Patient navigation: Development of a protocol for describing what navigators do

Objective. To develop a structured protocol for observing patient navigators at work, describing and characterizing specific activities related to their goals. Data Sources/Setting. Fourteen extended observations of navigators at three programs within a national trial of patient navigation. Study Design. Preliminary observations were guided by a conceptual model derived from the literature and expert consensus, then coded to develop and refine observation categories. These findings were then used to develop the protocol. Methods. Observation fieldnotes were coded, using both a priori codes and new codes based on emergent themes. Using these codes, the team refined the model and constructed an observation tool that enables consistent categorization of the observed range of navigator actions. Findings. Navigator actions across a wide variety of settings can be categorized in a matrix with two dimensions. One dimension categorizes the individuals and organizational entities with whom the navigator interacts; the other characterizes the types of tasks carried out by the navigators in support of their patients. Conclusions. Use of this protocol will enable researchers to systematically characterize and compare navigator activities within and across programs.