title: Understanding the processes of patient navigation to reduce disparities in cancer care: perspectives of trained navigators from the field.
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.
authors.affiliation: Radiation Oncology Department, University of Rochester Medical Center, Rochester, NY 14642, USA. PJean_Pierre@med.miami.edu
authors.forename: Pascal
authors.initials: P
authors.lastname: Jean-Pierre
authors.forename: Samantha
authors.initials: S
authors.lastname: Hendren
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.forename: Starlene
authors.initials: S
authors.lastname: Loader
authors.forename: Sally
authors.initials: S
authors.lastname: Rousseau
authors.forename: Bonnie
authors.initials: B
authors.lastname: Schwartzbauer
authors.forename: Mechelle
authors.initials: M
authors.lastname: Sanders
authors.forename: Jennifer
authors.initials: J
authors.lastname: Carroll
authors.forename: Ronald
authors.initials: R
authors.lastname: Epstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D010344:Patient Advocacy / Q000193:education*; D011787:Quality of Health Care / Q000592:standards*
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