Planning and Sustaining Breast Cancer Patient Navigation Programs: A CFIR-Informed Scoping Review of Implementation Determinants.

BACKGROUND

Patient Navigation Programs (PNPs) address fragmentation and socioeconomic barriers in breast cancer care, but sustainable implementation is complex and context dependent. This scoping review systematically maps and synthesises multilevel determinants of breast cancer PNPs to inform strategic planning and health system management for sustainable service delivery across diverse public health contexts.

METHODS

Guided by the Arksey and O'Malley methodology framework and reported in accordance with PRISMA-ScR, we conducted a comprehensive search across five databases, covering studies published between January 2000 and December 2025. Implementation determinants were retrospectively mapped using the Consolidated Framework for Implementation Research (CFIR v1.0) as an analytic lens. Dual independent screening and multi-reviewer construct coding were performed, with discrepancies resolved through consensus.

RESULTS

Twenty-six studies met the inclusion criteria. Determinants were identified across all five CFIR domains. Outer-setting pressures (e.g., financial and transportation barriers) frequently intersect with inner-setting constraints (e.g., workforce shortages, fragmented service structures). Process-related strategies, particularly stakeholder engagement and structured navigator training, were consistently described as enabling mechanisms that buffered contextual strain-intervention characteristics, including cost, complexity, and adaptability, moderated integration trajectories. Sustainability improved when navigation functions were embedded within routine service structures rather than maintained as externally funded add-ons.

CONCLUSION

The implementation of breast cancer PNPs appears to be shaped by dynamic cross-domain interactions. This synthesis suggests that sustainability may be strengthened through alignment of financing arrangements, workforce configuration, service integration mechanisms, and deliberate implementation strategies. A proposed phased implementation pathway offers a practical planning guide for resource-constrained systems.