Intervening in the Cancer Care System: An Analysis of Equity-Focused Nurse Navigation and Patient-Reported Outcomes

Ida Griesemer, Nisha C. Gottfredson, Kari Thatcher, Christine Rini, Sarah A. Birken, Aneri Kothari, Randall John, Fatima Guerrab, Thomas Clodfelter, Alexandra F. Lightfoot

Research output: Contribution to journalArticlepeer-review


Background: Nurse navigation can improve quality of cancer care and reduce racial disparities in care outcomes. Addressing persistent structurally-rooted disparities requires research on strategies that support patients by prompting structural changes to systems of care. We applied a novel conceptualization of social support to an analysis of racial equity-focused navigation and patient-reported outcomes. Method: We applied an antiracism lens to create a theory-informed definition of system-facing social support: intervening in a care system on a patient’s behalf. Participants were adults with early-stage breast or lung cancer, who racially identified as Black or White, and received specialized nurse navigation (n = 155). We coded navigators’ clinical notes (n = 3,251) to identify instances of system-facing support. We then estimated models to examine system-facing support in relation to race, perceived racism in health care settings, and mental health. Results: Twelve percent of navigators’ clinical notes documented system-facing support. Black participants received more system-facing support than White participants, on average (b = 0.78, 95% confidence interval [CI]: [0.25, 1.31]). The interaction of race*system-facing support was significant in a model predicting perceived racism in health care settings at the end of the study controlling for baseline scores (b = 0.05, 95% CI [0.01, 0.09]). Trends in simple slopes indicated that among Black participants, more system-facing support was associated with slightly more perceived racism; no association among White participants. Discussion: The term system-facing support highlights navigators’ role in advocating for patients within the care system. More research is needed to validate the construct system-facing support and examine its utility in interventions to advance health care equity.

Original languageEnglish
JournalHealth Promotion Practice
StateAccepted/In press - 2023
Externally publishedYes


  • cancer care
  • health equity
  • mental health
  • patient navigation
  • patient-reported outcomes
  • social support


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