Table 1.

State of Navigation across the country in 2016, as reported by participants at the 2016 conference workshop

British Columbia	No coordinated system of specific navigation roles for nurses; goal is to empower all oncology nurses to navigate, regardless of roles. Looking at models of care to position nurses in the cancer care system relative to patient needs, support to practise to full scope; rather than limit to another layer of “navigator” nursing roles. NPs attached to tumour groups; some in primary care; may bridge gaps in care; some breast nurse navigators in the past.
Alberta	3 Models (1) Generalist – from diagnosis to end of life care; any site – located in rural or isolated communities that have cancer care facilities. Provincially managed/organized; (2) One indigenous navigator located at the CCI, but funded by Indigenous health, works closely with the Community oncology navigation program referenced above; (3) Breast cancer – from suspicion to first surgical consult – three similar breast health programs in urban centres. Some ad hoc programs in other centres including breast navigators at Misericordia, ovarian navigator at the Royal Alex in Edmonton, and inpatient navigators in hematology.
Saskatchewan	Screening focused navigators for colorectal, breast, and prostate cancer. Social worker Navigators are the first point of contact for cancer agency and connect patients to resources as needed. The primary focus is on patients newly referred to the cancer centre - do not follow patient forward. Peer navigation – in development.
Manitoba	Navigators see the patient before starting treatment and support as needed. Provincial system transformation to embrace navigation teams; establish “hubs”; work with primary care. Initially roles were implemented in rural settings but are now being utilized in urban settings. In urban centres, focus is on reducing ER visits, also for patients with advanced disease who are awaiting clinic appointments; navigators can visit in person or contact by phone. Work closely with palliative care, rapid diagnostic clinic, family doctors (good network in the province).
Ontario	Many types of navigators situated in a variety of settings, populations, point in trajectory, etc. across the province (no overarching provincial structure or standards). Diagnostic assessment program (DAP) – roles across program vary; some are clerical navigators. Clerical navigation models are also being tested. Peer navigation also available. The role is primarily organizationally based; different roles and responsibilities as a result; every region/DAP is different; there is no overarching provincial model.
Quebec	Infirmière Pivot en Oncologie (IPO) with 4 functions (assessment, teaching, coordination, support). Nurses only (no lay navigators); ~250 in province, supported by provincial government. Access to IPO varies across province; each centre has criteria for who can see an IPO. More than 50% of care is delivered by telephone. Variation in models depending on size of centre – Large centre: IPOs are site specific; smaller centre: IPOs are generalists. Evaluation being done to determine impact of IPO on patient outcomes; also challenge to know when it is the optimal time to “end” the IPO relationship.
New Brunswick	Pediatric navigation services but no other coordinated navigation programs.
PEI	All nurses are navigators within the context of being an oncology nurse. There is one nurse who specifically is designated as a navigator; mental health background; located in main centre in Charlottetown but travels to Summerside 1 day a week. Main gap in patient care is the interval before connection to cancer centre. Navigator role is not well known yet at that point/evolving. After care (survivor follow up) is evolving.
Nova Scotia	Navigators are RNs: 9 navigators in adult oncology and 8 in pediatric oncology, “generalist”; community-based tend to follow the patient throughout the continuum of care; follow patient through entire experience, if patient in active treatment navigator steps back. Navigators at the cancer centre in Halifax focus on head and neck cancer, 2 for breast. Clinical Nurse Specialists take over once the patient is at the centre.
Newfoundland	The Cancer Patient Navigation team members are located throughout Newfoundland and Labrador. Cancer Patient Navigators, are culturally sensitive and highly trained registered nurses in oncology, available at point of suspicion to help patients and their families, health care providers, and community partners, ensuring they have information and knowledge to make the best decisions about their care.