Abstract A29: A qualitative study of underserved patients' experiences with navigation in cancer care

Context: Patient navigation, defined as the process of assessment and alleviation of barriers to health care, is a promising strategy for improving cancer care for underserved populations. Objective: To examine how navigation influences patients9 perspectives on their cancer care and to define the most effective (i.e., meaningful or valuable) aspects of navigation from the patient9s point of view. Design: Post-study patient interviews from a randomized controlled trial (usual care vs. navigation services) of patient navigation from cancer diagnosis through treatment completion Setting: Patients recruited from 16 primary care, hospital and community oncology practices in Monroe County, NY. Participants: 35 patients (32 female, 3 male) newly diagnosed with breast (n= 28) or colorectal (n=7) cancer who completed the study and were interviewed from May 2007 through March 2008. Instrument: Semi-structured interview asking patients about their specific experiences with cancer care including their expectations and experience of patient navigation or, for non-navigated patients, other sources of assistance. Results: Patients who received navigation were very positive about their experience with navigation services. Valued aspects of navigation included emotional support, assistance with information needs and problem-solving (such as with insurance or financial stressors), and logistical coordination of cancer care. Unmet cancer care needs expressed by patients randomized to standard care consisted of lack of assistance or support with childcare, household responsibilities, coordination of care, and emotional support. Conclusions: Instrumental (e.g., tangible benefits not directly related to emotional support) benefits were the most important expectations for navigation from navigated and non-navigated patients. However, when describing their actual experience of navigation, navigated patients frequently mentioned receiving emotional support as well as assistance with information needs, problem-solving, and logistical aspects of cancer care coordination.