PN is increasingly being incorporated into cancer-related care. The integration of PN into the cancer-related care process underscores a corresponding need for valid and reliable tools to assess the quality of PN. We developed the PSN-I to assess a key dimension of PN: patient perceptions of the interpersonal/relational aspects of navigation. The development of the PSN-I involved an iterative process. We incorporated items with high face validity designed to reflect patient perceptions of key interpersonal characteristics of navigation. The results of our structural analysis and psychometric validation revealed an internally consistent one-dimensional scale, the 9-item PSN-I, with high construct validity. As predicted, the PSN-I scale showed a statistically significant, but moderate, correlation with the Patient Satisfaction with Cancer-Related Care (a milieu-specific patient-oriented measure of perceived relevance and satisfaction with cancer care) [22
] and no statistically significant correlation with patients’ primary language, marital status and score on the REALM-LF; indicating adequate convergence and divergence of the PSN-I.
To our knowledge, the PSN-I represents the first validated scale for patient satisfaction with their navigator. Currently, there are no “gold standard” measures to assess the patient-navigator relationship. The PSN-I provides a convenient way for both research programs and community navigator programs to assess patient satisfaction with the interpersonal process of navigation. The 9-items PSN-I assesses key aspects of navigator performance including time spent, dependability and accessibility, in addition to more affective-laden aspects such as listening, respect and caring. As navigation becomes increasingly integrated into cancer care, it is critical to have valid measures for its assessment. Navigation programs could utilize the PSN-I to evaluate the quality of the interpersonal dimension of their navigation services and identify areas for improvement. In addition, the PSN-I could be used to assess differences in patients’ satisfaction with different models of navigation (i.e. telephone-based versus face-to-face navigation).
Certain limitations of the PSN-I warrant comment. The study sample was based primarily on female patients undergoing diagnostic testing following a cancer screening abnormality, rather than on patients with diagnosed cancer. However, analysis of this subsample of patients with diagnosed cancer revealed similar performance. In addition, patients who lacked primary English language proficiency were excluded. Further, it is not yet known whether this aspect of PN (satisfaction with the patient-navigator interpersonal relationship) is associated with other PN outcomes such as timely receipt of care, patient adherence, or improvements in health status. The PSN-I assesses only one dimension of navigation, interpersonal relationship. Lastly, like most patient satisfaction measures, the scale is skewed towards favorable ratings of navigators.33 However, we observed significant variation in PSN-I scores by site and by navigator.
In summary, the 9-item PSN-I scale reliably assesses patients’ perceptions of their interpersonal relationship with their navigator. Further study is required to assess whether patients’ satisfaction with their navigator is associated with improved outcomes. Additionally, the PSN-I can be used in addition to other measures such as the PSCC to evaluate the benefits of PN programs across the cancer care continuum.