Table 1.

Patient Navigation Studies

Study	Design	Primary Outcome	Participants and Setting	PN Hiring, Training, and Salary	PN interaction with Patient & staff	Results and comments
Jolly67 Navaneethan50	2×2 factorial RCT: 1) usual care; 2) enhanced personal health record only; 3) PN and enhanced personal health record; and 4) PN	ΔeGFR over 2 y	Adult English-speaking pts at CKD clinic. White, Black, Multiracial, and Asian/Pacific Islanders represented. Non-English speakers excluded.	PNs were lay individuals with good interpersonal skills and proficient with computers. Training was structured and included on-the-job shadowing of clinicians, EHR training, and CKD-specific training. Salary was commensurate with experience. No mention of cultural concordance.	PN met with pts every 2–4 wk face-to-face or over the phone during clinic visits. Additional interactions based on pt needs.	No change in eGFR after 2 y follow-up. Lesson learned: Importance of building a trusting relationship with pt to maintain good communication.
Sullivan51	Cluster RCT at dialysis facilities and Tx centers: 1) usual care; and 2) PN.	Tx process steps completed over 2 y	Adult English-speaking Tx candidates on dialysis. Whites, Blacks, and Others represented. Non-English speakers excluded.	Three lay PNs who were kidney Tx recipients. Training included education on kidney Tx process, human subjects protection, medical records abstraction, and motivational interviewing. Salary was the same as a study coordinator. No mention of cultural concordance.	PN met with pts monthly face-to-face during dialysis treatment. Additional interactions based on pt needs. PN shared personal experiences, reviewed the medical record, provided support in completion of Tx steps. PN communicated with Tx staff.	PN group completed twice as many steps in the Tx process compared to controls (3.5 vs 1.6 steps). Limitation: Due to small sample size and short duration, did not assess whether or not participants received a Tx.
Marlow53	Observational study comparing a nephrology practice with a PN program to one without	Increase in potential living kidney donors over 5 y	Adult English-speaking ESKD pts from an academic Tx center. Potential donors were family or friends. Blacks, Whites, and Others represented. Non-English speakers excluded.	Two PNs who were professional social workers. Training included on-the-job shadowing and organ donation-specific education from interdisciplinary clinicians (nurse coordinator, surgeons, and nephrologists). Also received cultural sensitivity training on the African American community.	PN provided education and support to Tx candidates and their potential living donors. Additional interactions based on pt needs.	Tx candidates at nephrology practice with a PN were more likely to have an initial inquiry (OR, 1.21 [1.01–1.44]) and a preliminary screening (OR, 1.27 [1.05–1.54]) of a potential living donor, but no significant differences in evaluated potential living donor (OR, 0.94 [0.61–1.45]). Lesson learned: May be beneficial to measure pt satisfaction with treatment and support. Building trust and providing tailored education were critical components.
Basu M54	RCT comparing usual care and PN	Increase wait-listing for kidney Tx	Adult ESKD Tx candidates; English or non-English speaking. Whites, Blacks, Others, Hispanics, and Non-Hispanics represented.	One PN with a Masters degree in social work who is Black. No description of the PN training.	PN called pts before their first Tx evaluation to conduct an initial assessment. Additional face-to-face and phone meetings until waitlisting decision. PN attended a multidisciplinary selection conference,	After 500 d, intervention participants were 3.3 times more likely to be successfully waitlisted compared to control participants (75% vs 25%; HR, 3.3 [1.20–9.12]). Lesson learned: Short duration and underpowered. One PN may have been overburdened by pt social challenges. Finding appropriate number of pts per navigator is critical.
Sullivan C52	Cluster RCT comparing: 1) dialysis facilities with a PN; and 2) dialysis facilities without a PN	No. of Tx process Steps completed over 2 y or at study end	Adult Englishspeaking dialysis pts at 40 dialysis facilities and 4 Tx centers	Four PNs who were Tx recipients. Training included a 3-d session on the kidney Tx process, medical records review, motivational interviewing, and human subjects protection. No mention of cultural concordance.	PN met with pts face-to-face monthly during a dialysis treatment. PN interactions with pts and staff similar to prior RCT by same PI.51 Additional interactions based on pt needs.	No difference between the intervention and control group in first visit, wait-listing, deceased donor Tx, and living donor Tx. Limitation: Short duration and underpowered. Many pts were ineligible or declined to participate. PNs supervised from afar, limiting ability to identify and address challenges.
Cervantes L55	Single-arm feasibility trial	Feasibility and acceptability over 2 y	Adult Spanish or English-speaking Hispanic ESKD patients. Hispanics targeted.	One Spanish-speaking Latina PN. The PN had personal experience as a caregiver for ESKD family member. Training included motivational interviewing and navigator fundamentals, on-the-job shadowing of clinicians, EHR, and ESKD-specific training.	PN met with pts every 2–4 wk face-to-face during a dialysis treatment or at home and was available over the phone. Additional interactions based on pt needs.	The intervention was feasible and acceptable. Of 49 eligible pts, 40 (82%) agreed to participate. None withdrew from intervention. Lesson learned: A trusting relationship between PN and pt during consent for study facilitated recruitment and subsequent study visits.

Values in brackets are 95% confidence intervals.

EHR, electronic health record; ESKD, end-stage kidney disease; HR, hazard ratio; OR, odds ratio; PI, principal investigator; Tx, transplantation