The nurse pivot-navigator associated with more positive cancer care experiences and higher patient satisfaction

Carmen G. Loiselle, Samar Attieh, Erin Cook, Lucie Tardif, Manon Allard, Caroline Rousseau, Doneal Thomas, Paramita Saha-Chaudhuri, Denis Talbot


Background and objectives: Growing evidence indicates that the nurse navigator-pivot (NN)*, is key to optimizing care processes and outcomes. However, large scale studies are needed to examine how patients exposed to NNs (as opposed to non-NN) differentially perceived their cancer care experiences. 

Method: Participants (N = 2,858) treated for cancer in the last six months at university-affiliated cancer centres in Montréal, Québec, completed the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). 

Results: Cancer care experiences and satisfaction were significantly higher in the NN group (n = 2,003) for all six care domains (Ds from 3.32 to 8.95) and all four nursing functions (Ds from 5.64 to 10.39) when compared to the non-NN group (n = 855). 

Discussion: The NN role is significantly related to enhanced cancer care experiences and higher patient satisfaction. Future research should explore potential causal effects between NNs and care processes, as well as patient outcomes. 

*NN includes both terms: nurse navigator and nurse pivot

Key words: cancer, oncology, nurse navigator, nurse pivot, patient satisfaction, patient cancer care experiences

Full Text:



Canadian Cancer Society. (2018, Nov. 22). Emotions and cancer [Internet]. Toronto (ON). Available from

Canadian Partnership Against Cancer. (2010). Virtual navigation in cancer: A pilot study. Toronto: Author.

Canadian Partnership Against Cancer. (2014).The 2014 Cancer System Performance Report. Toronto: Author.

Canadian Partnership Against Cancer. (2018). Living with cancer: A report on the patient experience. Toronto: Author.

Case, M. A. (2011). Oncology nurse navigator: Ensuring safe passage. Clin J Oncol Nurs., 15(1), 33.

Cook, S., Fillion, L., Fitch, M. I., Veillette, A. M., Matheson, T., Aubin, M., de Serres, M., Doll, R., & Rainville, F. (2013). Core areas of practice and associated competencies for nurses working as professional cancer navigators. Can Oncol Nurs J., 23(1), 44–52.

Deshields, T. L., Rihanek, A., Potter, P., Zhang, Q., Kuhrik, M., Kuhrik, N., & O’Neill, J. (2012). Psychosocial aspects of caregiving: Perceptions of cancer patients and family caregivers. Supportive Care in Cancer, 20(2), 349–56.

Dubé-Linteau, A. (2014). Enquête québécoise sur la qualité des services de lutte contre le cancer. L’infirmière pivot en oncologie et l’expérience patient. Québec : Institut de la statistique du Québec.

Fenn, K. M., Evans, S. B., McCorkle, R., DiGiovanna, M. P., Pusztai, L., Sanft, T., Hofstatter, E. W., Killelea, B. K., Knobf, M. T., Lannin, D. R., & Abu-Khalaf, M. (2014). Impact of financial burden of cancer on survivors’ quality of life. J Oncol Pract., 10(5), 332–8.

Ferguson, D. (2012). Validation of the NRC Picker Canada Ambulatory Oncology Patient Satisfaction Survey. Ontario: NRC Picker Canada.

Fethney J. (2010). Statistical and clinical significance, and how to use confidence intervals to help interpret both. Australian Critical Care, 23(2), 93–7.

Fillion, L., de Serres, M., Cook, S., Goupil, R. L., Bairati, I., & Doll, R. (2009). Professional patient navigation in head and neck cancer. Semin oncol nurs., 25(3), 212–221.

Finney-Rutten, L. J., Davis, T., Beckjord, E. B., Blake, K., Moser, R. P., & Hesse, B. W. (2012). Picking up the pace: Changes in method and frame for the health information national trends survey (2011–2014). J Health Commun., 17(8), 979–89.

Fournier, B., Simard, S., Veillette, A. M., & Fillion, L. (2015). An integrative framework to support the assessment function of Québec’s pivot nurses in oncology. Can Oncol Nurs J., 25(3), 335–40.

Griffiths, P., & Needleman, J. (2019). Statistical significance testing and p-values: Defending the indefensible? A discussion paper and position statement. International journal of nursing studies, 99, 1033–84.

Hébert, J., & Fillion L. (2011). Gaining a better understanding of the support function of oncology nurse navigators from their own perspective and that of people living with cancer: Part 1 & 2. Can Oncol Nurs J., 21(1), 33–38 & 21(2), 114–21.

Hryniuk, W., Simpson, R., McGowan, A., & Carter, P. (2014). Patient perceptions of a comprehensive cancer navigation service. Current Oncology, 21(2), 69.

Institute of Medicine (US) Committee on Approaching Death: Addressing Key End-of-Life Issues. (2015). Dying in America: Improving quality and honoring individual preferences near the end of life. Washington: National Academies Press.

Joseph, L., & Reinhold, C. (2005). Fundamentals of clinical research for radiologists: Statistical inference for continuous variables. AJR, 184, 1047–56.

Koh, C., Nelson, J. M., & Cook, P. F. (2011). Evaluation of a patient navigation program. Clin J Oncol Nurs., 15(1).

Kullberg, A., Sharp, L., Johansson, H., Brandberg, Y., & Bergenmar, M. (2017). Patient satisfaction after implementation of person-centred handover in oncological inpatient care–A cross-sectional study. PloS one, 12(4), e0175397.

Lee, T., Ko, I., Lee, I., Kim, E., Shin, M., Roh, S., Yoon, D., Choi, S., & Chang, H. (2011). Effects of nurse navigators on health outcomes of cancer patients. Cancer Nurse, 34(5), 376–84.

Lévesque-Boudreau, D., & Champagne, M. (2008). Ministère de la Santé et des Services sociaux. Rôle de l’infirmière pivot en oncologie. Direction de la lutte contre le cancer. Available from

Loiselle, C. G., Howell, D., Nicoll, I., & Fitch, M. (2019). Toward the development of a comprehensive cancer experience measurement framework. Supportive Care in Cancer, 27(7), 2579–2589.

McMullen, L. (2013). Oncology nurse navigators and the continuum of cancer care. Semin oncol nurs, 29(2), 105–117.

Meeker, C. R., Geynisman, D. M., Egleston, B. L., Hall, M. J., Mechanic, K. Y., Bilusic, M., Plimack, E. R., … Wong, Y. N. (2016). Relationships among financial distress, emotional distress, and overall distress in insured patients with cancer. J Oncol Pract., 12(7), e755–64.

Moody, L., Nicholls, B., Shamji, H., Bridge, E., Dhanju, S., & Singh, S. (2018). The person-centred care guideline: From principle to practice. Journal of Patient Experience, 4, 2374373518765792.

National Research Corporation. (2003). Development and Validation of the Picker Ambulatory Oncology Survey Instrument in Canada. Lincoln, NE: Author.

Robinson, J. H., Callister, L. C., Berry, J. A., & Dearing, K. A. (2008). Patient-centered care and adherence: Definitions and applications to improve outcomes. Journal of the American Academy of Nurse Practitioners, 20(12), 600–7.

SAS Institute Inc. (2013). Base SAS® 9.4 Procedures Guide: High-Performance Procedures (2nd ed.). Cary, NC: Author.

Shockney, L. D. (2015) The evolution of breast cancer navigation and survivorship care. The Breast Journal, 21(1), 104–10.

Sizmur, S. (2012). The reliability of trust-level survey scores: A comparison of three different scoring models. Picker Institute Europe.

Tariman, J. D., & Szubski, K. L. (2015). The evolving role of the nurse during the cancer treatment decision-making process: A literature review. Clin J Oncol Nurs., 19(5).

Tho, P. C., & Ang, E. (2016). The effectiveness of patient navigation programs for adult cancer patients undergoing treatment: A systematic review. JBI database of systematic reviews and implementation reports, 14(2), 295–321.

Trevillion, K., Singh-Carlson, S., Wong, F., & Sherriff, C. (2015). An evaluation report of the nurse navigator services for the breast cancer support program. Canadian Oncology Nursing Journal/Revue canadienne de soins infirmiers en oncologie, 25(4), 409–14.

Wagner, E. H., Ludman, E. J., Bowles, E. J., Penfold, R., Reid, R. J., Rutter, C. M., Chubak, J., & McCorkle, R. (2014). Nurse navigators in early cancer care: A randomized, controlled trial. J Clin Oncol., 32(1), 12.

Wang, T., Molassiotis, A., Chung, B. P., & Tan, J. Y. (2018). Unmet care needs of advanced cancer patients and their informal caregivers: A systematic review. BMC Palliative Care, 17(1), 96.

Westphal, E. C., Alkema, G., Seidel, R., & Chernof, B. (2016). How to get better care with lower costs? See the person, not the patient. J Am Geriatr Soc., 64(1), 19–21.

Yatim, F., Cristofalo, P., Ferrua, M., Girault, A., Lacaze, M., Di Palma, M., & Minvielle, E. (2017). Analysis of nurse navigators’ activities for hospital discharge coordination: A mixed method study for the case of cancer patients. Support Care Cancer, 25(3), 863–8.

Zibrik, K., Laskin, J., & Ho, C. (2016). Integration of a nurse navigator into the triage process for patients with non-small-cell lung cancer: Creating systematic improvements in patient care. Curr Oncol., 23(3), e280.


  • There are currently no refbacks.