Patient navigation moderates emotion and information demands of cancer treatment: a qualitative analysis



Patient navigation is increasingly employed to guide patients through cancer treatment. We assessed the elements of navigation that promoted patients’ involvement in treatment among patients with breast and colorectal cancer that participated in a navigation study.


We conducted qualitative analysis of 28 audiotaped and transcribed semi-structured interviews of navigated and unnavigated cancer patients.


Themes included feeling emotionally and cognitively overwhelmed and desire for a strong patient-navigator partnership. Both participants who were navigated and those who were not felt that navigation did or could help address their emotional, informational, and communicational needs. The benefits of logistical support were cited less often.


Findings underscore the salience of personal relationships between patients and navigators in meeting patients’ emotional and informational needs.

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  1. 1.

    Jemal A et al (2009) Cancer statistics, 2009. CA Cancer J Clin 59(4):225–249

    PubMed  Article  Google Scholar 

  2. 2.

    Shepherd HL, Tattersall MH, Butow PN (2008) Physician-identified factors affecting patient participation in reaching treatment decisions. J Clin Oncol 26(10):1724–1731

    PubMed  Article  Google Scholar 

  3. 3.

    Jean-Pierre P et al (2010) Race/ethnicity-based concerns over understanding cancer diagnosis and treatment plan. J Natl Med Assoc 102(3):184–189

    PubMed Central  PubMed  Google Scholar 

  4. 4.

    Wells KJ et al (2008) Patient navigation: state of the art or is it science? Cancer 113(8):1999–2010

    PubMed Central  PubMed  Article  Google Scholar 

  5. 5.

    Robinson-White S et al (2010) Patient navigation in breast cancer: a systematic review. Cancer Nurs 33(2):127–140. doi:10.1097/NCC.0b013e3181c40401

    PubMed  Article  Google Scholar 

  6. 6.

    Freeman HP, Rodriguez RL (2011) History and principles of patient navigation. Cancer 117(S15):3537–3540

    Article  Google Scholar 

  7. 7.

    Basu M et al (2013) The effect of nurse navigation on timeliness of breast cancer care at an academic comprehensive cancer center. Cancer 119(14):2524–2531

    PubMed  Article  Google Scholar 

  8. 8.

    Freund KM et al (2008) National Cancer Institute Patient Navigation Research Program: methods, protocol, and measures. Cancer 113(12):3391–3399

    PubMed Central  PubMed  Article  Google Scholar 

  9. 9.

    Fiscella K et al (2012) Patient navigation for breast and colorectal cancer treatment: a randomized trial. Cancer Epidemiol Biomark Prev 21(10):1673–1681

    Article  Google Scholar 

  10. 10.

    Hendren S et al (2010) Study protocol: a randomized controlled trial of patient navigation-activation to reduce cancer health disparities. BMC Cancer 10:551

    PubMed Central  PubMed  Article  Google Scholar 

  11. 11.

    Hibbard JH et al (2004) Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 39(4 Pt 1):1005–1026

    PubMed Central  PubMed  Article  Google Scholar 

  12. 12.

    Greene J, Hibbard JH (2012) Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med 27(5):520–526

    PubMed Central  PubMed  Article  Google Scholar 

  13. 13.

    Calhoun EA et al (2010) A national patient navigator training program. Health Promot Pract 11(2):205–215

    PubMed  Article  Google Scholar 

  14. 14.

    Family development credential. Available from:

  15. 15.

    Sandelowski M, Barroso J (2003) Classifying the findings in qualitative studies. Qual Health Res 13(7):905–923

    PubMed  Article  Google Scholar 

  16. 16.

    Freeman HP (2006) Patient navigation: a community based strategy to reduce cancer disparities. J Urban Health 83(2):139–141

    PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    van’t Spijker A, Trijsburg RW, Duivenvoorden HJ (1997) Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med 59(3):280–293

    Article  Google Scholar 

  18. 18.

    Sultan S et al (2004) Impact of functional support on health-related quality of life in patients with colorectal cancer. Cancer 101(12):2737–2743

    PubMed  Article  Google Scholar 

  19. 19.

    Kang SH, Bloom JR (1993) Social support and cancer screening among older black Americans. J Natl Cancer Inst 85(9):737–742

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Bloom JR (2008) Improving the health and well-being of cancer survivors: past as prologue. Psycho-Oncology 17(6):525–532

    PubMed  Article  Google Scholar 

  21. 21.

    Love RR et al (1989) Side effects and emotional distress during cancer chemotherapy. Cancer 63(3):604–612

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Mazor KM et al (2013) Patients’ and family members’ views on patient-centered communication during cancer care. Psycho-Oncology 22(11):2487–2495

    PubMed  Article  Google Scholar 

  23. 23.

    Schwabe L et al (2012) Stress effects on memory: an update and integration. Neurosci Biobehav Rev 36(7):1740–1749

    PubMed  Article  Google Scholar 

  24. 24.

    Jim HSL et al (2012) Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. J Clin Oncol 30(29):3578–3587

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  25. 25.

    Woodard GR, Edouard L (1992) Reaching out: a community initiative for disadvantaged pregnant women. Can J Public Health 83(3):188–190

    CAS  PubMed  Google Scholar 

  26. 26.

    Eng E, Smith J (1995) Natural helping functions of lay health advisors in breast cancer education. Breast Cancer Res Treat 35(1):23–29

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Brownstein JN et al (1992) Breast and cervical cancer screening in minority populations: a model for using lay health educators. J Cancer Educ 7(4):321–326

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Nguyen TU et al (2011) A qualitative assessment of community-based breast health navigation services for Southeast Asian women in southern California: recommendations for developing a navigator training curriculum. Am J Public Health 101(1):87–93

    PubMed Central  PubMed  Article  Google Scholar 

  29. 29.

    Heisler M et al (2009) Participants’ assessments of the effects of a community health worker intervention on their diabetes self-management and interactions with healthcare providers. Am J Prev Med 37(6 Suppl 1):S270–S279

    PubMed Central  PubMed  Article  Google Scholar 

  30. 30.

    Madore S et al (2014) Feasibility of a psychosocial and patient navigation intervention to improve access to treatment among underserved breast cancer patients. Support Care Cancer

  31. 31.

    Wagner EH et al (2013) Nurse navigators in early cancer care: a randomized, controlled trial. J Clin Oncol 32:12–18

    PubMed  Article  Google Scholar 

  32. 32.

    Bickell NA et al (2014) Do community-based patient assistance programs affect the treatment and well-being of patients with breast cancer? J Oncol Pract 10(1):48–54

    PubMed  Article  Google Scholar 

  33. 33.

    Matsuda A et al (2014) Effectiveness of psychoeducational support on quality of life in early-stage breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Qual Life Res 23(1):21–30

    PubMed Central  PubMed  Article  Google Scholar 

  34. 34.

    Murty VP et al (2010) fMRI studies of successful emotional memory encoding: a quantitative meta-analysis. Neuropsychologia 48(12):3459–3469

    PubMed Central  PubMed  Article  Google Scholar 

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We extend our thanks to the patients who participated in our patient navigation research program for sharing their insights, thoughts, and reflections with us. We also deeply appreciate the dedication, commitment, and hard work of the entire navigation staff in our program. We also acknowledge Carol Moulthroup for her assistance in preparing this manuscript for submission. The National Cancer Institute funded this project: U01CA116924-5.

Conflict of interest

There is no financial relationship between the authors and the organization that sponsored the research. The authors also state that they have full control of all primary data and that they agree to allow the journal to review their data if requested.

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Correspondence to Kevin Fiscella.

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Rousseau, S.J., Humiston, S.G., Yosha, A. et al. Patient navigation moderates emotion and information demands of cancer treatment: a qualitative analysis. Support Care Cancer 22, 3143–3151 (2014).

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  • Patient navigation
  • Cancer treatment
  • Breast cancer
  • Colorectal cancer