Cancer diagnoses affect millions of people in the United States each year. Today, cancer patients face many challenges when trying to navigate the complex healthcare system. Patient navigation programs were developed to address and overcome barriers patients may face as they make their way through the healthcare system. The purpose of this project was to provide an analysis and discussion of the current published literature to provide evidence for improving care coordination and patient satisfaction in the oncology clinical setting with a patient navigator program. The practice-focused question for this project asked if a patient navigator program for adult cancer patients improved patient outcomes. The systematic review, guided by Watson's theory of caring, included 11 studies published between 2010 and 2017 identified through Cochrane Library, CINAHL, ProQuest, PubMed, and Joanna Briggs Institute. Initially a total of 679 articles were identified; however the number reduced by removing duplicates and after review of titles and abstracts. The remaining articles were then evaluated by the level of evidence based on the Manly and Fineout-Overholt's guide on hierarchy of evidence. The results identified in this systematic review showed patient navigation can improve care coordination and patient satisfaction. This review offers findings on the impact of cancer care coordination and patient satisfaction, which may be used by healthcare leaders when determining how to improve cancer care and as a result may provide positive social change. If the organization implements a patient navigator program, it is expected that this change would benefit patients, families, healthcare providers and the organization.

This dissertation includes an introductory chapter (Chapter 1), a collection of four manuscripts (Chapters 2-5), and a concluding chapter (Chapter 6). Chapter 2 has been published in the Canadian Journal of Nursing Research and Chapter 3 has been published in the International Journal of Qualitative Research. Chapter 4 and Chapter 5 will be submitted for journal publication. / In Canada as well as other countries with shared colonial histories, the healthcare system is complex and as a result, fragmentation of services is experienced. Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations within Canada and around the world which increases the complexity of navigating the healthcare system. Patient navigation is known as a patient-centered approach to enable and empower individuals and families to overcome barriers experienced while accessing health and social services. The literature surrounding the Indigenous patient navigator (IPN) role remains sparse. Understanding the IPN role and how health and social service barriers are addressed and how enablers are promoted is necessary. A qualitative interpretive description methodology guided by a Two-Eyed Seeing framework and Social Determinants of Indigenous Peoples’ Health Tree Metaphor developed by Charlotte Loppie (2022) were employed. Interviews were conducted via telephone and virtual platform with 20 IPNs and 16 patients or family members who had received IPN services. Additionally, 10 IPN documents were reviewed. The results related to the barriers and enablers Indigenous Peoples experience when accessing biomedical health care services in Canada as well as the roles and activities the IPN enact to address these barriers and promote enablers to access health and social services. Findings suggest that the IPN role is an integral part of improving access to health and social services for Indigenous Peoples in Canada. Eight major IPN roles are outlined which assist to address health and social service barriers and promote enablers experienced by Indigenous Peoples in Canada across health care settings. Finally, findings will assist decision and policy makers to make informed choices surrounding the IPN role and how this role can bridge the gap in health inequity to improve access to health and social services for Indigenous communities across Canada and abroad. / Dissertation / Doctor of Philosophy (PhD) / Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations within Canada increasing the complexity of navigating the healthcare system. Patient navigation is known as a patient-centered approach to enable and empower individuals and families to overcome barriers experienced while accessing health and social services. The literature surrounding the Indigenous patient navigator (IPN) role remains sparse; specifically, how the role addresses health and social service barriers as well as how the role supports Indigenous community members who access biomedical health care services. This dissertation explores the role of the IPN across health care settings in Ontario, Canada to understand the health and social service barriers and enablers that Indigenous Peoples experience as well as the roles and activities that the IPN addresses to bridge the gap in health inequity. The results will benefit Indigenous communities and healthcare providers providing care to Indigenous populations in Canada and abroad.