Using Concept Mapping to Explore Interpersonal Communication Components of Patient Navigation in Breast Cancer Care

Background: Research exploring the relational dimensions of patient navigation indicate that interpersonal communication is fundamental to the patient navigator’s (PN) ability to assist patients in identifying barriers to care and improve cancer care outcomes.^1,2 There is also growing national recognition that interpersonal communication is integral to the patient navigation process as it is a core competency domain for all types of PNs (lay or medically licensed).^3-5 PNs have also acknowledged communication as a crucial skill, and improving communication with patients was noted as a need for professional development.³ However, the key components of interpersonal communication in patient navigation are commonly understudied and overlooked in training.⁵

Objective: To identify the key interpersonal communication components of patient navigation in breast cancer care that patients, PNs, and PN administrators perceived to impact the patient–navigator relationship and to explore the relative importance of each identified key component in interpersonal communication in patient navigation across groups (patients, PNs, administrators).

Methods: This study utilized concept mapping, a community-engaged research method. As a mixed method approach, concept mapping facilitates the examination of the range of factors that impact interpersonal communication in breast cancer care patient navigation and promotes the active participation of participants throughout the research process. Participants completed 3 concept mapping activities, including brainstorming, sorting and rating, and interpretation to identify the key components of interpersonal communication in breast cancer care patient navigation.

Results: A total of 31 persons participated in the study: 13 patients, 14 PNs, and 4 administrators from western Pennsylvania. First, 121 items were generated during brainstorming and combined into a final master list of 85 items. After sorting and rating, these 85 items were grouped into a 6-cluster concept map and named through a group consensus process during the interpretation sessions with each participant group. Among the 6 participant-identified concepts, both patients and PNs emphasized the importance of Empathetic, Comprehensive and Compassionate Support, Bridge to Clinical Education and Supportive Resources, and Ongoing Individualized Coordination of Care as the most important components for facilitating the patient–navigator relationship. Patients, PNs, and administrators also emphasized the need for PN training, as well as “spaces” for them to network and share resources with each other.

Conclusion: This study, in collaboration with stakeholders and study participants, identified 6 key components of interpersonal communication in breast cancer care patient navigation. Patients, PNs, and administrators all emphasized the essential role of interpersonal communication in the PN–patient relationship and how it is woven into every aspect of the PN role. As a core competency, interpersonal communication is a critical skill, and it is essential for PNs to identify barriers to care and to engage patients in shared decision-making. For patient navigation to be an evidence-based intervention, we need to work toward innovative, competency-based capacity building specifically developed for and by PNs to support their professional development and ultimately promote positive cancer care outcomes.

References

1. Bail J, Lisovicz N, Meneses K, et al. Communication a Key Element of Patient Navigation: Perspectives of the Patient Care Connect Program Lay Patient Navigators. 8th Biennial Cancer Survivorship Research Innovation in a Rapidly Changing Landscape. Washington, DC. 2016.
2. Phillips S, Nonzee N, Tom L, et al. Patient navigators’ reflections on the navigator-patient relationship. J Cancer Educ. 2014;29:337-344.
3. Lubejko BG, Bellfield S, Kahn E, et al. Oncology nurse navigation: results of the 2016 Role Delineation Study. Clin J Oncol Nurs. 2017;21:43-50.
4. Pratt-Chapman ML, Willis LA, Masselink L. Core Competencies for Non-Clinically Licensed Patient Navigators. The George Washington University Cancer Institute Center for the Advancement of Cancer Survivorship, Navigation and Policy: Washington, DC. 2014.
5. Ustjanauskas AE, Bredice M, Nuhaily S, et al. Training in patient navigation: a review of the research literature. Health Promot Pract. 2016;17:373-381.