Table 3.

Results of Semi-Structured Navigator Interviews

Theme	Sub-Theme (Polarity)	Illustrative Quotation
Affective Comments
	Shared Experiences (+)	“I watched some patients tense up as they saw me coming towards them in my white coat and clipboard in hand. However, once I told them that I was not a doctor but had been on dialysis and had a transplant more than 16 years ago, those shoulders would drop and they would become more relaxed immediately.”
	Developed Relationships (+)	“One thing that I found so overwhelmingly awesome is being able to visit the patient a few days after their transplant. I had it happen a few times and it’s a wonderful feeling. Each time, I’m invited to visit after the transplant I get that weird belly thing, my heart races, and I am very nervous. When I step into the room and make eye contact with the patient those tears of joy come flowing from my eyes. It’s wonderful.”
	Personal Satisfaction (+)	“Although working with all of my patients was memorable, I would have to say the most fulfilling was when I was able to offer information to a patient that he actually followed through on. I gave him information on living donors, and, the next thing you knew, he had a friend from church who agreed to give his kidney.”
	Shared Successes (+)	“I also felt tremendous joy when one of my patients made a major step forward. While the accomplishment had to come from the patients themselves, the joy that I may have played a part in their success was very satisfying. I cannot even explain the feeling of when one of my patients received a transplant. You can only imagine.”
	Difficult Mental Illness (−)	“I wish I would have known to expect the mental conditions of some of the patients. It was very disappointing at times when some of my patients were not able to move forward with their work – up due to their mental conditions, or, anxieties. I concluded that I would not be able to help everyone.”
	Patient Non-Adherence (−)	“The challenge of what to do with those that do not want to help themselves. I could easily deal with those who are willing to make an effort to change, even if they are unsuccessful. However, I found it hard to deal with those who were capable of bettering their lives by getting off dialysis, but who were not willing to make any kidney of change in their lifestyle.”
	Found to be Unsuitable for Transplant (−)	“Several years ago, Mr. X had been turned down by the transplant center because he has hepatitis C. He was very discouraged that he was not eligible for a transplant, but tried to put up a good front. …there was no way to transplant patients with hepatitis C, but now there is. This news meant a second chance for him. For a few months everything was going well, until a complication arose that put him in the hospital. Further testing showed that his heart would not be strong enough for an operation. Depression followed, there were good and bad days. On my last visit, the patient seemed to be very ill, and perhaps fighting for his life. I am very sad because I feel that we got to him too late, that medical research and marvels that we have now for hepatitis C came too late for this patient who I call my friend.”
	Progressive Illness and Death (−)	“The other difficult experience was patients enrolled in the study who passed away. Some of the patients were moving forward while others were still contemplating what they wanted to do. But, either way, you become attached to the patients and I felt a great deal of grief when they passed away.”
Pragmatic Comments
	Process Improvement	“I would push for more educational materials geared towards the family to learn more about transplantation and organ donation. I would include a patient’s family in the dialysis session where I am presenting information and give a patient questionnaire that discusses family support.” “I would not limit the number of patients. I would try to meet with and reach as many patients as possible.”
	Navigator Skills	“It means being a cheerleader and helping patients get over barriers…It also means being present and supporting patients regardless of their decision or the outcome with regard to their transplant evaluation.”
	Knowledge Gaps	“I never felt like I could answer questions about insurance issues; that subject had me completely baffled! I had a wonderful finance team so I could refer the patients to them with questions that I could not answer.”