title: Improving healthcare empowerment through breast cancer patient navigation: a mixed methods evaluation in a safety-net setting.
abstract: BACKGROUND
  Breast cancer mortality rates in the U.S. remain relatively high, particularly among ethnic minorities and low-income populations. Unequal access to quality care, lower follow up rates, and poor treatment adherence contribute to rising disparities among these groups. Healthcare empowerment (HCE) is theorized to improve patient outcomes through collaboration with providers and improving understanding of and compliance with treatment. Patient navigation is a health care organizational intervention that essentially improves healthcare empowerment by providing informational, emotional, and psychosocial support. Patient navigators address barriers to care through multilingual coordination of treatment and incorporation of access to community services, support, and education into the continuum of cancer care.
  
  
  METHODS
  Utilizing survey and qualitative methods, we evaluated the patient navigation program in a Northern California safety-net hospital Breast Clinic by assessing its impact on patients' experiences with cancer care and providers' perspectives on the program. We conducted qualitative interviews with 16 patients and 4 service providers, conducted approximately 66 hours of clinic observations, and received feedback through the self-administered survey from 66 patients.
  
  
  RESULTS
  The role of the patient navigator at the Breast Clinic included providing administrative assistance, psychosocial support, improved knowledge, better understanding of treatment process, and ensuring better communication between patients and providers. As such, patient navigators facilitated improved collaboration between patients and providers and understanding of interdisciplinary care processes. The survey results suggested that the majority of patients across all ethnic backgrounds and age groups were highly satisfied with the program and had a positive perception of their navigator. Interviews with patients and providers highlighted the roles of a navigator in ensuring continuity of care, improving treatment completion rates, and reducing providers' workload and waiting time. Uncertainty about the navigator's role among the patients was a weakness of the program.
  
  
  CONCLUSIONS
  Patient navigation in the Breast Clinic had a positive impact on patients' experiences with care and healthcare empowerment. Clarifying uncertainties about the navigators' role would aid successful outcomes.
authors.forename: Guzyal
authors.initials: G
authors.lastname: Gabitova
authors.affiliation: Department of Anthropology, History, and Social Medicine and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA. nburke@cc.ucsf.edu.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Burke
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy; D002140:California; D003266:Continuity of Patient Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D062526:Patient Navigation; D017060:Patient Satisfaction; D011203:Poverty; D011209:Power, Psychological; D036301:Qualitative Research; D012944:Social Support; D011795:Surveys and Questionnaires