Article

A Breast Navigator Program: Barriers, Enhancers, and Nursing Interventions

Susan Korber

Cynthia Padula

Julie Gray

Margot Powell

nurse navigator
ONF 2010, 38(1), 44-50. DOI: 10.1188/11.ONF.44-50

Purpose/Objectives: To identify barriers to and enhancers of completion of breast cancer treatment from the perspective of participants in a breast health navigator program.

Research Approach: Qualitative, using focus group methodology and telephone interview.

Setting: Two teaching hospital ambulatory cancer centers.

Participants: Women enrolled in the breast navigator program, including patients who completed (n = 13) and did not complete (n = 1) breast cancer treatment.

Methodologic Approach: Researchers used semistructured, open-ended questioning to guide the interviews and elicit identification of barriers to and enhancers of treatment. A flexible approach was used and the interviews were recorded. Content analysis was used to identify themes.

Main Research Variables: Perceived barriers and enhancers of breast cancer treatment.

Findings: The most common theme was the value of the education and information received from the navigator. Several participants saw this as the essence of the role. Assistance with managing symptoms, access to financial and community resources, and the team approach were completion enhancers.

Conclusions: Completion of breast cancer therapy and care can be improved by recognizing the value the nurse navigator role brings to the patient experience and enhancing that role.

Interpretation: The intentional presence of the oncology nurse and the nursing emphasis on culturally appropriate education and care can be seen as key competencies of the navigator. As the concept of the navigation process is expanded to other cancers, oncology nurses are particularly well positioned to advocate for the navigator role as a nursing domain.

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    References

    American Cancer Society. (2010). Cancer facts and figures 2010. Atlanta, GA: Author.
    Ayres, L., Kavanaugh, K., & Knafl, K. (2003). Within-case and across-case approaches to qualitative data analysis. Qualitative Health Research, 13, 871-883.
    Battaglia, T., Roloff, K., Posner, M., & Freund, K. (2007). Improving follow-up to abnormal breast cancer screening in an urban population. A patient navigation intervention. Cancer, 109(2, Suppl.), 359-367. doi: 10.1002/cncr.22354
    Bickell, N. (2002). Race, ethnicity, and disparities in breast cancer: Victories and challenges. Women's Health Issues, 12, 238-251.
    Bickell, N., & Cohen, A. (2008). Understanding reasons for underuse: An approach to improve quality and reduce disparities in breast cancer treatment. Mount Sinai Journal of Medicine, 75, 23-30. doi: 10.1002/msj.20013
    Dignan, M., Burhansstipanov, L., Hariton, J., Harjo, L., Rattler, T., Lee, R., & Mason, M. (2005). A comparison of two Native American navigator formats: Face-to-face and telephone. Cancer Control, 12(Suppl. l2), 28-33.
    Ell, K., Padgett, D., Vourlekis, B., Nissly, J., Pineda, D., Sarabia, O., … Lee, P. (2002). Abnormal mammogram follow-up: A pilot study in women with low income. Cancer Practice, 10, 130-138.
    Ell, K., Vourlekis, B., Lee, P., & Xie, B. (2007). Patient navigation and case management following an abnormal mammogram: A randomized clinical trial. Preventive Medicine, 44, 26-33. doi: 10.1016/j.ypmed.2006.08.001
    Farber, J., Deschamps, M., & Cameron, R. (2002). Investigation and assessment of the navigator role in meeting the information, decisional, and educational needs of women with breast cancer in Canada. Retrieved from http://www.phac-aspc.gd.ca/publications-eng.php
    Ferrante, J., Chen, P. H., & Kim, S. (2008). 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. doi: 10.1007/s11524-007-9228-9
    Freeman, H., Muth, B., & Kerner, J. (1995). Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Practice, 3, 19-30.
    Goodwin, J., Satish, S., Anderson, E., Nattinger, A., & Freeman, J. (2003). Effect of nurse case management on the treatment of older women with breast cancer. Journal of the American Geriatrics Society, 51, 1252-1259.
    Katz, S., Lantz, P., Paredes, Y., Janz, N., Fagerlin, A., Liu, L., & Deapen, D. (2005). Breast cancer treatment experiences of Latinas in Los Angeles County. American Journal of Public Health, 95, 2225-2230. doi: 10.2105/AJPH.2004.057950
    Kim, S., Ferrante, J., Won, B., & Hameed, M. (2008). Barriers to adequate follow-up during adjuvant therapy may be important factors in the worse outcome for black women after breast cancer treatment. World Journal of Surgical Oncology, 6, 26. doi: 10.1186/1477-7819-6-26
    Lantz, P., Keeton, K., Romano, L., & Degroff, A. (2004). Case management in public health screening programs: The experience of the national breast and cervical cancer early detection program. Journal of Public Health Management Practice, 10, 545-555.
    Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
    Mansell, I., Bennett, G., Northway, R., Mead, D., & Moseley, L. (2004). The learning curve: The advantages and disadvantages in the use of focus groups as a method of data collection. Nurse Researcher, 11(4), 79-88.
    Masi, C., Blackman, D., & Peek, M. (2007). Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. Medical Care Research and Review, 64(5, Suppl.), 195S-242S. doi: 10.1177/1077558707305410
    McCarthy, E., Ngo, L., Roetzheim, R., Chirikos, T., Li, D., Drews, R., & Iezzoni, L. (2006). Disparities in breast cancer treatment and survival for women with disabilities. Annals of Internal Medicine, 145, 637-645.
    Palmieri, F., DePeri, E., Mincey, B., Smith, J., Wen, L., Chewar, D., … Perez, E. (2009). Comprehensive diagnostic program for medically underserved women with abnormal breast screening evaluations in an urban population. Mayo Clinic Proceedings, 84, 317-322. doi: 10.4065/84.4.317
    Shavers, V., & Brown, M. (2002). Racial and ethnic disparities in the receipt of cancer treatment. Journal of the National Cancer Institute, 94, 334-357.
    Till, J. (2003). Evaluation of support groups for women with breast cancer: Importance of the navigator role. Health and Quality of Life Outcomes, 1, 16-21.
    Vargas, R., Ryan, G., Jackson, C., Rodriguez, R., & Freeman, H. (2008). Characteristics of the original patient navigation programs to reduce disparities in the diagnosis and treatment of breast cancer. Cancer, 113, 426-433. doi: 10.1002/cncr.23547
    Yard, D. H. (2009). Oncology nurses can shine as numbers of PCPs, oncologists run low. Oncology Nursing News, 3(5), 24-25.