Cancer Patient Navigation Program Research Articles

Abstract A022: Assessing, understanding, and addressing social determinants of cancer health disparities through patient navigation among rural Arkansans

Abstract The Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences (UAMS), Office of Community Outreach and Engagement has developed a Cancer Patient Navigation Program dedicated to improving cancer care for everyone in Arkansas. The team includes nurse navigators and community health workers that help bridge the gap between cancer patients, and financial resources in the community, and health care providers. The Cancer Patient Navigation Program emphasizes patient empowerment through prevention, screening, and treatment for rural and underserved populations across the state. The aim of the program is to help eliminate barriers to health care by providing resources for cancer treatment to rural and underserved populations across Arkansas. Navigators and community health works are located throughout every geographic region of Arkansas and are representative of the diversity in the communities they serve. Navigators and community health workers use the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE®) to identify cancer patients’ barriers to care. PRAPARE® is a standardized patient risk assessment tool consisting of a set of national core measures as well as a process for addressing the social drivers at both the patient and population levels. Since May 2022, the Cancer Patient Navigation program has assessed and addressed the needs of 350 cancer patients. The data collected by navigators and community health workers has improved care coordination services, increased collaborations with local community partners with similar goals, and provided a unique opportunity for UAMS to better understand challenges of cancer patients and provide more appropriate services and care that is needed on a community level. The PRAPRE data has allowed the Office of Community Outreach and Engagement to understand the number of social determinants risks as well as the most common social determinant risks in our patient population. The risk tally score established a baseline to determine who might be more “at risk” by both geographic location and cancer diagnosis. To date, the data collected has been analyzed to track referrals and interventions. The data will further be used to ensure community-engagement priorities and resources are integrated into all Winthrop P. Rockefeller Cancer Institute research cores and clinical enterprises. Addressing the adverse social drivers of health will ultimately allow UAMS to improve patient well-being, facilitate access to prevention, screening, and treatment. Citation Format: Valandra L. German. Assessing, understanding, and addressing social determinants of cancer health disparities through patient navigation among rural Arkansans [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A022.

15 Development of a student-led cervical cancer patient education and navigation program

15 Development of a student-led cervical cancer patient education and navigation program

COVID-19-Related Employment Disruptions and Increased Financial Burden Among Survivors of Adolescent and Young Adult Cancer.

Background: Financial burden is a major concern for survivors of adolescent and young adult (AYA) cancers. We identified if employment disruptions during the COVID-19 pandemic affected AYA survivors' financial burden. Methods: AYAs who were enrolled in a cancer patient navigation program were e-mailed a survey in fall 2020. Survey items included sociodemographics, employment disruption, and two measures of financial burden: COmprehensive Score for Financial Toxicity (COST) and material and behavioral financial hardship items (for any reason, COVID-19 induced, cancer induced). Financial burden outcomes were dichotomized at the median (COST = 21; financial hardship = 3). The association of employment disruptions and sociodemographics with financial burden was assessed using multivariable logistic regression models. Results: Reduced hours/job loss was reported by 24.0% of 341 participants. Survivors with a high school education or less (odds ratio [OR]: 2.70; 95% confidence interval [CI]: 1.21-6.03) or who had decreased hours or job loss (OR: 3.97; 95% CI: 2.01-7.84) had greater odds for high financial toxicity. Reduced hours/job loss was the only factor associated with high material and behavioral financial hardship for both any reason (OR: 2.75; 95% CI: 1.41-5.33) and owing to COVID-19 (OR: 4.98; 95% CI: 2.28-10.92). Cancer treatment since March 2020 was associated with cancer-induced high material and behavioral financial hardship (OR: 3.31; 95% CI: 1.96-5.58). Conclusion: Employment disruptions owing to the COVID-19 pandemic, lower education levels, and cancer treatment were associated with high financial burden among AYA cancer survivors. Our findings suggest the need for multilevel interventions to identify and address financial burden among vulnerable cancer survivors.

Navigating Financial Barriers to Papanicolaou Tests and Mammograms for Young Adult Women Residing in Rural and Border Areas of Texas.

Purpose: Costs of Papanicolaou (Pap) tests and mammograms are a primary barrier for women aged 18-39 seeking screening and diagnostic services. Race/ethnicity and rural/border resident status compound their risks for delayed diagnosis, possibly resulting in higher mortality. Methods: We analyzed cross-sectional data from young adult (YA) women (aged 18-39) from a cancer education and patient navigation (PN) program in rural and border Texas from 2012 to 2016. Descriptive statistics, Chi-square tests, and logistic regressions summarized sociodemographic variables and receipt of PN, Pap tests, and mammograms. Results: The sample consisted of 1181 women aged 31.8 years (standard deviation 5.5) on average. A total of 795 (67.3%) received PN, 494 (41.8%) received a Pap test, and 121 (10.3%) received a mammogram. The YA women attending the program due to cost (odds ratio [OR]: 7.24; confidence interval [CI]: 4.74-11.05) and reporting 1 (OR: 3.84; CI: 2.40-6.14) or 2+ barriers (OR: 6.00; CI: 3.61-9.99) had higher odds of being navigated than those not concerned about cost and not identifying a barrier. The YA women attending due to cost (OR: 2.22, CI: 1.61-3.05) and receiving navigation (OR: 1.92; CI: 1.29-2.84) had higher odds of receiving a Pap test than their counterparts. The majority receiving a mammogram were worried about cost (85.1%); 40.5% had a family history of breast cancer, and a doctor or nurse recommended a mammogram for 15.7%. Conclusion: Detection of cervical and breast cancer in YA women residing in rural and border Texas may be improved with PN to assist with financial barriers to care and service coordination.

136 Implementing a Standardized Breast Cancer Patient Navigation Program to Advance Health Equity Across the City of Boston: Challenges and Opportunities

OBJECTIVES/GOALS: Translating Research into Practice (TRIP), a hybrid implementation pragmatic clinical trial and CTSA collaboration, aims to implement a standardized breast cancer patient navigation protocol across five sites in Boston, MA. The goal of this study was to assess individual and institutional barriers and facilitators to implementing this protocol. METHODS/STUDY POPULATION: From November 2019 to August 2020, researchers conducted ethnographic observations of Patient Navigators (PN) at three of the five participating sites. Each PN at each site was observed for two, four-hour blocks by researchers trained in ethnographic research. Observers took notes using TRIPs 11 Step Protocol as a guide, which includes identifying patients at risk for delays in care, screening and referring patients to resources for health-related social needs, and tracking patients across the care continuum. Fieldnotes were uploaded into Dedoose and coded deductively by four researchers using a comparison and consensus approach. Researchers analyzed the data to identify barriers and facilitators to both implementing each protocol step and maximizing navigations ability to promote health equity. RESULTS/ANTICIPATED RESULTS: Across all sites, PNs faced barriers to adhering to the TRIP Protocol due to practical workflow constraints including their level of engagement across the cancer care continuum. Although there are other staff members who engage in navigation activities, navigation is often viewed solely as the responsibility of the PN. Operationalizing navigation as a person rather than a process creates confusion around the role, and PNs are often seen as a catchall position when other staff do not know how to help a patient. The time that PNs spend on tasks unrelated to core navigation activities described in the TRIP Protocol prevents PNs from navigating patients most at risk for delays in care. A lack of continuity across the care continuum can create role confusion for the PNs. DISCUSSION/SIGNIFICANCE: Patient Navigation can promote health equity; however, any task that pulls PNs away from navigating patients most at risk for delays in care diminishes this potential. PNs abilities to enact the TRIP protocol, which they saw as valuable, is circumscribed by the extent to which navigation is operationalized as a process within the institution.

An Evaluation of Breast and Cervical Cancer Screening Outcomes in an Education and Patient Navigation Program in Rural and Border Texas.

This study examines breast and cervical cancer screening uptake in a cancer education and patient navigation (PN) program for residents of rural and border counties in Texas by level of participation (education only, PN only, or education and PN). Data collected from March 1, 2012, to November 5, 2016, included 6663 follow-up surveys from participants aged 21-74. Logistic regression models assessed program participation on the odds of completing breast or cervical cancer screening. For women aged 40-74years (N = 4942; mean age = 52years), 58.4% reported a mammogram within 6months on average from initial contact. In the breast cancer screening model, women who only received PN (OR: 6.06, CI: 4.87-7.53) or who participated in both the education plus PN program (OR: 3.33, CI: 2.77-4.02) had higher odds of mammogram screening compared to women who only received education. For women aged 21-64years (N = 6169; mean age = 46years), 37.7% received a Papanicolaou (Pap) test within 6months on average from initial contact. In the Pap screening model, both education and PN (OR: 3.23, CI: 2.66-3.91) and PN only (OR: 2.35, CI: 1.88-2.93) groups had higher odds of screening for cervical cancer compared to those only receiving education. Graphed predicted probabilities examined significant interactions between race/ethnicity/language and program participation (P < 0.0001) for both screenings. PN, solely or in combination with education, is an effective strategy to increase screening for breast and cervical cancer, beyond educational outreach efforts alone, among un-/underserved, racially/ethnically diverse women in rural and border Texas counties.

The Development of Cancer Patient Navigation Program in Taiwan

Background and context: Cancer has been the leading cause of death since 1982 in Taiwan. Taiwan cancer case management program started from major 4 cancers (breast cancer, liver cancer, colorectal cancer, oral cancer) since 2004. However, only 82% of patients with a confirmed cancer diagnosis received their first cancer treatment within 3 months in 2012. Aim: To increase the navigation coverage for all cancer patients, Health Promotion Administration (HPA) sets the goal that 91% of patients with a confirmed cancer diagnosis should receive their first cancer treatment within 3 months in 2018. Strategy/Tactics: (1) Subsidize cancer hospitals (2) Accreditation for oncology case management (3) Pay for performance (P4P) Program/Policy process: We subsidized hospitals to establish oncology case manager since 2004. Gradually, hospitals in Taiwan accept this new nursing role and recognize its positive impacts on cancer care. Moreover, Taiwan Accreditation Program of Cancer Care mandated all cancer care institutes to establish the program for oncology case management since 2010. However, there were only 4-6 major cancer patients got the case management service. Thus HPA launched P4P Cancer Patient Navigation Program in 2014 and established reporting system. Outcomes: 95% of newly cancer diagnosis patients (including 92 hospitals) in Taiwan receive the service and 96% of patients with a confirmed cancer diagnosis receive their first cancer treatment within 3 months in 2017. Through the implementation of subsidy, accreditation and P4P, the relative survival rate showed significant improved. The 5-year relative survival rate for all cancers increases from 49% during 2003-2007% to 55.8% during 2011-2015. What was learned: A successful program might start small from few trial sites, should be fully supported and well established the systems by government and will move fast by all healthcare professionals.

Introducing Patient Navigation to Trinidad and Tobago As a Method to Improve Public Cancer Care Delivery

Background and context: Despite significant public health care investment, Trinidad and Tobago (T&amp;T) has poor cancer patient outcomes. For example, T&amp;T has one of the highest breast cancer (BC) mortality rates in the Caribbean and the highest BC mortality/incidence ratio in the Americas. The BC 5-year survival rate for the period 1995-2007 was approximately 20%-30%, compared with 80% for the US. Many factors contribute to this disparity including healthcare administration challenges such as unavailability of drugs, long delays in securing appointments, loss of paper records and loss to follow-up. The introduction of a tailored patient navigation model is intended to address these challenges. Aim: To pilot the first, comprehensive public cancer patient navigation program with a focus on advanced breast cancer (ABC) patients in the Caribbean. Strategy/Tactics: Following ethical approval, focus groups will be held with hospital staff and the Ministry of Health to ascertain the most pressing patient needs and develop a clinical pathway that includes the navigator. Another focus group will be held with patients to determine needs. One full-time oncology nurse navigator will be assigned to an oncology unit where a physician and nurse liaison will be identified to provide support and supervision. A job description, scope of work, code of ethics, clinical pathway, consent forms, an oncology navigation software and instructions for use will be provided to the navigator. After patient consent, the navigator will provide tailored navigation services based on the predetermined scope of work. Services may include education, referrals to support groups and cancer treatment options, ensuring follow-up is complete, booking appointments and tracking all medical records electronically. The navigator will meet with the project coordinator biweekly to address challenges. The Patient Satisfaction with Cancer Care (PSCC) and the Patient Satisfaction with Navigator (PSN-1) questionnaires will also be administered as part of the process of validating of these metrics for this setting. Program/Policy process: Advocacy and support through personalized case management for cancer patients. Outcomes: We aim to enroll &gt; 100 ABC patients. The following will be reported: (i) Number of ABC patients navigated; (ii) Average number of navigation appointments per patient and average time per appointment; (iii) Results of patient needs assessments; (iv) Validated PSCC and PSN-1 questionnaires; (v) Description of the clinical epidemiology of the cohort; (vi) Description of navigation role and code of ethics; (vii) Protocols for software use; (viii) Recommendations for implementation of a local training program; (ix) Evaluation of time to diagnostic resolution, time to treatment and follow-up care with comparisons to nonnavigated patients where possible.

Evaluation of a cancer patient navigation program (\u201cOnkolotse\u201d) in terms of hospitalization rates, resource use and healthcare costs: rationale and design of a randomized, controlled study

BackgroundConcepts for the nursing and care of cancer patients through a “navigation service” have attracted much interest. However, there is still room for improvement in terms of their funding and coverage. The Saxon Cancer Society designed a prospective, randomized, multicenter, longitudinal study with a view to determining the positive effects of a cancer patient navigator program. The objective of this ongoing study is to evaluate the impact of the cancer patient navigation program on cancer patients and cost bearers in Germany.MethodsThe study population in this evaluation comprises cancer patients with gastric carcinoma, pancreatic carcinoma, colorectal cancer, melanoma or gynecological cancer who have been hospitalized at least once at one of the study centers as well as their relatives, outpatient and inpatient physicians, and cancer nurses. It is planned to randomize 340 cancer patients (stomach, colonic/rectal cancer, gynecological cancer, melanoma) at five centers to an intervention group (care by patient navigators based on standardized operating procedures) or a control group in a one-to-one ratio. The primary target parameter is the number of hospitalizations within the 12-month intervention period. The participants are asked to complete various questionnaires on patient-related outcomes at baseline and at 3 and 12 months (SF 36, HADS, PAM 13, and others). Data on drug therapy, utilization of health services, and medical expenses will also be analyzed.DiscussionFor the first time, the study will provide data on the effectiveness of a patient support program in cancer care in Germany from a randomized trial with a high level of evidence.Trial registrationThe study has been registered under DRKS00013199 in the German Clinical Trials Register.

Patient Navigation Preferences for Adolescent and Young Adult Cancer Services by Distance to Treatment Location.

To describe how distance to treatment location influences patient navigation preferences for adolescent and young adult (AYA) cancer patients and survivors. This study is part of a statewide needs assessment to inform the development of an AYA cancer patient and survivor navigation program. Participants were recruited from outpatient oncology clinics in Utah. Eligible participants had been diagnosed with cancer between ages 15-39 and had completed at least 1 month of treatment. Participants completed a semi-structured interview on preferences for patient navigation. Summary statistics of demographic and cancer characteristics were generated. Thematic content analysis was used to describe navigation preferences among participants classified as distance (≥20 miles) and local (<20 miles), to explain differences in their needs based on distance from their treatment center. The top three patient navigation needs were general information, financial, and emotional support. More local patients were interested in patient navigation services (95.2%) compared to distance participants (77.8%). Fewer local (38.1%) than distance participants (61.1%) reported challenges getting to appointments, and distance patients needed specific financial support to support their travel (e.g., fuel, lodging). Both local and distance patients desired to connect with a navigator in person before using another form of communication and wanted to connect with a patient navigator at the time of initial diagnosis. Distance from treatment center is an important patient navigation consideration for AYA cancer patients and survivors. After initially connecting with AYAs in person, patient navigators can provide resources remotely to help reduce travel burden.

A Mixed Methods Review of Education and Patient Navigation Interventions to Increase Breast and Cervical Cancer Screening for Rural Women

ABSTRACTReviews have assessed studies of breast and cervical cancer screening access and utilization for rural women, but none analyze interventions to increase screening rates. A mixed methods literature search identified studies of breast and/or cervical cancer prevention education and patient navigation interventions for rural women. Rural areas need greater implementation and evaluation of screening interventions as these services address the challenges of delivering patient-centered cancer care to un-/underserved communities. The lack of intervention studies on breast and cervical cancer education and patient navigation programs compared to urban studies highlights the need for validation of these programs among diverse, rural populations.

Breast Cancer Patient Navigation Program in a Resource-Constrained Health Care Setting in Asia

Abstract 23 Background: Breast cancer incidence is rapidly increasing in Asia as a result of changes in life expectancy and lifestyle factors. In Malaysia, incidence is expected to double in the next decade and survival is poor (50% to 75%) because of late presentation and poor adherence to treatment. This burden is greater for women in underserved communities, but few studies have examined systematic approaches to reduce late presentation and poor treatment adherence. We sought to determine whether a patient navigation program (PNP) could be a community-based solution to improve outcomes of patients with breast cancer, particularly in a resource-constrained setting. Methods: PNP was implemented in a secondary hospital that serves a suburban area near Kuala Lumpur. A decision aid, which incorporated local key messages, was developed. Nurses and community workers in the program received skills training in navigation, communications, patient management, and resource identification and utilization. Data were retrieved from baseline questionnaires and a patient tracking system and was analyzed by using descriptive statistics. Results: In the first year of the program, 225 women were served, of whom 137 were patients with breast cancer. Compared with the prior year, more patients in the PNP received diagnoses within 14 days of their first visit (67.7% v 62.4%; P = .516) and had surgery within 28 days from diagnosis (68.4% v 61.3%; P = .487). There were also fewer reported patients who experienced default in the PNP (4.4% v 6.6%; P = .797). Conclusion: This 1-year evaluation showed that patient navigation is feasible in a resource-constrained setting, but longer follow-up is required to determine the impact on outcomes. Moving forward, we seek to increase the efficiency of patient navigation by increasing access to palliative care and improving interdepartment coordination and patient tracking systems. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Maheswari Jaganathan No relationship to disclose Dhiauddin Hai No relationship to disclose Nur Hidayati Zainal No relationship to disclose Nadia Rajaram No relationship to disclose Mohamed Yusof No relationship to disclose Soo-Hwang Teo Honoraria: AstraZeneca Consulting or Advisory Role: AstraZeneca Speakers' Bureau: AstraZeneca Research Funding: AstraZeneca Travel, Accommodations, Expenses: AstraZeneca

Developing a Provincial Cancer Patient Navigation Program Utilizing a Quality Improvement Approach. Part Three: Evaluation and Outcomes.

In 2012, the provincial cancer agency in Alberta initiated a provincial quality improvement (QI) project to develop, implement, and evaluate a provincial Cancer Patient Navigation (CPN) program spanning 15 sites across over 600,000 square kilometres. This project was selected for two years of funding (April 2012-March 2014) by the Alberta Cancer Foundation (ACF) through an Enhanced Care Grant process (ACF, 2015). A series of articles has been created to capture the essence of this quality improvement (QI) project, the processes that were undertaken, the standards developed, the education framework that guided the orientation of new navigator staff, and the outcomes that were measured. The first article in this series focused on establishing the knowledge base that guided the development of this provincial navigation program and described the methodology undertaken to implement the program across 15 rural and isolated urban cancer care delivery sites. The second article delved into the education framework that was developed to guide the competency development and orientation process for the registered nurses who were hired into cancer patient navigator roles and how this framework evolved to support navigators from novices to experts. This third and final article explores the evaluation approach used and outcomes achieved through this QI project, culminating with a discussion section, which highlights key learnings, and subsequent steps that have been taken to broaden the scope and impact of the provincial navigation program.

Developing a Provincial Cancer Patient Navigation Program Utilizing a Quality Improvement Approach Part Three: Evaluation and Outcomes

En 2012, l’agence provinciale du cancer de l’Alberta lancait un projet d’amelioration de la qualite dans le but de creer, de mettre en œuvre et d’evaluer un programme provincial de navigation pour patients cancereux englobant 15 etablissements repartis sur plus de 600 000 kilometres carres. Ce projet a ete selectionne pour recevoir un financement de deux ans (d’avril 2012 a mars 2014) de l’Alberta Cancer Foundation (ACF) accorde a la suite d’un processus de subvention pour ameliorer les soins (Enhanced Care Grant). Une serie d’articles a ete redigee pour capturer l’essence de ce projet d’amelioration de la qualite des processus amorces, des normes elaborees, du cadre educatif determinant l’orientation du nouveau personnel navigateur et des resultats mesures. Le premier article de la serie portait sur la base de connaissances ayant guide l’elaboration du programme provincial de navigation et sur la methodologie employee pour mettre le programme en œuvre dans 15 centres de soins du cancer situes en region rurale ou en milieu urbain isole (Anderson et al., 2016). Le deuxieme article a approfondi le cadre educatif concu pour guider l’acquisition des competences et le processus d’orientation des infirmieres (et infirmiers) autorisees engagees pour remplir le role d’intervenant pivot aupres des patients cancereux. Il a egalement expose comment le cadre a evolue pour aider a ce que les navigateurs passent du statut de novice a celui d’expert. Le present article, troisieme et dernier de la serie, explore les resultats obtenus grâce a ce projet d’amelioration de la qualite et se terminera par une section de discussion mettant en lumiere les principales lecons retenues, les mesures d’adaptation mises en place, ainsi que les prochaines etapes en cours pour etendre la portee et les effets du programme provincial de navigation.

HELENE HUDSON LECTURESHIP: Developing a provincial cancer patient navigation program utilizing a quality improvement approach Part two: Developing a Navigation Education Framework

En 2012, l’agence provinciale du cancer de l’Alberta lancait un projet d’amelioration de la qualite dans le but de creer, de mettre en œuvre et d’evaluer un programme provincial de navigation pour patients cancereux englobant 15 etablissements repartis sur plus de 600 000 kilometres carres. Ce projet a ete selectionne pour recevoir un financement de deux ans (d’avril 2012 a mars 2014) de l’Alberta Cancer Foundation (ACF), accorde a la suite d’un processus de subvention pour ameliorer les soins (Enhanced Care Grant). Une serie d’articles a ete redigee pour capturer l’essence de ce projet d’amelioration de la qualite des processus amorces, des normes elaborees, du cadre educatif determinant l’orientation du nouveau personnel navigateur et des resultats mesures. Le premier article de la serie portait sur la base de connaissances ayant guide l’elaboration du programme provincial de navigation et sur la methodologie employee pour mettre le programme en œuvre dans 15 centres de soins du cancer situes en milieu rural ou en milieu urbain isole (Anderson et al., 2016). Le present article, deuxieme de la serie, approfondit le cadre educatif concu pour guider l’acquisition des competences et le processus d’orientation des infirmieres (et infirmiers) autorisees engagees pour remplir le role d’intervenant pivot aupres des patients cancereux. Il expose egalement comment le cadre a evolue pour aider a ce que les navigateurs passent du statut de novice a celui d’expert. Le troisieme et dernier article explorera les resultats obtenus grâce a ce projet d’amelioration de la qualite et se terminera par une section de discussion mettant en lumiere les principales lecons retenues, les mesures d’adaptation mises en place, ainsi que les prochaines etapes en cours pour etendre la portee et les effets du programme provincial de navigation.

Developing a provincial cancer patient navigation program utilizing a quality improvement approach Part two: Developing a Navigation Education Framework.

In 2012, the provincial cancer agency in Alberta initiated a provincial quality improvement project to develop, implement, and evaluate a provincial cancer navigation program spanning 15 sites across more than 600,000 square kilometres. This project was selected for two years of funding (April 2012-March 2014) by the Alberta Cancer Foundation (ACF) through an Enhanced Care Grant process (ACF, 2015). A series of articles has been created to capture the essence of this quality improvement (QI) project, the processes that were undertaken, the standards developed, the education framework that guided the orientation of new navigator staff, and the outcomes that were measured. The first article in this series focused on establishing the knowledge base that guided the development of this provincial navigation program and described the methodology undertaken to implement the program across 15 rural and isolated urban cancer care delivery sites (Anderson et al., 2016). This article, the second in the series, delves into the education framework that was developed to guide the competency development and orientation process for the registered nurses who were hired into cancer patient navigator roles and how this framework has evolved to support navigators, as they move from novice to expert practice. The third and final article will explore the outcomes that were achieved through this quality improvement project culminating with a discussion section highlighting key learnings, adaptations made, and next steps underway to broaden the scope and impact of the provincial navigation program.

Developing a provincial cancer patient navigation program utilizing a quality improvement approach Part one: Designing and implementing.

In 2012, the provincial cancer agency in Alberta initiated a provincial quality improvement project to develop, implement, and evaluate a provincial navigation program spanning 15 sites across over 600,000 square kilometres. This project was selected for two years of funding (April, 2012-March 31, 2014) by the Alberta Cancer Foundation (ACF) through an Enhanced Care Grant process. A series of articles has been created to capture the essence of this quality improvement project, the processes that were undertaken, the standards developed, the educational framework that guided the orientation of new navigator staff, and the outcomes that were measured. This first article in the series focuses on establishing the knowledge base that guided the development of this provincial navigation program and describing the methodology undertaken to implement the program across 15 rural and isolated urban cancer care delivery sites. The second article in this series will delve into the educational framework that was developed to guide the competency development and orientation process for the registered nurses who were hired into the newly developed cancer patient navigator roles. The third and final article will explore the outcomes that were achieved through this quality improvement project culminating with a discussion section highlighting key learnings, adaptations made, and next steps underway to broaden the scope and impact of the provincial navigation program.

HELENE HUDSON LECTURESHIP Developing a provincial cancer patient navigation program utilizing a quality improvement approach Part one: Designing and implementing

En 2012, l’agence provinciale du cancer de l’Alberta lancait un projet d’amelioration de la qualite dans le but de creer, de mettre en œuvre et d’evaluer un programme de navigation provincial englobant 15 etablissements repartis sur plus de 600 000 kilometres carres. Ce projet a ete selectionne pour recevoir un financement de deux ans (d’avril 2012 au 31 mars 2014) de l’Alberta Cancer Foundation (ACF), accorde a la suite d’un processus de subvention amelioree des soins (Enhanced Care Grant). Une serie d’articles a ete redigee pour capturer l’essence de ce projet d’amelioration de la qualite, des processus amorces, des normes elaborees, du cadre educatif determinant l’orientation du nouveau personnel navigateur et des resultats mesures. Le premier article de la serie porte essentiellement sur la base de connaissances ayant guide l’elaboration du programme de navigation provincial et sur la methodologie employee pour mettre le programme en œuvre dans 15 centres de soins du cancer situes en milieu rural ou en milieu urbain isole. Le deuxieme article de la serie approfondit le cadre educatif concu pour guider l’acquisition des competences et le processus d’orientation des infirmieres autorisees engagees pour remplir ce nouveau role d’infirmieres pivots aupres des patients atteints de cancer. Le troisieme et dernier article explore les resultats obtenus grâce a ce projet d’amelioration de la qualite et se termine par une section de discussion mettant en lumiere les principales lecons retenues, les mesures d’adaptation mises en place, ainsi que les prochaines etapes en cours pour etendre la portee et les effets du programme de navigation provincial.

Moving the Agenda Forward for Cancer Patient Navigation: Understanding Volunteer and Peer Navigation Approaches

Across Canada, individuals diagnosed with cancer have identified concerns about access to services before, during, and following treatment, highlighting a very real uncertainty that exists about where to turn for information and assistance. Cancer patient navigation programs are emerging as effective interventions, well-equipped to meet these patients' diverse needs. While many provinces have initiated professionally led navigation services, little is known about the potential for volunteer-led navigation. This article highlights pilot programs in British Columbia, Ontario, and Newfoundland, where volunteers are engaged as lay or peer providers of cancer patient navigation services. By describing the recruitment, training, and role of the navigators within each program, the paper underscores the capacity for unique programs to work within current care frameworks across distinct communities. These programs provide an innovative approach to overcoming barriers and augmenting access to supportive care for cancer patients and their family members.

Follow-Up and Timeliness After an Abnormal Cancer Screening Among Underserved, Urban Women in a Patient Navigation Program

We evaluated the efficacy of a Chicago-based cancer patient navigation program developed to increase the proportion of patients reaching diagnostic resolution and reduce the time from abnormal screening test to definitive diagnostic resolution. Women with an abnormal breast (n = 352) or cervical (n = 545) cancer screening test were recruited for the quasi-experimental study. Navigation subjects originated from five federally qualified health center sites and one safety net hospital. Records-based concurrent control subjects were selected from 20 sites. Control sites had similar characteristics to the navigated sites in terms of patient volume, racial/ethnic composition, and payor mix. Mixed-effects logistic regression and Cox proportional hazard regression analyses were conducted to compare navigation and control patients reaching diagnostic resolution by 60 days and time to resolution, adjusting for demographic covariates and site. Compared with controls, the breast navigation group had shorter time to diagnostic resolution (aHR = 1.65, CI = 1.20-2.28) and the cervical navigation group had shorter time to diagnostic resolution for those who resolved after 30 days (aHR = 2.31, CI = 1.75-3.06), with no difference before 30 days (aHR = 1.42, CI = 0.83-2.43). Variables significantly associated with longer time to resolution for breast cancer screening abnormalities were being older, never partnered, abnormal mammogram and BI-RADS 3, and being younger and Black for cervical abnormalities. Patient navigation reduces time from abnormal cancer finding to definitive diagnosis in underserved women. Results support efforts to use patient navigation as a strategy to reduce cancer disparities among socioeconomically disadvantaged women.