Lay patient navigator program implementation for equal access to cancer care and clinical trials

Abstract

BACKROUND. Disparities in cancer detection, treatment, and outcomes among racial/ethnic minorities and low-income patients are well documented. One way to reduce these disparities is to use patient navigators to address barriers to care.However, little information about optimal characteristics of navigator programs or considerations for those interested in setting up such programs is available. METHODS.The design and implementation of a patient navigator program for underserved cancer patients in an urban, nonacademic community hospital setting is described. The program, which used lay navigators, was conceived as a component of the Urban Latino African American Cancer (ULAAC) Disparities Project in South Los Angeles, a National Cancer Institute (NCI)-sponsored project to improve cancer care and clinical trial access for minority and low-income patients.RESULTS. Careful initial planning, including input from a community advisory committee, was essential to smooth program implementation. Thirty-one volunteers completed navigator training in the program's first year of operation. Of 135 patients offered navigation services, 75 (56%) accepted, and preliminary feedback from patients, navigators, and providers suggests high levels of satisfaction with navigation.Standardized templates used by navigators and staff to record key information are proving helpful for monitoring quality and outcomes (such as effectiveness in addressing specific barriers to care) and continually improving the program. CONCLUSIONS.The ULAAC program represents a viable model for developing lay navigator programs in community hospitals. Preliminary assessments suggest that the program has a positive effect on minority and low-income cancer patients' experience with care and reduces barriers to care. Additional time and research are needed, however, to fully assess the impact on care and outcomes.

Racial Ethnic Differences in Rates and Determinants of Deceased Donor Kidney Transplantation

“…The use of patient navigators might further enhance access to kidney transplantation for certain populations. 30 Collectively, our findings suggest the need for re-evaluation of current kidney allocation algorithms in an effort to reduce persistent racial ethnic disparities.…”

Consent Timing and Experience: Modifiable Factors That May Influence Interest in Clinical Research

“…Accordingly, much effort has been devoted to identifying the variables that limit and facilitate clinical trial accrual. Cited factors include patient characteristics such as age, 5,6 sex, 3 race, [7][8][9] and socioeconomic status 7,10,11 ; institutional factors such as clinical trial availability 4,9 ; and study factors such as eligibility criteria. 12 However, relatively little research has focused on the role of the consent process in clinical trial participation.…”

Overcoming Poor Attendance to First Scheduled Colonoscopy: A Randomized Trial of Peer Coach or Brochure Support

“…13,14 As an alternative to professional health educators, trained laypersons are increasingly used to offer support, especially for minority or low-income patients. 15 Because patients who have never had a colonoscopy may dread this test, 16 we hypothesized that a trained peer 'coach' could demystify the procedure and address common barriers to completion. This intervention's theoretical construct comes from the Theory of Planned Behavior (TPB).…”