different stages of responsibilities within a patient navigation role. In contrast to other standards that address patient navigators, nurse navigators, and social work navigators separately, the resources in this article apply to all patient navigators at the entry, intermediate, and advanced levels.

The patient navigator is an advocate for patients and needs to also be an advocate for their career development. By understanding the depth and breadth of navigation, administrators can better appreciate the value of navigators across the cancer continuum. The 2024 table can be a useful tool for administrators to identify which skills are relevant to the navigator’s level of expertise and experience. The field of oncology patient navigation is expanding rapidly to fields beyond cancer. Flexibility should be built into the job description, enabling the candidate to evolve within navigation.

In conclusion, the table is a tool that can assist administrators by showing a linear progression of skills based on levels of expertise. This can lead to opportunities that foster the advancement of navigation oncology careers. As administrators coordinate training and evaluation opportunities based on levels of expertise, there is overall improved care coordination and evolution of task-shifting and task-sharing to overcome barriers and improve patient outcomes.

As navigators evolve in their role, they can train and mentor other navigators and members of the oncology care team. They become key in leading efforts to identify gaps in community resources and collaborate with other service providers and inform policymaker (Advanced, Domain IV, and TANaopic 4).¹¹

Arti Varanasi: Conceptualization, investigation, writing–original draft, writing–review and editing, project administration, supervision, and methodology. Linda Burhansstipanov: Conceptualization, investigation, writing–original draft, methodology, writing–review and editing, supervision, and project administration. Sharon Gentry: Writing–original draft and writing–review and editing. Michelle Chappell: Writing–original draft and writing–review and editing. Carrie Dorn: Writing–original draft and writing–review and editing. Julie McMahon: Writing–original draft and writing–review and editing. Kimberly Bradsher: Writing–original draft and writing–review and editing. Elba L. Saavedra Ferrer: Writing–original draft and writing–review and editing. LaSonia Barnett: Writing–original draft and writing–review and editing. Marjorie Leighliter: Writing–original draft and writing–review and editing. Donna Moore Wilson: Writing–original draft and writing–review and editing. Tracie Lewis: Writing–original draft and writing–review and editing.

Linda Burhansstipanov reports fees for professional activities from the Native American Cancer Research Corporation. Arti Varanasi reports fees for professional activities from the American Cancer Society. The other authors report no conflicts of interest.