Abstract
Patient navigation (PN) programs are being widely implemented to reduce disparities in cancer care for racial/ethnic minorities and the poor. However, few systematic studies cogently describe the processes of PN. We qualitatively analyzed 21 transcripts of semistructured exit interviews with three navigators about their experiences with patients who completed a randomized trial of PN. We iteratively discussed codes/categories, reflective remarks, and ways to focus/organize data and developed rules for summarizing data. 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. Four categories of factors affecting cancer care outcomes emerged: patients, navigators, navigation processes, and external factors. These categories formed a preliminary conceptual framework describing ways in which PN processes influenced outcomes. Relationships between processes and outcomes were influenced by patient, navigator, and external factors. The process of PN has at its core relationship-building and instrumental assistance. An enhanced understanding of the process of PN derived from our analyses will facilitate improvement in navigators’ training and rational design of new PN programs to reduce disparities in cancer-related care.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Estachon J, Armour B, Ofili E et al (2001) Racial and ethnic disparities in health care. JAMA 285:883
Fiscella K, Franks P, Gold MR et al (2000) Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA 283:2579–2584
Institute of Medicine (2002) The future of the public’s health. Washington, D.C. National Academy Press
Smedley BD, Stith AY, Nelson AR (eds) (2003) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: confronting racial and ethnic disparities in health care appendix C: federal-level and other initiatives to address racial and ethnic disparities in healthcare. (384–391). Washington, DC. National Academies Press
Van Ryn M, Burke J (2000) The effect of patient race and socioeconomic status on physicians’ perceptions of patients. Soc Sci Med 50:813–828
Bradley CJ, Given CW, Roberts C (2001) Disparities in cancer diagnosis and survival. Cancer 91(1):178–188
LaVeist TA (2002) “Segregation, poverty, and empowerment: health consequences of African Americans.” In T A. LaVeist (ed) Race, ethnicity, and health: a public health reader. San Franscisco, Jossey-Bass
Roetzheim RG, Pal N, Tennant C et al (1999) Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst 91:1409–1915
Gornick ME, Eggers PW, Riley GF (2004) Associations of race, education, and patterns of preventive service use with stage of cancer at time of diagnosis. Health Serv Res 39:1403–1428
Griggs JJ, Culakova E, Sorbero ME et al (2007) Social and racial differences in selection of breast cancer adjuvant chemotherapy regimens. J Clin Oncol 25(18):2522–2527
Shavers VL, Brown ML (2002) Racial and ethnic disparities in the receipt of cancer treatment. J Nat Cancer Inst 94:334–357
Cooper LA, Hill MN, Powe NR (2002) Designing and evaluating interventions to eliminate racial and ethnic disparities in health care. J Gen Intern Med 17:477–486
Battaglia TA, Roloff K, Posner MA et al (2007) Improving follow-up to abnormal breast cancer screening in an urban population: a patient navigation intervention. Cancer Supplement 109(2):359–367
Freeman H (2006) Patient navigation: a community based strategy to reduce cancer disparities. Journal of Urban Health: Bulletin of the New York Academy of Medicine 83(2):139–141
Vargas RB, Ryan GW, Jackson CA et al (2008) Characteristics of the original patient navigation programs to reduce disparities in the diagnosis and treatment of breast cancer. Cancer 113(2):426–433
Dohan D, Schrag D (2005) Using navigators to improve care of underserved patients: current practices and approaches. Cancer 104(4):848–855
Freeman HP, Muth BJ, Kerner JF (1995) Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract 3:19–30
Petereit DG, Molloy K, Reiner ML et al (2008) Establishing a patient navigator program to reduce cancer disparities in the American Indian communities of South Dakota: initial observations and results. Cancer Control 15(3):254–259
Miles, MB and Huberman, AM. An expanded sourcebook—qualitative data analysis (2/e). Thousand Oaks, CA: SAGE
Carroll, JK, Humiston, SG, Meldrum, SC, Salamone, CM, Jean-Pierre, P, Epstein, RM, Fiscella, K. Patients’ expectation with navigation for cancer care. Patient Education and Counseling (In Press)
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by the National Cancer Institute public health service grants 5U01CA116924-04S1, U01CA116924-04S2, and 1R25CA10261801-A1.
Rights and permissions
About this article
Cite this article
Jean-Pierre, P., Hendren, S., Fiscella, K. et al. Understanding the Processes of Patient Navigation to Reduce Disparities in Cancer Care: Perspectives of Trained Navigators from the Field. J Canc Educ 26, 111–120 (2011). https://doi.org/10.1007/s13187-010-0122-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13187-010-0122-x