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Connecting Patients to Care: The St. Louis Regional Breast Navigator Workgroup (2010 to present)

A collaboration between St. Louis Safety-Net Breast Health Providers, the Integrated Health Network, and the Program for the Elimination of Cancer Disparities at the Siteman Cancer Center of Barnes-Jewish Hospital and Washington University School of Medicine

What is a breast health navigator?

Have you ever been given the responsibility for a task, but felt there were too many obstacles to complete it successfully? Some people would simply give up. However, there is a motivated and resourceful group of individuals in the St. Louis region that never give up. Who are they? Their formal titles within organizations can vary from case manager, to navigator, to community health worker, to coordinator and so on. Essentially, they are breast health navigators in the St. Louis Metropolitan area in Missouri and Illinois.

Breast health navigators work through every challenge, over every hurdle and around any barrier to help successfully facilitate women through breast cancer screening and diagnosis. They leave no stone unturned. For example, one navigator states, “I help women overcome financial, physical and emotional barriers [to mammography].” This includes ensuring timely follow-up appointments and coordination of services and treatment.

The complex nature of breast cancer disparities, which remain prevalent among racial/ethnic minorities and underserved populations, reveals the importance of breast health navigators as linchpins in the breast cancer screening and diagnostic process. The process alone can involve many health care providers, organizations, and departments within organizations. And this is after a woman is engaged in a care pathway.

Collectively, breast health navigators help ensure that women do not fall through the cracks in meeting breast cancer screening guidelines. One navigator says, “Case managing and keeping one-to-one communication with the patients is very important. It keeps those who are hard to reach from being lost in the system. Sometimes women are hesitant to have their mammograms done due to fear or anxiety. It’s important for those patients to have someone that can answer questions and allay those fears.”

The St. Louis Regional Breast Navigator Workgroup

The St. Louis Regional Breast Navigator Workgroup is a unique collaborative partnership among safety-net providers. These dedicated breast navigators work one-on-one with large panels of patients on a daily basis within their own organizations. Empowered by each other, the navigators use quarterly workgroup meetings to identify collective concerns and develop potential solutions. This enhances their ability to serve as change agents in the broader community as well as in their own organizations. As such, navigators have tremendous impact on the health and empowerment of uninsured and underinsured women in the region. They have shared and implemented process improvements, shared best practices, and connected each other to resources.

This group was established in 2010 in response to interest expressed at meetings of the Siteman Cancer Center’s Program for the Elimination of Cancer Disparities (PECaD) Breast Cancer Community Partnership and based on the following recommendation from the St. Louis Integrated Health Network’s (IHN) Breast Cancer Referral Initiative:

“Key contact persons at each organization (breast navigator or referral coordinator at each community health center, community-outreach-navigator(s) at the breast health center(s), and the utilization management nurse at ConnectCare) to meet quarterly to enhance communication, improve processes, share suggestions, and provide support in the effort to facilitate all breast health referrals from the safety-network.” – Excerpt from IHN Breast Cancer Referral Initiative Recommendations

The workgroup is facilitated by Heidi Miller, MD, a safety-net primary care provider at Family Care Health Centers. Dr. Miller led a consensus process as a consultant of the Integrated Health Network to develop the IHN Breast Cancer Referral Initiative Recommendations. “These enthusiastic and thoughtful navigators have an enormous impact on the health of their patients. They work tirelessly to overcome the socioeconomic, logistical, and emotional reasons that vulnerable patients may miss out on breast screening. It is an honor to facilitate their discussion and to understand what their patients are actually experiencing,” says Dr. Miller.

PECaD has supported the goals of this coalition by nurturing its development and underwriting all activities of the workgroup including administrative and logistical support, securing facilitator time, and foster movement and progress on discussion topics for the purpose of aiding the group’s advancement and charge.