This is a secondary analysis of self-reported survey data collected over 10 years by a national CBO that offers no-cost patient navigation (PN) services to women at-risk for and/or surviving with breast cancer. As part of the PN outcome evaluation, data were collected 30 days following participation in one or more of the organization’s programs, with the goal of ascertaining individual-level feedback to improve care quality. For the purpose of this evaluation, program participation was defined as one or more completed encounters between women and the CBO and/or its representatives (e.g., peer supporters). Evaluation surveys were distributed by email to all women who engaged with the CBO, and data were collected using an online survey platform. Survey non-responders received three reminders weekly after survey initiation, and a final reminder was sent on the fourth week. After that time, and if no response was received, no further survey attempts were made. This study was reviewed and approved by the host university’s (external evaluation partner’s) Institutional Review Board.

When individuals in need contact the CBO, they speak with a member of the professional staff and participate in an intake evaluation to assess each individual’s needs for breast cancer information and support. The CBO staff consists of paid professionals who lead intakes, coordinate PN services, and oversee program operations. Many have backgrounds in oncology social work, and community health education and PN. Then as part of PN, one or more programs may be offered. The CBO provides a broad range of programming, including educational workshops, supportive services, and disease management resources focused on breast cancer control and prevention. These programs cover topics such as breast cancer treatment decision-making, managing side effects, financial and practical assistance, psychosocial well-being, and healthy living. Records in the PN evaluation dataset may have engaged in more than one program: PS represents only one component of the CBO broader model of service delivery.

In the case of the PS program, breast cancer previvors and survivors are connected to one-on-one PS with a lay peer health advisor. These peer supporters are members of the community who volunteer their time to engage with women along their breast cancer journey. Peer supporters are women who have either survived breast cancer or are previvors at elevated hereditary risk (e.g., BRCA carriers). Matching is performed by the CBO staff following the intake evaluation and based on women’s age, breast previvor/survivorship status, and the peer supporter’s training and experience addressing the range and type of women’s needs. Peer supporters provide tips and resources for coping, emotional support, and navigating the shared breast cancer experience together [21].

All peer supporters enrolled with the CBO receive formal training and undergo a multi-day instructional offering that provides them with basic medical information about breast cancer risk, diagnosis, and treatment as well as supportive guidance. Training equips volunteers with the skills to provide meaningful, compassionate support to women and families facing breast cancer. Training emphasizes active listening, empathy, and cultural sensitivity, while also teaching boundaries, confidentiality, and self-care to ensure supporters can sustain their role effectively. Through role-play, breakout discussions, and guidance from experts, volunteers practice offering emotional support, sharing personal experiences thoughtfully, and connecting peers to reliable resources. The program also highlights opportunities for outreach and advocacy, empowering supporters to not only journey alongside women’s breast cancer experiences but also strengthen community awareness and connection [8].

All of the evaluation measures used as part of this effort have been developed and validated by the investigator team through prior work with the CBO [8, 21–22].

All analyses were conducted in SPSS version 29.0. Descriptive statistics were generated to summarize and inspect all data elements. Bivariate analyses, including Pearson’s χ² tests and Student’s t-tests, were then used to assess demographic and clinical factor differences between women who were and were not offered PS services. Next, among those offered PS services, bivariate analyses examined differences between women who did and did not utilize PS. Among those who utilized PS, additional bivariate tests were performed to examine relationships between demographic/clinical factors and their PS experience. Using a conventional threshold of p < 0.10, factors were examined using multivariable logistic regression to model the likelihood of being offered and of utilizing PS: a separate multivariable regression model was used to analyze PS experience. Among those who did not utilize PS, the open-ended responses to the “Other” option were content-coded using an AI-assisted text analysis methodology to identify common themes.[24] The initial AI-assisted coding was reviewed and validated by a member of the study team to ensure accuracy and consistency. Frequencies and percentages were then calculated for each identified theme to summarize the distribution of responses.

The demographic and clinical characteristics of the analytic sample are shown in Table 1. Among the N = 1,054 women (17.4% non-white) who contacted the CBO for information and support, N = 518 (49.1%) fell between the ages of 46–64 years old. The majority of women in this sample were partnered (N=678, 66.2%) and mothers (N=821, 78.9%). Additionally, N=547 (51.9%) of women carried a BRCA pathogenic alteration and N=930 (88.2%) had a breast cancer diagnosis.

A total of 807 women (76.6%) were offered PS. Women who were offered PS tended to be younger (t = −2.86, df = 1,050, p = 0.004) and have lower household incomes (t = 2.22, df = 1,021, p = 0.03). Further, they reported an enhanced experience with PN (t = −3.64, df = 345, p < 0.001) and the quality of PN care they received from the CBO overall (t = −4.57, df = 317, p < 0.001). Using logistic regression modeling, the odds of being offered PS were greater for younger women (Odds Ratio [OR] = 1.24, 95% Confidence Interval [CI] = 1.04–1.48), those with lower household incomes (OR = 1.37, 95% CI = 1.02–1.85), and those who reported a more beneficial experience with the CBO (OR = 1.19, 95% CI = 1.08–1.32) (Table 2).

Among those offered PS, N = 304 (37.7%) utilized it. Those who utilized PS tended to be breast cancer previvors (χ² = 4.24, p = 0.04), raising children (i.e., mothers; χ² = 5.15, p = 0.03), and experiencing lower QoL (t = 2.23, df = 800, p = 0.03). A logistic regression analysis revealed that the odds of utilizing PS were greater for mothers (OR = 1.57, 95% CI = 1.10–2.24), those without a breast cancer diagnosis (OR = 1.59, 95% CI=1.02–2.47), and those with poorer QoL (OR = 1.18, 95% CI = 1.02–1.37) (Table 3).

Women who utilized PS generally reported positive experiences with the program overall (M = 44.4/50), particularly on measures of feeling supported, understood, and reassured. Those who were younger (r = −0.11, p = 0.05) and had more beneficial experiences with PN (r = 0.50, p < 0.001) and the CBO overall (r = 0.55, p < 0.001) tended to have positive experiences with PS as well. In a multivariable regression accounting for 37% of the model’s variance (N = 285), younger age (ß = −0.84, p = 0.03), higher-quality CBO care (ß = 1.71, p<0.001), and PN quality (ß = 0.58, p < 0.001) all contributed significantly to an enhanced PS outcome (Table 4).

Among women who did not utilize PS (N = 503; 62.3%), participants were asked to endorse any barriers they may have faced, with the option to endorse multiple reasons. In total, there were N = 441 selections. The most commonly endorsed barriers included being too busy (n = 77 endorsements, 17.5% of all selections) and feeling uncomfortable sharing personal information with a peer supporter (n = 43 endorsements, 9.8%). Notably, “Other” was selected n = 282 times (63.9%), with respondents prompted to provide a written explanation. Common written themes included declining PS because it was not needed or due to a lack of interest (n = 55; e.g., “It was not necessary”), lacking time or readiness to engage (n = 41; e.g., “I got busy and it’s hard for me to get on the phone”), and expressing intentions to connect later, not yet being assigned, or awaiting follow-up (n = 38; e.g., “I haven’t yet but will soon”). Many also indicated they already had support from family, friends, or other networks (n = 32; e.g., “I have a lot of existing peer support”). Few responses mentioned challenges with matching based on circumstances, preferences, or availability (n = 18), and even fewer noted concerns or challenges with the PS process itself (n = 9). Smaller groups reported declining due to specific situational barriers (n = 8), already serving as a peer supporter (n = 7), or provided positive feedback about the CBO’s support (n = 6) (Figure 1).

This study is subject to several limitations. First, the use of self-reported data introduces potential concerns related to subjectivity and memory recall, which may influence participants’ responses. Additionally, selection bias may have affected results, as the data were drawn exclusively from those who were offered and chose to participate in at least one of the CBO’s programs (including PS) and completed an evaluation survey. As a result, the views of individuals who were not offered and/or declined program participation, or did not complete the survey, are not reflected in the findings. Moreover, the predominance of women with breast cancer diagnoses may limit generalizability to women with other hereditary or female cancers (other than breast) or at-risk individuals without a diagnosis. Furthermore, the sample predominantly consisted of White, college-educated women, which constrains the applicability of these findings to the broader population affected by breast cancer. Community-based evaluations may also be subject to a polarization effect, where individuals with particularly strong opinions are more inclined to respond, potentially skewing the results. Additionally, data were collected over a 10-year span. Although the CBO continues to operate and provide PS, aspects of service delivery such as the incorporation of virtual formats have evolved over time. This may limit the applicability of some findings to current practices, even as the longevity of the PS program underscores its sustained relevance for women at-risk for or living with breast cancer. Finally, all outcome measures were collected approximately 30 days after participation in PN and without baseline assessments, meaning observed associations are correlative rather than causal and may reflect pre-existing differences in women’s needs or well-being that cannot be ruled-out.

PS is a valued and well-received component of care for many women navigating breast cancer, particularly those facing greater psychosocial stressors. Continued refinement of outreach, matching, and delivery processes may enhance program accessibility and impact. Further research is needed to explore how PS can be effectively integrated into broader care pathways and tailored to the evolving needs of diverse patient populations.