Skip to main content

Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness

  • Wendy Duggleby (a1), Carole A. Robinson (a2), Sharon Kaasalainen (a3), Barbara Pesut (a4), Cheryl Nekolaichuk (a5), Roderick MacLeod (a6), Norah C. Keating (a7), Anna Santos Salas (a8), Lars K. Hallstrom (a9), Kimberly D. Fraser (a10), Allison Williams (a11), Kelly Struthers-Montford (a12) and Jennifer Swindle (a13)...

Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts – in rural aging, rural palliative care, and navigation – as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation.


Les navigateurs aident les adultes ruraux âgés avec des maladies avancées, ainsi que leurs familles, de se connecter aux ressources, à l’information, et aux gens qui peuvent améliorer leur qualité de vie. Cet article décrit le processus utilisé pour engager des experts—en vieillissement en milieu rural, les soins palliatifs en milieu rural, et la navigation—ainsi que les intervenants dans les collectivités rurales, d’élaborer une définition conceptuelle d’une telle navigation et de délimiter les compétences pertinentes pour la prise en charge de cette population. Un document de discussion sur les considérations importantes pour la navigation dans cette population a été développé, suivi d’un processus Delphi en quatre étapes avec 30 membres invités experts. Les résultats de l’étude ont abouti à cinq compétences générales de navigation pour les fournisseurs de soins de santé qui prennent soin des personnes âgées rurales et de leurs familles à la fin de vie: la capacité de fournir le dépistage des patients / famille; à préconiser pour le patient / famille; de faciliter les relations avec la communauté; de coordonner l’accès aux services et aux ressources; et de promouvoir l’engagement actif. Les compétences particulières ont également été développées. Ces compétences constituent la base pour la recherche et le développement de programmes d’études en navigation.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness
      Available formats
Corresponding author
La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Wendy Duggleby, Ph.D., R.N., AOCN Professor and Nursing Research Chair, Aging and Quality of Life Faculty of Nursing University of Alberta 3rd Level ECHA 11405 – 87th Ave. Edmonton, AB T6G 1C9 (
Hide All
Calhoun E. A., Whitley E. M., Esparza A., Ness E., Greene A., Garcia R., et al. (2010). A national patient navigator training program. Health Promotion Practice, 11(2), 205215.
Canadian Hospice Palliative Care Association. (2012). Synthesis of recommendations from national reports on hospice palliative care: A discussion paper. Accessed 2 April 2015
Canadian Hospice Palliative Care Association. (2013a). Valuing caregiving and caregivers: Family caregivers in the integrated approach to palliative care. Retrieved from (Accessed 2 April 2105)
Canadian Hospice Palliative Care Association. (2013b). The way forward: An integrative approach to palliative care. Retrieved from (Accessed 2 April 2105)
Canadian Partnerships Against Cancer (2012). Navigation: A guide to implementing best practices in person-centred care. Toronto, ON: Author. Retrieved from
Case M. A. B. (2011). Oncology nurse navigator: Ensuring safe passage. Clinical Journal of Oncology Nursing, 15(1), 3340. doi: 10.1188/11.CJON.33-40
Castleden H., Crooks V. A., Schuurman N., & Hanlon N. (2010). “It’s not necessarily the distance on the map….”: Using place as an analytic tool to elucidate geographic issues central to rural palliative care. Health and Place, 16, 284290.
Crooks V. A., & Schuurman N. (2008). Reminder: Palliative care is a rural medicine issue. Canadian Journal of Rural Medicine, 13(3), 139140.
Duggleby W., Penz K., Goodridge D., Wilson D., Leipert B., Berry P., et al. (2010). The transition experience of rural older persons with advanced cancer and their families: A grounded theory study. BMC Palliative Care, 9(1), 5. doi:10.1186/1472-684x-9-5
Duggleby W., Penz K., Leipert B. D., Wilson D., Goodridge D., & Williams A. (2011). ‘I am part of the community but ...’ The changing context of rural living for persons with advanced cancer and their families. Rural and Remote Health, 11, 1733.
Duggleby W., Williams A., Holtslander L., Thomas R., Cooper D., Hallstrom L., et al. (2014). Hope of rural women caregivers of persons with advanced cancer: Guilt, self-efficacy and mental health. Rural and Remote Health, 14, 2561.
Fillion L., Cook S., Veillette A. M., Aubin M., de Serres M., Rainville F., et al. (2012). Professional navigation framework: Elaboration and validation in a Canadian context. Oncology Nursing Forum, 39(1), E58E69. doi: 10.1188/12.ONF.E58-E69
Goodridge D., & Duggleby W. (2010). Using a quality framework to assess rural palliative care. Journal of Palliative Care, 26(3), 141150.
Kaasalainen S., Brazil K., Williams A., Wilson D., Willison K., Marshall D., et al. (2012). Barriers and enablers to providing palliative care in rural communities: A nursing perspective. Journal of Rural and Community Development, 7(4), 419.
Keating N. (2008). Rural ageing: A good place to grow old? Bristol, England: The Policy Press, University of Bristol.
Keating N., Eales J., & Phillips J. E. (2013). Age-friendly rural communities: Conceptualizing ‘best-fit’. Canadian Journal on Aging, 32(3), 319332.
Keating N., Swindle J., & Fletcher S. (2011). Aging in rural Canada: A retrospective and review. Canadian Journal on Aging, 30(3), 323338. doi: 10.1017/S07149808110000250
Kelley M. L. (2007). Developing rural communities’ capacity for palliative care: A conceptual model. Journal of Palliative Care, 23(3), 143.
Linstone H. A., & Turoff M. (2002). The delphi method: techniques and applications. Don Mills, ON: Addison-Wesley. Available from Accessed March 9, 2016.
Lockie S. J., Bottorff J. L., Robinson C. A., & Pesut B. (2010). Experience of rural family caregivers who assist with commuting for palliative care. Canadian Journal of Nursing Research, 42(1), 7491.
McKee M., Kelley M. L., Guirguis-Younger M., MacLean M., & Nadin S. (2010). It takes a whole community: The contribution of rural hospice volunteers to the whole-person palliative care. Journal of Palliative Care, 26(2), 103111.
National Case Management Network. (2012). Canadian core competency profile for case management providers. Retrieved from
Norton R. E. (1997). DACUM hanbook (2nd ed.). Columbus, OH: Ohio State University.
Parliamentary Committee Palliative and Compassionate Care (2011). Not to be forgotten: Care of vulunerable Canadians. Retrieved from
Pedersen A. E., & Hack T. F. (2011). The British Columbia patient navigation model: A critical analysis. Oncology Nursing Forum, 38(2), 200206. doi: 10.1188/11.ONF.200-206
Pesut B., McLeod B., Hole R., & Dalhuisen M. (2012). Rural nursing and quality end-of-life care: Palliative care ... palliative approach ... or somewhere in-between? Advances in Nursing Sciences, 35(4), 288304. doi: 10.1097/ANS.0b013e31826b8687
Robinson C., Pesut B., & Bottorff J. (2010). Issues in rural palliative care: Views from the countryside. The Journal of Rural Health, 26, 7484.
Robinson C., Pesut B., Bottorff J., Mowry A., Broughton S., & Fyles G. (2009). Rural palliative care: A comprehensive review. Journal of Palliative Medicine, 12(3), 253258.
Robinson C. A., Pesut B., & Bottorff J. L. (2012). Supporting rural family palliative caregivers. Journal of Family Nursing, 18(4), 467490.
Wells K. J., Battaglia T. A., Dudley D. J., Greene A., Calhoun E. A., Mandelblatt J. S., et al. (2008). Patient navigation: State of the art or is it science? American Cancer Society, 113(8), 19992010. doi: 10.1002/cncr.23815
Wilcox B., & Bruce S. D. (2010). Patient navigation: A “Win-Win” for all involved. Oncology Nursing Forum, 37(1), 2125. doi: doi: 10:10.1188/10ONF.21-25
Wilson D. M., Fillion L., Thomas R., Justice C., Bhardwaj P., & Viellette A. M. (2009a). The “good” rural death: A report of an ethnographic study in Alberta, Canada. Journal of Palliative Care, 25(1), 21.
Wilson D. M., Fillion L., Thomas R., Justice C., Veillette A. M., & Bhardwaj P. (2009b). Planning and providing for a good death using rural French-Canadian and English-Canadian insights. Reviews in the Neurosciences, 20(3–4), 313319.
Wilson D. M., Truman C. D., Thomas R., Fainsinger R., Kovacs-Burns K., Frogatt K., et al. (2009c). The rapidly changing location of death in Canada, 1994–2004. Social Science and Medicine, 68(10), 17521758.
World Health Organization (2013). Definition of palliative care. Retrieved from
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
  • URL: /core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 24
Total number of PDF views: 166 *
Loading metrics...

Abstract views

Total abstract views: 340 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd November 2017. This data will be updated every 24 hours.