The role of peer support and patient navigation for empowerment in breast cancer survivors: implications for community cancer control

Abstract

Community-based organizations (CBO) offer support, including patient navigation (PN), to women at-risk for (eg, those with BRCA pathogenic variants) and surviving with breast cancer. However, the impacts of CBO efforts on survivors' empowerment (eg, control, self-confidence, knowledge/skills, coping) are largely unknown. As part of a quality improvement initiative (N = 2,247) focused on PN, care satisfaction, peer support, and quality of life (QoL), we conducted a secondary analysis of a CBO care delivery model on women's empowerment. Under CBO led cancer control, empowerment was high: most survivors felt confident in (71.2%) and knowledgeable about (66.4%) managing their care. Perceived care quality was also high (91%): it was recommendable to others (93.9%), helpful (92.7%), informative (92.6%), timely (92.2%), reliable (91.5%), supportive (91.3%), and effective (88.7%). Regarding CBO care satisfaction, survivors felt supported by abundant resources (92.8%) and programs (91.2%), understood (92.0%), and helped (91.6%). Peer support (offered to >25%) demonstrated high engagement (>85%). Regarding QoL, 25.3% were in fair/poor health and 25.6% endorsed frequent mental distress (M = 7.2 physically unhealthy days, M = 7.8 mentally unhealthy days, and M = 6.4 activity-limited days within the past month). Disparities in empowerment were observed as a function of survivors' QoL: lowest among those with more frequent mental distress (t = −2.13, P < .05), mentally unhealthy days (r = −0.083, P < .05), and activity-limited days (r = −0.058, P < .05)). These burdens may have influenced survivors' feelings of empowerment, especially among those without peer support (t = 3.77, P < .001), who downgraded the quality of PN (t = 0.60, P < .01), and were least satisfied with CBO cancer control (t = 0.57, P < .01). In a multivariable model adjusting for mental distress, both perceived PN quality (B = 0.16, SE = 0.01, P < .001) and peer support (B = 0.24, SE = 0.13, P = .05) were positively associated with empowerment: survivors who rated their PN higher, and offered peer support, felt more empowered. CBO cancer control can uplift most survivors: addressing socially determined disparities, through programs such as peer support, may enhance their effectiveness and particularly among those with poor mental health.