Background: To address the inequities that underserved populations often face during their cancer experience, the Wake Forest Baptist Comprehensive Cancer Center developed a novel nonclinical navigation program for African American (AA), Hispanic, and rural cancer patients. Population health navigators (PHNs) provide culturally and linguistically competent navigation services to cancer patients, families, and caregivers to help them overcome healthcare system and social barriers, facilitating timely access to quality medical and supportive care through cancer treatment. Additionally, tailored patient education about the role of research in cancer care is provided.
Objective: Review PHN data on diverse patients to understand unique characteristics and identify potential needs for further tailoring the innovative navigation intervention in underserved populations to address cancer health disparities.
Methods: Data captured by the 3 PHNs in EPIC/Healthy Planet, RedCap database (acuity scale), and Encore clinical trial registry were abstracted retrospectively from September 1, 2019, to June 30, 2021, for analysis. Data are reported in the aggregate.
Results: In this cohort (N = 386: Hispanic, n = 127; AA, n = 116; rural, n = 143), Hispanic patients were younger (77% ≤59 years), and rural patients were older (65% ≥60 years). Rural patients were also more likely to be male (53%), whereas AA patients were more likely female (62%). The most common cancer sites for rural and AA patients were thoracic (33% and 29%, respectively), and hematologic (25%) for Hispanic patients. The most common patient barriers documented by the PHNs were treatment logistics and financial/insurance for both rural (84% and 71%, respectively) and AA (66% and 54%, respectively) patients. Hispanic patients’ top barrier was communication (92%). Acuity scores based on patient characteristics and barriers indicate the level of navigation intensity from no to high navigation. Rural patients tend to have lower intensity levels (59%), a majority of AA patients are at the medium level (54%), and Hispanics have the largest percentage of high-intensity patients (13%). Rates of participation in clinical trials for navigated patients were higher than in the general cancer center patient population for rural, AA, and Hispanic patients—41%, 19%, and 24%, respectively.
Conclusion: After initial success with our inaugural Hispanic Patient Navigator position, the Population Health Navigation Program was expanded to include rural and AA populations. By looking at equivalent data for the 3 HPNs, we are able to begin to ascertain unique aspects of each respective population to assist in determining areas of further tailoring of the navigation services provided. Areas for tailoring could include resources, caseload, and clinical trial education, among others. Ongoing analysis will continue highlighting differences and potential areas for intervention.
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