Nurturing Patient Trust: A Qualitative Study of the Interaction Between Vulnerable Lung Cancer Patients and Nurse Navigators in the Intervention Study NAVIGATE.

OBJECTIVE: Patient trust is fundamental to ensuring optimal cancer care, especially for vulnerable patients who may face additional challenges. However, there is a limited understanding of what it entails for nurses to establish and maintain trust among vulnerable patients. Grounded in the concept of Trust Work, this study explored nurses' efforts to nurture patient trust.

METHODS: Drawing on qualitative insights from NAVIGATE, a multicenter randomized controlled trial, we explored the interaction between nurses and vulnerable patients with lung cancer in clinical encounters. We included 16 patients and eight nurses from five Danish hospital sites. Among other sources, data comprised 45 audio-recorded clinical encounters conducted over one year, 15 of which were also observed in clinic settings or patients' homes, as well as semi-structured interviews with all participating patients and nurses. Analyses were based on thematic analysis principles.

RESULTS: We found that nurses were continuously engaged in nurturing trust. This trust work involved three interrelated aspects: (1) 'Recognition' - meticulous preparation to remember individual patients and recognize their lived experiences, (2) 'Witnessing' or 'Guarding' - sustained support, though with varying levels of engagement, and (3) 'Involvement' or 'Detachment'-engaging with affirming resources or disengaging from colleagues' or the broader healthcare system. These aspects were shaped by contextual factors, including nurses' available time and continuity of care, professional affiliations and roles, and collegial and institutional relationships.

CONCLUSION: This study highlights nurses' critical role in nurturing patient trust and identifies important contextual factors for improving care targeting vulnerable cancer patients.