Navigators’ and Patients’ Perspectives on the Navigation Experience

Imbalanced investment and relational amelioration emerged as areas of care that were viewed differently by navigators and their patients in an analysis of perspectives from each group. Researchers from the University of Rochester interviewed 18 pairs of patients and navigators as part of a larger randomized controlled trial. In doing so, Yosha and colleagues identified struggles the navigators, in this study well-trained lay community health workers supervised by social workers, were experiencing but to which the patients were unaware.

Most noticeably, navigators expressed tension from their dual responsibilities of advocacy for their patients’ autonomy in decision making and their desire to promote decisions consistent with guideline- concordant care. Patients not only expressed comfort with their decisions but also, when asked, noted that they were unaware of the navigators’ struggle regarding this issue.

Another significant struggle for navigators was improving, and not worsening, any relationship difficulties between a patient and other members of the healthcare team. Navigators ex pressed discomfort in having to support a patient without passing judgment on medical providers when there was an adversarial relationship between that patient and provider. Navigators noted that not making the situation worse was an important goal in these situations.

There was consensus on patient needs identified. Emotional support, informational support, and accompaniment emerged as important for both groups. These needs, however, were viewed differently by navigators and patients. Navigators often saw emotional support as a main part of their job function. Patients generally did not expect emotional support but found it beneficial as time progressed. Most patients expressed appreciation for their navigators in the interviews conducted after acute treatment. They appreciated not only the help they received but the help their family members received from the navigation intervention.

The researchers concluded that as patient navigation programs continue to evolve, instruction on the imbalanced investment in the relationship between patient and navigator can be used to improve navigator training. Training programs should educate navigators to anticipate these struggles and offer navigators methods to help manage them.

“This study clearly identifies some of the unique issues that navigators deal with every day, especially in the 3 complex ‘struggles’ explained in the findings. These issues can be very time-consuming in a patient–navigator meeting,” noted Frank delaRama, RN, MS, AOCNS, a practicing navigator and clinical nurse specialist at the Palo Alto Medical Foundation Cancer Care Clinic. “Healthcare these days often seems to be occupied with patient satisfaction, dashboard measures, and other stats. Provider perspectives could easily identify an area of need, or even validate aspects of current practice, as well as help support the amount of time/resources allocated to navigator services.”

Published study results are available in: Yosha AM, Carroll JK, Hendren S, et al. Patient navigation from the paired perspectives of cancer patients and navigators: a qualitative analysis. Patient Educ Couns. 2001;82:396-401.