Article

An Exploration of the Patient Navigator Role: Perspectives of Younger Women With Breast Cancer

Allison E. Pedersen

Thomas F. Hack

Susan E. McClement

Jill Taylor-Brown

breast cancer, patient navigation, patient navigator, nurse navigator, supportive care
ONF 2013, 41(1), 77-88. DOI: 10.1188/14.ONF.77-88

Purpose/Objectives: To delineate the role of the oncology patient navigator, drawing from the experiences and descriptions of younger women with breast cancer.

Research Approach: Interpretive, descriptive, qualitative research design.

Setting: Participants' homes, researcher's home, and via telephone, all in Winnipeg, Manitoba, Canada.

Participants: 12 women aged 50 years or younger who were diagnosed with breast cancer within the last three years.

Methodologic Approach: Face-to-face semistructured interviews explored patient experiences with the cancer care system, including problems encountered, unmet needs, and opinions about the functions of the patient navigator role. The audio-recorded interviews were transcribed and data were broken down and inductively coded into four categories. Constant comparative techniques also were used during analysis.

Findings: The role of the oncology patient navigator included two facets: "Processual facets," with the subthemes assigned to me at diagnosis, managing the connection, mapping the process, practical support, and quarterbacking my entire journey; and "Personal qualities: The essentials," with the subthemes empathetic care tenor, knowing the cancer system, and understanding the medical side of breast cancer.

Conclusions: Despite the tremendous effort directed toward enhancing care for younger women undergoing treatment for breast cancer, gaps continue to exist. Younger women with breast cancer require a care approach providing ongoing dialogue, teaching, and emotional support from the point of diagnosis through treatment, including transitions of care within the oncology setting and back to their primary care practitioner.

Interpretation: Oncology nurse navigators are well positioned to provide patients with anticipatory guidance from diagnosis to the end of treatment.

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    References

    Adams, E., McCann, L., Armes, J., Richardson, A., Stark, D., Watson, E., & Hubbard, G. (2011). The experiences, needs and concerns of younger women with breast cancer: A meta-ethnography. Psycho-Oncology, 20, 851-861. doi:10.1002/pon.1792
    American Cancer Society. (2013). Breast cancer facts and figures 2013-2014. Retrieved from http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-040951.pdf
    Amir, Z., Scully, J., & Borrill, C. (2004). The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams. European Journal of Oncology Nursing, 8, 306-314. doi:10.1016/j.ejon.2003.12.011
    Ashida, S., Palmquist, A.E., Basen-Engquist, K., Singletary, S.E., & Koehly, L.M. (2009). Changes in female support network systems and adaptation after breast cancer diagnosis: Differences between older and younger patients. Gerontologist, 49, 549-559. doi:10.1093/geront/gnp048
    Avis, N.E., Crawford, S., & Manuel, J. (2004). Psychosocial problems among younger women with breast cancer. Psycho-Oncology, 13, 295-308. doi:10.1002/pon.744
    Badger, T., Segrin, C., Dorros, S.M., Meek, P., & Lopez, A.M. (2007). Depression and anxiety in women with breast cancer and their partners. Nursing Research, 56(1), 44-53. doi:10.1097/00006199-200701000-00006
    Beaulieu, J.E., Massey, C.S., Tucker, T.C., Schoenberg, N., & Ross, F. (2003). Rural-urban variation in breast-conserving surgery in Kentucky. Journal of the Kentucky Medical Association, 101, 455-459.
    Beaver, K., Twomey, M., Witham, G., Foy, S., & Luker, K.A. (2006). Meeting the information needs of women with breast cancer: Piloting a nurse-led intervention. European Journal of Oncology Nursing, 10, 378-390. doi:10.1016/j.ejon.2006.02.004
    Belkora, J., Stupar, L., O'Donnell, S., Loucks, A., Moore, D., Jupiter, C., … Wilson, L. (2012). Decision support by telephone: Randomized controlled trial in a rural community setting. Patient Education and Counseling, 89, 134-142. doi:10.1016/j.pec.2012.06.009
    Bowman, S., & Grim, R. (2008). The efficacy of the nurse navigator in a community hospital breast care program. Seminars in Breast Disease, 11(1), 26-30. doi:10.1053/j.sembd.2008.04.007
    Canadian Breast Cancer Network. (2001). Perspectives of rural women with breast cancer. Retrieved from http://www.cbcn.ca/documents/cbcn_special_reports/Perspectives-RuralReport-English-Updated.pdf
    Carroll, J.K., Humiston, S.G., Meldrum, S.C., Salamone, C.M., Jean-Pierre, P., Epstein, R.M., & Fiscella, K. (2010). Patients' experiences with navigation for cancer care. Patient Education and Counseling, 80, 241-247. doi:10.1016/j.pec.2009.10.024
    Cordova, M.J., Studts, J.L., Hann, D.M., Jacobsen, P.B., & Andrykowski, M.A. (2000). Symptom structure of PTSD following breast cancer. Journal of Traumatic Stress, 13, 301-319. doi:10.1023/A:1007762812848
    Corporate Research Associates Inc. (2004). Cancer patient navigation evaluation. Retrieved from http://www.cancercare.ns.ca/site-cc/media/cancercare/PatientNavigationEvaluationFindings.pdf
    Coyne, E., & Borbasi, S. (2006). Holding it all together: Breast cancer and its impact on life for younger women. Contemporary Nurse, 23, 157-169.
    Dohan, D., & Schrag, D. (2005). Using navigators to improve care of underserved patients: Current practices and approaches. Cancer, 104, 848-855. doi:10.1002/cncr.21214
    Doll, R., Stephen, J., Barroetavena, M.C., Linden, W., Poole, G., Ng, E., … Habra, M. (2003). Patient navigation in cancer care: Program delivery and research in British Columbia. Canadian Oncology Nursing Journal, 13, 193.
    Ell, K., Vourlekis, B., Lee, P.J., & Xie, B. (2007). Patient navigation and case management following an abnormal mammogram: A randomized clinical trial. Preventive Medicine, 44(1), 26-33. doi:10.1016/j.ypmed.2006.08.001
    Ferrante, J.M., Chen, P.H., & Kim, S. (2007). The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: A randomized controlled trial. Journal of Urban Health, 85, 114-124.
    Fillion, L., Cook, S., Veillette, A.M., Aubin, M., de Serres, M., Rainville, F., … Doll, R. (2012). Professional navigation framework: Elaboration and validation in a Canadian context [Online exclusive]. Oncology Nursing Forum, 39, E58-E69. doi:10.1188/12.ONF.E58-E69
    Fillion, L., de Serres, M., Lapointe-Goupil, R., Bairati, I., Gagnon, P., Deschamps, M., … Demers, G. (2006). Implementing the role of patient-navigator nurse at a university hospital centre. Canadian Oncology Nursing Journal, 16(1), 5-17.
    Fiorentino, L., Rissling, M., Liu, L., & Ancoli-Israel, S. (2011). The symptom cluster of sleep, fatigue and depressive symptoms in breast cancer patients: Severity of the problem and treatment options. Drug Discovery Today: Disease Models, 8(4), 167-173.
    Fitch, M.I., Porter, H.B., & Page, B.D. (Eds.). (2008). Supportive care framework: A foundation for person-centred care. Ontario, CA: Pappin Communications Ontario.
    Freeman, H.P., Muth, B.J., & Kerner, J.F. (1995). Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Practice, 3(1), 19-30.
    Gould, J., Grassau, P., Manthorne, J., Gray, R.E., & Fitch, M.I. (2006). ‘Nothing fit me’: Nationwide consultations with young women with breast cancer. Health Expectations, 9, 158-173. doi:10.1111/j.1369-7625.2006.00383.x
    Hack, T.F., Degner, L.F., Parker, P.A., Baile, W., Brundage, M., Bultz, B., … Tishelman, C. (2005). The communication goals and needs of cancer patients: A review. Psycho-Oncology, 14, 831-845.
    Kissane, D.W., Grabsch, B., Love, A., Clarke, M., Bloch, S., & Smith, G.C. (2004). Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Australian and New Zealand Journal of Psychiatry, 38, 320-326.
    Koopman, C., Butler, L.D., Classen, C., Giese-Davis, J., Morrow, G.R., Westendorf, J., … Spiegel, D. (2002). Traumatic stress symptoms among women with recently diagnosed primary breast cancer. Journal of Traumatic Stress, 15, 277-287. doi:10.1023/A:1016295610660
    Korber, S., Padula, C., Gray, J., & Powell, M. (2011). A breast navigator program: Barriers, enhancers and nursing interventions. Oncology Nursing Forum, 38, 44-50. doi:10.1188/11.ONF.44-50
    Leahy, M., Krishnasamy, M., Herschtal, A., Bressel, M., Dryden, T., Tai, K.H., & Foroudi, F. (2013). Satisfaction with nurse-led telephone follow up for low to intermediate risk prostate cancer patients treated with radical radiotherapy: A comparative study. European Journal of Oncology Nursing, 17, 162-169. doi:10.1016/j.ejon.2012.04.003
    Lee, T., Ko, I., Lee, I., Kim, E., Shin, M., Roh, S., … Chang, H. (2011). Effects of nurse navigators on health outcomes of cancer patients. Cancer Nursing, 34, 376-384. doi:10.1097/NCC.0b013e3182025007
    Matthews, E.E., Schmiege, S.J., Cook, P.F., & Sousa, K.H. (2012). Breast cancer and symptom clusters during radiotherapy. Cancer Nursing, 35(2), E1-E11. doi:10.1097/NCC.0b013e3182277222
    Meden, T., St. John-Larkin, C., Hermes, D., & Sommerschield, S. (2002). Relationship between travel distance and utilization of breast cancer treatment in rural Northern Michigan. JAMA, 287, 110-115.
    Melinyshyn, S., & Wintonic, A. (2006). The role of the nurse navigator in the breast assessment program at Hotel Dieu Hospital. Retrieved from http://www.krcc.on.ca/pdf/The%20Role%20of%20the%20Nurse%20Navigator%20in%20the%20Breast%20Assessment%20Program.pdf
    Morse, J.M., & Field, P.A. (1995). Qualitative research methods for health professionals (2nd ed.). Thousand Oaks, CA: Sage.
    Mosher, C.E., & Danoff-Burg, S. (2005). A review of age differences in psychosocial adjustment to breast cancer. Journal of Psychosocial Oncology, 23(2-3), 101-114. doi:10.1300/J077v23n02_07
    Patton, M.Q. (2002). Qualitative research and evaluation methods. (3rd ed.). Thousand Oaks, CA: Sage.
    Pedersen, A., & Hack, T.F. (2010). Pilots of oncology health care: A concept analysis of the patient navigator role. Oncology Nursing Forum, 37, 55-60. doi:10.1188/10.ONF.55-60
    Psooy, B., Schreuer, D., Borgaonkar, J., & Caines, J. (2004). Patient navigation: Improving timeliness in the diagnosis of breast abnormalities. Canadian Association of Radiology Journal, 55(3), 145-150.
    Robinson-White, S., Conroy, B., Slavish, K.H., & Rosenzweig, M. (2010). Patient navigation in breast cancer: A systematic review. Cancer Nursing, 33, 127-140. doi:10.1097/NCC.0b013e3181c40401
    Sandelowski, M. (1986). The problem of rigor in qualitative research. Advances in Nursing Science, 8(3), 27-37.
    Schwaderer, K.A., & Itano, J.K. (2007). Bridging the healthcare divide with patient navigation: Development of a research program to address disparities. Clinical Journal of Oncology Nursing, 11, 633-639. doi:10.1188/07.CJON.633-639
    Smithies, M., Bettger-Hahn, M., Forchuk, C., & Brackstone, M. (2009). Telephone contact intervention in women undergoing treatment for breast cancer. Canadian Oncology Nursing Journal, 19, 122-128.
    Strong, V., Waters, R., Hibberd, C., Rush, R., Cargill, A., Storey, D., … Sharpe, M. (2007). Emotional distress in cancer patients: The Edinburgh Cancer Centre symptom study. British Journal of Cancer, 96, 868-874. doi:10.1038/sj.bjc.6603626
    Thewes, B., Butow, P., Girgis, A., & Pendlebury, S. (2004). The psychosocial needs of breast cancer survivors: A qualitative study of the shared and unique needs of younger versus older survivors. Psycho-Oncology, 13, 177-189.
    Thomsen, D.K., Pedersen, A.F., Johansen, M.B., Jensen, A.B., & Zachariae, R. (2007). Breast cancer patients' narratives about positive and negative communication experiences. Acta Oncologica, 46, 900-908.
    Thorne, S. (2008). Interpretive description. Walnut Creek, CA: Left Coast Press.
    Thorne, S.E., Bultz, B.D., & Baile, W.F. (2005). Is there a cost to poor communication in cancer care? A critical review of the literature. Psycho-Oncology, 14, 875-884. doi:10.1002/pon.947
    Yoo, G.J., Levine, E.G., Aviv, C., Ewing, C., & Au, A. (2010). Older women, breast cancer, and social support. Supportive Care in Cancer, 18, 1521-1530. doi:10.1007/s00520-009-0774-4
    Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19-28.