Patient Navigation Process: Addressing Barriers to Care


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During the Commission on Cancer Surveyors and Consultants Training an emphasis was made repeatedly that hiring a Patient Navigator does not imply compliance with Standard 3.1.    A Patient Navigator may be implementing the patient navigation process driven by a triennial Community needs Assessment but that cannot always be the assumption.   The navigation process required by Standard 3.1 is dependent upon the particular type, severity, and/or complexity of the identified barrier.  The process can involve several individuals and can include referral services.

If your facility has a patient navigator, what barrier are they addressing this year?  Can the patient navigator answer that question?  Can you find that answer in your cancer committee discussion documentation?   You must have all of those answers for your CoC surveyor!

Here are just a few examples of barriers to care:

  • Literacy
  • Childcare
  • Disabilities
  • Housing
  • Fear/Anxiety
  • Adequate supply of clinicians
  • Scheduling delays
  • Missed appointments
  • Perception of care being delivered

As mentioned in previous blog posts, I have had a recent experience with a family member’s cancer experience.  A significant barrier to her care was the hours of operation for radiation therapy.   The facility did not schedule patients after 2:30 PM.  This eliminated the possibility of working a full day followed by radiation therapy.

The intent of the standard is to address a new barrier yearly unless the cancer committee members determine that addressing the same barrier continues to be of the most concern and ongoing need for their community.  This discussion and decision must be documented.  Progress must be reported annually to the cancer committee and the committee (not just the navigator) must decide if continuing to address this barrier until resolved.  Often more than one barrier is being addressed throughout the year.

I would recommend sharing the following information with the individual reporting on the Patient Navigation Process to the cancer committee.


  • Populations to be served as identified by the Community Needs Assessment
  • Health disparities and barriers identified by the Community Needs Assessment
  • Description of the navigation process to overcome barriers
  • Documentation of activities and metrics
  • Areas for improvement, enhancement, and future directions

Be watching for the revisions to the 2016 SAR (to be released soon) for the Chapter 3 Standards.  The revisions will allow for more detailed compliance documentation.