1. Age [Mean (SD)] 69.1 (9.40)
N %
Gender
Male 22 84.6
Female 4 13.4
Race/Ethnicity
White 21 80.8
Black or African American 4 15.4
Latino 1 3.8
Marital Status
Married 19 73.2
Single, never married 3 11.5
Separated/Divorced 1 3.8
Widowed 3 11.5
Education
Less than High School 2 7.7
High School graduate 7 26.9
Some college 8 30.8
Bachelor's degree 8 30.8
Unknown 1 3.8
Interview Guide Questions:
Q8. Sometimes monitoring and
treatment for cancer can be confusing
and difficult to follow. What do you think
about the idea of having someone who is
a nonmuscle-invasive bladder cancer
survivor act as a sort of “coach” to help
people through the system?
 Probe 8a: Imagine the “perfect coach” to
help bladder cancer patients through
diagnosis and treatment, what would this
person be like?
 Probe 8b: What kinds of knowledge and
skills would this “coach” need to have?
 Probe 8c: Any thoughts or suggestions
about what we could do to make a
program like that serve patients’ needs?
 Most participants
(n=21) endorsed
having a navigator
or “coach” as an
aide during the
treatment and
monitoring
process.
 Their proposals fell
along a continuum
ranging from
navigator as a
facilitator of access
to programs and
services (“Harlem
model”) to
navigator as
psychological
counselor
(“Canadian
model”).
Harlem Canadian“Hybrid”
 “You know, foods stamps and then
something to help me out …that’s
about (it), food stamps and anything
else I could get…disability…(so I could)
live and do things what I need to
do…That’s all I would need.” – VA03 –
African American Male
 “Contact people that are on the clean
side of it and ask them if they’d be
willing to talk to people, and then
maybe you could tie them (the
navigator and patient) together on the
phone.” – VA17 – White Male
 “And they’d have to be reliable,
knowledgeable, compassionate… But it’s
the psychological part before and after the
operation and knowing you have cancer,
anybody’s gonna get, it’s a shock to
anybody…And, for the psychological part,
the idea for the patient knowing you're
not the only one…Would make a
difference right there.” – VA04 – White
Male
 “And someone that can relate to the
medical professions without stepping on
any toes…when you're going through
something like that…you don’t really have
time to be trying to figure out what's
going on…You need to have somebody can
give you at least an intelligent answer.” –
VA22 – African American Female
 “…talk about their experience with other folks,
people…And talk about their, what they think
about their doctors and their support groups
or their family, how their family treating
them…And what kind of attitude that they got
about it, you know…About their treatment…
You’d need to have experienced some of this
yourself…In order for to tell somebody else
about it.” – VA08 – African American Male
 “Probably be a little bit like a mentor I guess to
give them the other side from, not from the
doctor’s perspective, but from the patient’s
perspective…Just to prepare em a little bit
better for what they're gonna go through if
they do the operation, or even if they elect the
other way.” – VA10 – White Male
• Bladder cancer is the 4th leading cause of cancer mortality in
the U.S. (ACS, 2009)
 There are approximately 70,980 new cases and 14,330
deaths annually
 In excess of 500,000 bladder cancer survivors live in the
U.S.
 More than 30,000 vets were treated for bladder cancer in
the VA system in 2007 (Moye et al., 2010)
• Bladder cancer patients are generally White males and older
age (almost 90% are >55 years)
 The disease is 3-4 times more common in males than
females
 Women and men of color tend to be diagnosed at later
stages
• Primary risk factors include smoking and workplace/chemical
exposure
 At risk occupations include:
Metal and textile workers, painters, machinists,
hairdressers, truck drivers, and individuals working
in the chemical, rubber, and leather industries.
• 75-80% of new bladder cancer cases manifest as nonmuscle-
invasive bladder cancer (NMIBC), which requires a prolonged,
invasive surveillance period (cystoscopy & cytology)
Harlem Model
 “In addition to expanding screening and education services
throughout the community, specified members of the
community provided patient navigation to women who had a
clinical finding suspicious for cancer.” Well et al. (2008)
“…social position, economic status, culture, and environment
(are) critical determinants of who develops and survives
cancer and of the quality of life of cancer survivors” (Freeman,
2006).
Canadian Model
 “Timely access to informational and
emotional support around the time of cancer
diagnosis is crucial in helping patients adapt
and prepare for their journey in navigating
the health-care system” (Doll et al., 2005).
 “Navigation should seek to address patients’
informational, emotional, and practical needs
during the cancer journey” (Doll et al., 2005).
Results
Background Methods
Discussion
Conclusion
Figure 1. Patient navigation
models and patient endorsement
Figure 2. Distribution of patient support for three
navigation models
N = 26
• Semi-structured interviews were conducted with Michael E. DeBakey
VA Medical Center (n = 14) and Baylor College of Medicine (n = 12)
urology patients diagnosed with nonmuscle-invasive bladder cancer
• Interviews were recorded and transcribed (average: 1 hour and 10
minutes)
• Transcripts from interviews were analyzed
• Open-ended responses were coded into three patient navigation
categories: Canadian, Harlem, Hybrid
• More participants endorsed having cancer patient
navigator programs that included psychosocial
components (n=15) than solely economic/access
assistance (n=6) components.
• Most participants who supported the Canadian or
Hybrid models recommended that navigators
intervene as soon as possible (diagnosis stage) for
maximum effect.
 Participants emphasized that navigators would
need excellent communication skills, good
knowledge of the healthcare system and NMIBC,
and ability to liaison between patients, families,
and members of the medical team.
• Current findings support cancer patient navigation
services as a means for reducing the psychological
and relational burden of NMIBC; increasing ancillary
service access; and improving surveillance
adherence.
• Further work is needed to understand specific
navigation components needed by NMIBC survivors
prior to designing and evaluating such a program.
Specific areas to target include:
 Disease-specific literacy and patient education
 Couples and family counseling, including sex
therapy
 Community and national resource referrals
Heather Honoré Goltz1,2, Gilad E. Amiel1,2, Seth P. Lerner1, David M. Latini1,2
1. Baylor College of Medicine, 2. Veterans Affair Health Services Research & Development Center of Excellence
Results
Table 1. Demographic and Clinical
Characteristics
Some individuals who did not endorse navigator programs for
themselves reported that such programs may be helpful for
others diagnosed with NMIBC.