Improvements in the Identification of Barriers to Care for an Oncology Population

November 2019 Vol 10, No 11
Nora J. Barrett, BSN, RN, OCN, ONN-CG
Kristi C. Garrison, MS, CHES, CHW, OPN-CG
Kristi M. Griffith, MSN, RN, CHPN, ONN-CG
Stacey L. Webb, MPA-HCA, BSN, RN, ONN-CG
Baylor Charles A. Sammons Cancer Center
Dallas, TX

Background: Every cancer patient experiences barriers to accessing quality, timely care throughout all stages of the cancer care continuum, from diagnosis through survivorship. This can lead to decreased treatment compliance, intensified psychosocial distress, and financial toxicity, increasing the difficulty in accessing healthcare. The Commission on Cancer (CoC) Standard 3.1 Patient Navigation Process requires the development of a community needs assessment and identification of disparate populations within the community served.1 An opportunity was recognized in improving the identification of barriers specific to the needs of the oncology population served by nurse and patient navigators (navigators) and tailoring resources and process improvements to increase the quality of care and patient satisfaction.

Objective: To identify, address, and understand barriers to care faced by oncology patients at a major cancer center.

Methods: A team of 4 navigators recognized the opportunity for better tracking of barriers to care data and developed barrier documentation and tracking, utilizing an existing navigation database. The barrier categories were established based on documentation requirements for CoC annual reporting. Documentation included patient demographics, category and subcategory of barriers, date identified, intervention type, resource, outcome, and date addressed. Categories included patient-centered (PTC), provider-centered (PRC), and health system (HS) barriers. Subcategories included common barriers to care, as defined by the CoC Standard 3.1.

Results: From August 15, 2018, to May 23, 2019, 1706 barriers were identified among 557 patients in the outpatient oncology setting, averaging 3.7 barriers per patient. PTC was the most common category, comprising 1224 of total barriers identified, followed by PRC (287), and HS (195) barriers. Most common subcategories of barriers identified for PTC were: fear/anxiety (412), family or social support (224), and language/literacy (141). Common PRC barriers included: provider communication (171), lack of patient trust/familiarity (67), and clinician attitudes (27). Lastly, HS barriers were commonly identified as fragmented medical system (122), scheduling issues (62), and missed appointments (9). Navigators were able to address 1412 (82%) of the barriers identified through referral to internal, community, and governmental resources; educating patients and families appropriately; and providing emotional support.

Conclusion: In identifying barriers to care, navigators play a unique role due to the supportive relationship often developed between navigators, patients, and families. Understanding common barriers faced by the population allows navigators to provide more appropriate and individualized support to patients and families.


  1. American College of Surgeons. Commission on Cancer. Cancer Program Standards: Ensuring Patient-Centered Care (2016 Edition).
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