Understanding Processes of Patient Navigation to Reduce Disparities in Cancer Care: Perspectives of Trained Navigators from the Field

Background: Patient navigation (PN) programs are being widely implemented to reduce disparities in cancer care for racial/ethnic minorities and the poor. However, systematic data that cogently described processes of PN are lacking. This qualitative study was designed to enhance understanding of PN processes.

Methods: We analyzed 21 semi-structured exit interviews (SSEIs) about navigated patients who completed a randomized trial of PN. The SSEIs addressed overall experience of navigation, barriers to care, and personal and institutional factors influencing PN processes and outcomes. We met weekly for five months to discuss codes/categories, reflective remarks, ways to focus/organize the data, and developed rules for summarizing data, drawing conclusions and verification. We followed a three-stage analysis model: reduction, display, and conclusion drawing/verification. We used ATLAS.ti_5.2 for text segmentation, coding, and retrieval.

Results: Five categories/factors relating to processes of PN emerged: patients, navigators, navigation processes, external, and outcomes. These categories formed a multilevel model which proposed ways in which PN processes (e.g., building relationships between patients and clinicians, removing barriers, and facilitating access and treatment adherence) influenced outcomes (e.g., treatment adherence, patient satisfaction). Relationships between PN processes and outcomes were dependent upon patients' factors (e.g., personal characteristics, attitude towards healthcare), navigators factors' (e.g., ability to set boundaries, being assertive), and external factors (e.g., social support, medical insurance, transportation).

Conclusion: PN processes are essential elements of effective PN programs to reduce race/ethnicity and socioeconomically-based disparities in cancer care.