While data supports PN’s potential to enhance the quality of life of breast cancer survivors, the historical use of navigation focused on directing action (scheduling, adherence with tests etc.) and not on changing the individual’s knowledge or skillset to allow them to “navigate” themselves. The “survivorship navigator” can help patients through communication and information exchange to increase utilization of existing resources through coaching. Health coaching is a patient-centered educational strategy that uses a relational approach to promote sense making of health information and facilitate goal setting to support behavioral change (e.g., risk management, behavioral modification [13, 14]. Health coaching has emerged as an essential part of “lifestyle” medicine in primary care, shown to be effective in the prevention and treatment of conditions impacted by modifiable behavioral risk factors. The coaching process is viewed as “a systematic process and is typically directed at fostering the ongoing self-directed learning and personal growth” [15, 16]. Coaching can help reduce barriers and facilitate access to survivorship care and services through communication and information exchange for patients. Patient navigators, then, can improve health outcomes and quality of life of survivors by providing health coaching. An example of this approach is an undertaking by The American Cancer Society which is enhancing its lay patient navigator program to include tailored coaching in addition to resource navigation [17]. A pilot of this new model tests six navigators in six different program sites who have completed a training in coaching, active listening and action planning with the patient. Preliminary data shows that patients responded positively to this coaching-based lay PN and were able to create action plans, achieve those actions, and ultimately overcome non-medical barriers to cancer care [17].

In conclusion, as breast cancer survival improves, the needs of survivors will require increased attention. With the recent COVID-19 pandemic, survivorship needs have been deprioritized as resources shift to meet the demands of this public health crisis. However, as the virus is now controlled, our focus will have to shift to those with chronic conditions including cancer and specifically those medically underserved populations that have disparate outcomes and poor functionality in survivorship. It is time to systematically address these disparities with tools such as PN. As PN evolves along the breast cancer care continuum, studies are needed to evaluate the impact of patient report outcomes with the use of a retooled approach such as coaching-based navigation (Table 1). Furthermore, navigation can still maintain relevance further out in survivorship (5 to 10 years), especially for patients at risk for discontinuing surveillance. Historically, African American patients over time are lost to follow-up at higher rates. This group can still benefit from the capacity building and help in maintaining engagement with the healthcare system. In our institution, there is talk of the navigation becoming a billable service and if this occurs it will be reasonable to have PNs dedicated to the unique spaces within the breast cancer care continuum beyond screening.