Patient Navigation Research Articles

Effectiveness of the Colorectal Cancer Alliance's digital screening quiz and navigation model for promoting CRC screening.

97 Background: Evaluating the effectiveness of a Colorectal Cancer screening navigation model delivered in a digital platform offered by a patient advocacy organization. Designed as a digital screening quiz tool and live navigation to promote CRC screening, the Colorectal Cancer Alliance’s Screening Quiz is a risk stratification tool that connects respondents to live certified cancer care navigators delivering evidence-based interventions to increase CRC screening, education and patient and family support. The framework utilizes small and mass media, one-on-one education and patient navigation services to help address and reduce barriers to care. Research on these critical interventions shows that on-time screening for CRC leads to better outcomes. Methods: The Screening Quiz has been promoted through social sharing, community outreach, and media, including influencer campaigns to increase outreach to at-risk communities. Questions assess personal and family history, hereditary syndromes, and demographics to provide a CRC screening recommendation based on current USPSTF guidelines. Respondents overdue for screening are triaged to the Alliance’s patient navigation team. This interaction includes phone calls and emails for symptomatic individuals/high risk for CRC, telephone and email for average-risk uninsured, and emails for average-risk insured. At-risk individuals are connected to resources, such as financial assistance, free at-home screening tests, and colonoscopy scheduling services. Results: July 2022 to July 2024, the Screening Quiz provided over 50,000 screening recommendations. The median age of respondents was 46; 32% of respondents were between the ages of 45 to 64. Of the respondents, 29% were male and 71% were female. Most were White (79.2%), but nearly half of those who opted into navigation identified as BIPOC, including 16.7% Black/AA, 6.6% Asian, and 2.1% AI/AN. Additionally, 8.4% of respondents identified as ethnically Hispanic/Latino with another race. Most respondents were symptomatic (66.6%) but 6.5% were asymptomatic high-risk. These two groups represented 88% of 1,869 respondents triaged to patient navigation. Conclusions: The digital Screening Quiz, combined with live navigation, represents a promising approach for increasing CRC screening rates and addressing care gaps compared to traditional methods. The Alliance’s ability to engage at-risk communities through its national network of volunteers and partners, combined with evidence-based interventions, positions it well to continue closing screening gaps. Going forward, the Alliance aims to leverage its relationships with healthcare providers and community organizations further to expand the reach of its CRC screening efforts.

Travel Burden of Radiation Therapy in the Philippines.

Travel burden negatively impacts the stage at diagnosis, treatment, outcome, and quality of life among patients with cancer. Travel burden-quantified as distance, time, and cost of travel-is magnified in low- and middle-income countries like the Philippines, where radiation therapy (RT) resources are lacking and are inequitably distributed. We compared Philippine Radiation Oncology Society data and the population census to determine the distribution and density of RT facilities across the country's 17 regions. For distance and travel time, we used the Google Maps route planner to determine the best routes from each province to the nearest private and government RT facility. Travel cost was calculated by multiplying distance by the local price of diesel per liter and the mean fuel economy of passenger vehicles in the Philippines. There are only 54 RT facilities in the Philippines (0.5 per 1 million population). More than a third are in the National Capital Region (NCR). Four regions do not have an RT facility. Nationally, the average distance to any RT facility is 101.02 km with a travel time of 2.66 hours and a travel cost of PHP 4811.11 ($85.91). Travel burden to any RT facility is the least in NCR and greatest in Visayas. Travel burden to a government RT facility is greater, with an average distance of 136.94 km, travel time of 3.05 hours, and travel cost of PHP 6353.43 ($113.45). Travel burden to a government RT facility is least in NCR and greatest in Mindanao. The travel burden of RT in the Philippines is significant and varies regionally and by RT facility type (private or government). Data-driven installation of government RT facilities in underserved regions, alternative reimbursement systems to encourage hypofractionation when appropriate, patient subsidies for housing/transportation while on treatment, better public transportation, and patient navigation are needed.

Multi-target stool DNA test adherence among average-risk 45- to 49-year-old patients from 2017-2023.

102 Background: Colorectal cancer (CRC) is the third most common cancer in the United States and the second most common cause of cancer-related mortality. In 2021, the US Preventive Services Task Force (USPSTF) lowered the age of initial CRC screening from 50 to 45 years of age for average risk individuals. At that time, only 20% of adults aged 45-49 years were up-to-date with CRC screening. With its at-home use, accessibility, and patient navigation, the multi-target stool DNA test (mt-sDNA) could help support screening uptake in this population. Here, we analyzed national claims data to investigate mt-sDNA adherence rates among average-risk adults aged 45-50 years. Methods: Using a national claims database of over 165 million individuals linked with Exact Sciences Laboratories data, mt-sDNA orders for AA patients were retrospectively identified from 2017 to 2023. Average CRC risk individuals aged ≥45 years, and new to mt-sDNA, were included in this analysis. Primary outcome of interest was adherence, defined as mt-sDNA kit return rate within 365-days from shipment. Test return time was examined as the secondary outcome. Demographics were age, sex, ordering provider, residential geography, payor, and outreach preference. Covariates on adherence were examined using logistic regression. Results: A total of 607,388 mt-sDNA orders were prescribed during the study period, with an overall 365-day return rate of 65.4%. Average time to test return was 30.4 days. Women outnumbered men in the cohort (58.6%), and most mt-sDNA orders were prescribed by primary care providers (59.4%). The majority of individuals preferred ‘Digital SMS’ communication (62%), and nearly 90% of the cohort was Commercially insured (87.6%). Among those in the cohort participants’ self-reported race/ethnicity was: White (37.3%), Hispanic or Latino (10.1%), Black or African American (8.8%), unknown (8.8%), Asian or pacific islander (4.6%), and other (3.7%). Adherences for the four identified races/ethnicities were all near, or above 60%. Men demonstrated higher adherence than women (66.7% vs 64.5%; p<0.0001). Time to test return was shortest in men (28.9 days) and African American persons (28.5 days). Tests ordered by gastroenterologists yielded the quickest adherence times amongst providers (26 days). After controlling for race, gender, payor class, setting (urban/rural classification), and preferred language, digital outreach and provider type were significantly associated with increased mt-sDNA adherence. Conclusions: This large, national analysis reports a substantially higher rate of adherence among individuals ages 45-49 with the mt-sDNA test than the current nationally reported rates. At-home testing, along with standard and preference-based navigation may have contributed to high mt-sDNA completion rates. More research is warranted to explore screening behaviors and the benefits of screening within this younger population.

Adherence to multi-target stool DNA test in the US Asian population from 2017-2024.

101 Background: In 2024, incidence and mortality cases related to colorectal cancer (CRC) in the US are estimated to reach 152,810 and 53,010, respectively. CRC screening can help identify malignant lesions at earlier stages; however, in 2021, only 48% of Asian American persons between the ages of 45-75 were up-to-date. Multi-target stool DNA test (mt-sDNA), a highly sensitive and guideline recommended CRC screening modality, may improve screening adherence in average-risk individuals within this population. Herein, we examined CRC screening adherence with mt-sDNA in Asian Americans using national claims data. Methods: A large claims database of over 165 million individuals linked with Exact Sciences Laboratories data, was used to source mt-sDNA orders for Asian Americans from 2017 to 2024. Eligible individuals were aged ≥45 years, new to mt-sDNA and average risk for CRC during the baseline period of 12 months. Primary outcome was adherence to mt-sDNA, defined as return of mt-sDNA kit within 365-days from shipment. The secondary outcome was time to kit return in days. All individuals received a standard mailed letter along with additional digital outreach through the accompanying mt-sDNA patient navigation program, according to their desired mode of communication. Baseline demographic measures included age, sex, ordering provider, residential geography, payor, and outreach preference. Association of adherence with patient characteristics was evaluated using multivariable regression. Results: Of the 182,259 eligible mt-sDNA orders shipped during the study period, overall adherence was 68.9%. Average time to test return was 27.1 days. The cohort was comprised mostly of women (56.7%), aged 50-64 years (58.42%), primary care provider (74.7%), and preferred ‘Digital SMS’ outreach (50.9%). Average adherence for all age groups, 45-49 years, 50-64 years, 65-75 years, and 76+ years, exceeded 65%, at 67.2%, 68.8%, 69.7%, and 72%, respectively. Medicare recipients demonstrated the highest adherence by payor type (71%, p < 0.0001), and persons who opted for ‘Digital SMS + Email’ communication were most adherent (70.9%; p < 0.0001). Of all provider specialties, individuals having their tests ordered by gastroenterologists produced the shortest time to adherence (21.8 days). Multivariable regression revealed that age, digital outreach (compared to none), micropolitan residence, and ordering provider were independent predictors of increased mt-sDNA adherence. Conclusions: The results of this large cohort and nationally representative analysis demonstrated high mt-sDNA adherence amongst Asian American persons, despite a low percentage of this population being current with CRC screening overall. The use of mt-sDNA, in concordance with its included patient navigation, is a viable modality to encourage test completion through screening engagement – which has the potential to reduce screening barriers in this population.

Service Lines, Neurology, and Academic Medicine: Departmental Perspectives, Implementation Strategies, and Keys to Success.

Service lines are increasingly common for organizing multidisciplinary patient care. Concerns regarding impacts of neuroscience service lines were voiced at several national neurology department chair summits, prompting the American Academy of Neurology to convene a Service Lines Workgroup. Neurology department leaders nationally at institutions that had created or considered a neuroscience service line were interviewed to elicit their experiences and lessons learned. Potential benefits identified stemmed from additional resources that the service line structure yielded (patient navigators, quality improvement staff, technicians) and strengthening of cross-department collaboration. Potential pitfalls included top-down institutional decision-making regarding service line creation, lack of explicit goals, late involvement of neurology, imbalances in neurology representation in leadership, unclear impacts on department finances, and lack of education and research mission integration into service lines. Establishing a satisfactory decision-making structure in a matrixed arrangement and ensuring that funds flow allocations acknowledged neurology's "upstream" contributions were also challenges.

Multi-target stool DNA test adherence in average-risk African Americans from 2017-2024.

99 Background: Colorectal cancer (CRC) stands as the second most common cause of cancer-related mortality in the United States, while being the third most common cancer in the country. African Americans (AA) are disproportionately affected with CRC (incidence and mortality), yet the disease can be prevented through screening and early detection. Data reveals that only 59% of AA between ages 45-75 were up to date with CRC screening as of 2021. Broad availability of the navigation-supported, at home multi-target stool DNA (mt-sDNA) test may help mitigate barriers to screening adherence in this population. We examined multi-target stool-DNA (mt-sDNA) test adherence rates in a nationally representative AA population. Methods: Using a national claims database of over 165 million individuals linked with Exact Sciences Laboratories data, mt-sDNA orders for AA patients were retrospectively identified from 2016 to 2024. Average CRC risk individuals aged ≥45 years, and new to mt-sDNA, were included in this analysis. Primary outcome of interest was adherence, defined as mt-sDNA kit return rate within 365-days from shipment. Time to test return was examined as the secondary outcome. Demographics were age, sex, ordering provider, residential geography, payor, and outreach preference. Covariates on adherence were examined using logistic regression. Results: Among 434,951 mt-sDNA orders from 2017-2024, the overall adherence rate was 62%, and the average time to test return was 27.6 days. The cohort included higher percentages of women (61.7%), ages 50-64 years (57.8%), located in Southern US (51.4%), and metro areas (90.9%). Most patients were also commercially insured (56.1%) and received their mt-sDNA order from their primary care provider (65.4%). Digital SMS was the most preferred outreach option (47%). Patients ages ≥76 years demonstrated the highest adherence (70.3%), with all age categories near or above 60% (45-49 yrs [59.4%]; 50-64 yrs [60.8%], 65-75 yrs [64.3%]). Across payors, patients with Medicare had the highest adherence rates (66.5%). Across outreach, highest adherence was among those who preferred ‘Digital SMS + Email’ outreach (64.3%). Men were quicker to return their test than women (26.8 days vs 28 days, p<0.001). Those ages ≥76 years and with tests ordered by GIs had the shortest time to test return (21.3 and 22.2 days, respectively). Adjusted analyses revealed multiple factors were associated with increased odds of adherence, including older age (≥76 years; OR=1.54; p<0.001), ‘Digital SMS + Email’ outreach (OR=1.25; p<0.001), rural residence (OR=1.23; p<0.001), and males (OR=1.05; p<0.001). Conclusions: Mt-sDNA adherence was higher for AA patients in this large, national cohort as compared to previously reported overall CRC screening adherence data for this population group. Findings suggest mt-sDNA utilization, with its included patient navigation, may help reduce screening disparities among AA patients.

Adherence to the multi-target stool DNA test in the US Hispanic population from 2016-2024.

100 Background: With colorectal cancer (CRC) as the second most common cause of cancer-related mortality in the US, adherence to CRC screening is a vital component to alleviating the cancer burden. Statistics show that only 52% of Hispanic or Latino individuals ≥45 years were up-to-date with CRC screening in 2021. A guideline-recommended, at-home CRC screening option, such as the multi-target stool DNA test (mt-sDNA), could be an efficient modality for screening average-risk individuals. Using a large national claims database, we examined CRC screening adherence with mt-sDNA in the US Hispanic population. Methods: Data was sourced from a database of over 165 million individuals linked with Exact Sciences Laboratories data. Hispanic persons who received mt-sDNA orders and resided in the US were retrospectively identified from 2016 to 2024. The analyses included persons who were ≥45 years of age, new to mt-sDNA and average risk for CRC during the 12-month pre-index period. Primary outcome of interest was adherence, which was defined as the mt-sDNA kit return rate within 365-days from shipment. All patients received a mailed letter along with digital outreach through the accompanying patient navigation program, according to their communication preference. The modes of digital outreach included: SMS, email, or both. Baseline demographics collected included age, sex, ordering provider, residential geography, payor, and outreach preference. Adjusted analyses were used to examine effects of covariates on adherence. Results: A total of 447,968 mt-sDNA orders were shipped during the study period and the overall adherence rate was 62.5%. Average time to test return was 28.5 days. Women comprised the majority of the cohort (59.9%), resided mostly in the Southern US (46.9%), aged 50-64 (60.9%), resided in a metropolitan area (91.2%), and received their mt-sDNA order from their primary care provider (62.7%). Across evaluated age groups, adherence was above 60% for all: ages 45-49 [60.5%]; 50-64 [62.6%], 65-75 [62.6%]), and ≥ 76 years [66.8]. By payor, Medicare-insured patients demonstrated the highest adherence (65.5%). Digital SMS was the preferred contact method (51.2%), and those opting for SMS + Email had the highest adherence rate (64.2%). Of provider specialties, individuals having their tests ordered by GIs produced the shortest time to adherence (23.2 days). Regression analyses revealed that older age (≥ 76 years), living in a rural area, and receiving fully or partially digital outreach were associated with increased mt-sDNA adherence. Conclusions: This large, national analysis reveals high mt-sDNA adherence amongst Hispanic individuals in the US, despite reports of low national CRC screening rates in this population. These data support the important role of mt-sDNA in facilitating screening engagement, while emphasizing the importance of preference-based navigation in facilitating screening test completion.

2672 Exploring stakeholders’ experiences implementing a navigation program for people living with dementia and their carers

Abstract Introduction Navigating dementia care is challenging, but patient navigation (PN) offers valuable support for this population. The ‘Navigating Dementia NB/Naviguer la démence NB’ program piloted a PN program in New Brunswick, Canada, targeting people living with dementia (PLWD) and their carers. The program aimed to assist participants in navigating health and social care systems, matching their needs with available services. Methods Navigating Dementia NB was co-developed by researchers, patient partners, and clinicians. This pilot program embedded six PNs in primary care clinics/centres across the province between July 2022 and July 2023. Using a mixed methods approach, participant surveys and interviews were used to explore program benefits and recommendations for improvement. Focus groups were used to explore facilitators and barriers to program development and implementation. Results There were 150 participants (PLWD and carer dyads) enrolled in the PN program who provided informed consent. Interviews were conducted with 36 PLWD and their carers. Focus groups were conducted with nine members of the research team and five patient navigators. Program benefits included: emotional support from navigators, provision of relevant information, and facilitating connections to appropriate services. Recommendations for improvement included: the need for PLWD and their carers to have access earlier in the patient journey and the need to reassess provincial policies related to home care support. Facilitators for implementing a PN program included: providing appropriate staff training and leveraging established connections within the health and social systems. Barriers included a compressed timeline and existing systemic issues to service access. Conclusions The findings suggest that embedding PN for PLWD in community based primary care can be done. The program was beneficial for PWLD and their caregivers/care partners. Future plans involve partnering with government to support the implementation and evaluation of a province-wide scale-up of the PN program for this population.

2671 A description of a patient navigator program for persons living with dementia in Canada

Abstract Introduction Receiving a dementia diagnosis can be overwhelming for persons living with dementia (PLWD) and their carers. Accessing information and home supports can be challenging. Having access to a Patient Navigation (PN) program is one way that may assist PLWD and their carers. Methods This study used a mixed methods design and involved the implementation of a Patient Navigation (PN) program in 6 primary care settings in New Brunswick, Canada, between July 2022–July 2023. PLWD/carers living in their own homes were eligible to enrol. Results There were 150 PLWD with a mean age of 76.4 (SD = 9.4) years and 51.4% were male. The majority (60.7%) were living in rural communities. Most (50.7%) had been diagnosed within the past 2 years with 50.7% having seen a specialist, most commonly a geriatrician. Almost all (88.7%) had a primary care provider; however, only 25.2% were connected to the social care system, and 19.8% were connected to the home care system. The most common reasons for enrolling were gaining access to social programs and home supports and seeking dementia specific information. The average number of goals per PLWD/carer was 3.79 (SD = 1.7). The average time in the program was 121.7 days (SD = 100.0) and 76.6% achieved their goals. The majority (84.0%) were somewhat to very satisfied with the PN program. Carers stated that with increased knowledge, access, and support there was a decrease in social isolation as well as improved confidence, which allowed PLWD to remain in the community longer. Conclusions Most PLWD/carers were connected to the health system, but the minority were connected to social and home care programs. Through connection to the PN program, carers increased their confidence; improved their knowledge; and increased their access to home supports and other care programs, allowing PLWD to remain in the community longer.

Doing ‘detective work’ to find a cancer: how are non-specific symptom pathways for cancer investigation organised, and what are the implications for safety and quality of care? A multisite qualitative approach

BackgroundOver the past two decades, the UK has actively developed policies to enhance early cancer diagnosis, particularly for individuals with non-specific cancer symptoms. Non-specific symptom (NSS) pathways were piloted and...

Screening for comprehensive social needs in patients with cancer: a narrative review.

Patients with cancer who report social needs have worse quality of life, lower healthcare access, and suboptimal health outcomes. However, screening for social needs does not happen systematically and successful screening tools, strategies, and workflows have seldom been described. The downstream effects of screening including resource navigation have also not been well characterized. This objective of this narrative review was to fill these gaps. Two investigators searched Pubmed and Embase for studies that implemented a patient-facing social screening tool among patients with cancer between 2008-2023 using search terms including "social screening," "social needs," and "cancer." We identified 19 articles that met study inclusion criteria. The most common tool used was the validated Health Leads Social Toolkit. Most often, screening tools were administered electronically, sent directly to patients, and captured needs at a single time point during a patient's diagnosis. Screening response rates ranged between 10-60%. Less than half of the studies described downstream resource navigation for patients who screened positive for social needs Only one study evaluated the impact of screening on clinical outcomes and quality of life. Screening for patients who do not speak English or who belong to historically racial, ethnic, and gender minority groups was limited. Screening for social needs has been shown to be feasible across delivery systems with numerous validated tools available. However, gaps remain in generalizability to diverse patient populations. Future work must identify how screening workflows can be successfully incorporated into routine clinical workflows.

An Ancillary Effect of Patient Navigation Following Detox: Fewer Arrests

Abstract Patient navigation (PN) is increasingly used to help people overcome barriers to accessing health care. In a recent trial, PN was added to motivational interviewing (MI) to help patients discharged from detoxification (detox) transition to follow-up care. The goal was to test whether PN in addition to MI increased transition rates and reduced subsequent readmissions into detox compared with MI alone. Results demonstrated little evidence of a treatment effect on either of these two outcomes, but post hoc exploratory analyses showed that patients who received PN were less likely to be arrested in the year following discharge than patients who did not receive PN. In addition, the group that received PN had fewer multiple arrests resulting in a lower average number of arrests per person. These findings are hypothesis-generating and need replication for conclusive inference. Nevertheless, economic analysis indicates that PN after detox could be a cost-beneficial intervention to reduce arrests among a population at high risk for involvement in the criminal justice system.

A Framework to Optimize Primary Care of Older Surgical Patients

An increasing number of older adults are undergoing surgery. Older adults face significant challenges throughout the spectrum of perioperative care. No frameworks exist to support primary care clinicians in helping older adults navigate perioperative care beyond preoperative medical clearance. We aimed to develop a framework to assist primary care clinicians in surgical care navigation for older patients. This qualitative study used semistructured interviews with a sample of geriatricians from across the US between January and June 2022. Interviews were conducted one on one via an online video conferencing platform without observers present. Demographics of participants were analyzed using descriptive statistics. Directed content analysis of interview data was used to examine how primary care clinicians can optimally support older patients throughout the perioperative process. This qualitative study included 24 geriatricians, 16 (67%) women, with median time in practice of 12.4 years (IQR, 5.0-24.5 years). Of those, 11 (46%) worked at an academic or tertiary referral center. Qualitative analysis identified 7 actions that geriatricians perform when caring for patients through the surgical continuum: conduct risk-benefit analysis of surgical referral, elicit and communicate patient goals, prepare patient and family for surgical consultation, set realistic expectations, assist with decision about surgery, advocate for patient and family, and coordinate postoperative care. In this qualitative study of geriatricians, 7 key domains of perioperative care for older adults were identified. The resulting framework can be used by primary care clinicians as they help their older patients navigate surgical care.

Understanding and Improving Pediatric Hearing Care Navigation: A Human-Centered Design Approach.

Explore the experiences of stakeholders within hearing care pathways using a human-centered design process to design a patient navigator (PN) to improve hearing health equity for deaf or hard-of-hearing children. A qualitative, prospective, observational study utilizing the Empathize, Define, and Ideate phases of Human-Centered Design. Academic tertiary children's hospital with interviews over Zoom. We interviewed 12 hearing care providers, diverse in role and education across the United States, and 10 parents of deaf or hard-of-hearing children, diverse in preferred language and delays in care (mean age at diagnosis of 4.7 months, mean age at intervention of 10.5 months). The main outcomes were themes and subsequent insights that arose from the thematic analysis of interviews, which were used within a design synthesis session. Qualitative analysis revealed 3 themes: Intrinsic Barriers, Extrinsic Barriers, and Areas of Opportunity. Within Intrinsic Barriers, a majority of providers and parents described a grieving process that led to delays. Within Extrinsic Barriers, interviewees expressed challenges navigating multiple deaf or hard-of-hearing care pathways. Within Areas of Opportunity, providers and parents agreed on connecting parents of new hearing loss diagnoses with mentor families to improve the care-seeking experience. Intercoder reliability was achieved (Cohen's κ = 0.73). Findings from the qualitative analysis were incorporated in a synthesis session with diverse stakeholders to design a PN role. Providers and parents agree that the deaf or hard-of-hearing care pathway is difficult to navigate at baseline with delays in accessing care further exacerbated by barriers intrinsic to the family unit.

Evaluating the implementation and impact of a volunteer navigation oncology support programme: study protocol for a pragmatic, real-world hybrid type 2 study

IntroductionPatient navigation is recommended by accrediting bodies such as the Commission on Cancer and is a key element in payment reform demonstration projects, due to the established benefits in reducing...

A Proposed mHealth Intervention to Address Patient Barriers to Colposcopy Attendance: Qualitative Interview Study of Clinic Staff and Patient Perspectives.

Cervical cancer disparities persist among minoritized women due to infrequent screening and poor follow-up. Structural and psychosocial barriers to following up with colposcopy are problematic for minoritized women. Evidence-based interventions using patient navigation and tailored telephone counseling, including the Tailored Communication for Cervical Cancer Risk (TC3), have modestly improved colposcopy attendance. However, the efficacious TC3 intervention is human resource-intense and could have greater reach if adapted for mobile health, which increases convenience and access to health information. This study aimed to describe feedback from clinic staff members involved in colposcopy processes and patients referred for colposcopy regarding adaptions to the TC3 phone-based intervention to text messaging, which addresses barriers among those referred for colposcopy after abnormal screening results. Semistructured depth qualitative interviews were conducted over Zoom [Zoom Communications, Inc] or telephone with a purposive sample of 22 clinic staff members (including clinicians and support staff members) and 34 patients referred for colposcopy from 3 academic obstetrics and gynecology (OB-GYN) clinics that serve predominantly low-income, minoritized patients in different urban locations in New Jersey and Pennsylvania. Participants were asked about colposcopy attendance barriers and perspectives on a proposed text message intervention to provide tailored education and support in the time between abnormal cervical screening and colposcopy. The analytic team discussed interviews, wrote summaries, and consensus-coded transcripts, analyzing output for emergent findings and crystallizing themes. Clinic staff members and patients had mixed feelings about a text-only intervention. They overwhelmingly perceived a need to provide patients with appointment reminders and information about abnormal cervical screening results and colposcopy purpose and procedure. Both groups also thought messages emphasizing that human papillomavirus is common and cervical cancer can be prevented with follow-up could enhance attendance. However, some had concerns about the privacy of text messages and text fatigue. Both groups thought that talking to clinic staff members was needed in certain instances; they proposed connecting patients experiencing complex psychosocial or structural barriers to staff members for additional information, psychological support, and help with scheduling around work and finding childcare and transportation solutions. They also identified inadequate scheduling and reminder systems as barriers. From this feedback, we revised our text message content and intervention design, adding a health coaching component to support patients with complex barriers and concerns. Clinic staff members and patient perspectives are critical for designing appropriate and relevant interventions. These groups conveyed that text message-only interventions may be useful for patients with lesser barriers who may benefit from reminders, basic educational information, and scheduling support. However, multimodal interventions may be necessary for patients with complex barriers to colposcopy attendance, which we intend to evaluate in a subsequent trial.

Economic Impact of the Apoyo con Cariño Intervention: Improving Palliative Care for Hispanics with Serious Illness.

Context: Specialty palliative care has been associated with cost savings at the end of life, while patient navigators have been independently associated with cost savings due to screening and treatment early in the course of disease. Evidence is limited regarding patient navigators and cost savings at the end of life. Objectives: To determine the cost-effectiveness of a lay patient navigator intervention in improving palliative care outcomes for Hispanic persons with serious noncancer illness. Methods: Total health care expenditures in the last 30, 90, and 180 days of life were compared for a randomized sample of 56 Hispanic persons. Expenditures included all inpatient, outpatient, and pharmaceutical claims. Results: Overall spending in the final 180, 90, and 30 days of life was $76,008, $34,731, and $16,613. Spending was lower (p = 0.05) in the last 30 days of life for individuals who died in hospice ($9,403) than those who did not ($19,032), and persons in the intervention had a significantly (p = 0.03) higher probability of dying in hospice (63%) versus those in the control group (37%). Conclusion: Study results support the use of a culturally tailored lay patient navigator intervention to improve palliative care outcomes. The results suggest a potential return on investment for culturally appropriate lay patient navigator interventions of 4:1.

Analysis of Urban Indian Organizations' Promotion of Cancer Services.

The burden of cancer remains elevated for American Indian/Alaska Natives (AI/AN) in the United States, particularly urban communities. Urban Indian Organizations (UIOs) are part of the Indian health care system for urban AI/AN populations to receive culturally competent care; therefore, it is important that UIOs convey the importance of cancer preventive and treatment options through their websites. The purpose of this study was to utilize the Indian Health Service (IHS) Office of Urban Indian Health Programs' official website to identify, analyze, and describe IHS funded UIOs offering cancer-related services. We utilized qualitative content analysis on UIOs with primary care service capabilities. After determination of UIOs, each eligible website was reviewed to determine if promotion of specific cancer related services was being done based on the following categories: primary prevention, cancer screening, cancer support, and information/technology services that focus on the social determinants of health. There is limited, vague, or outdated information on UIO websites regarding the type of cancer-related services and programs provided. We found that while twenty-one of thirty-four UIOs list any mention of cancer screenings, few mentioned specific testing capabilities for various cancers. In addition, the listing of support and preventative services was also limited with less than half of UIOs reporting on patient navigation services, among others. There is untapped potential in the utilization of websites for extending the impact of UIOs and their work with urban AI/AN populations in prevention, screening, and support of cancer patients in a culturally appropriate manner that can improve outcomes.

Bridging the Gap: Interventions to Increase Cancer Screening Adherence in Individuals with Mental Disorders-A Systematic Review.

Patients with mental illnesses adhere to organized cancer screening programs less frequently than the general population. This systematic review aims to examine the literature to identify studies that evaluate interventions designed to increase cancer screening adherence in people with mental disorders. The review protocol was registered (CRD42024510431) and Pubmed and Scopus were searched up to January 2024. Breast, colorectal, or cervical cancer screening were considered. We adhered to the PROSPERO guidelines. Study quality was assessed. Overall, six articles were included: two RCT studies, two before-after studies, and two cohort studies. Four interventions were conducted in the USA, one in Canada, and one in Japan. Two studies evaluated all three cancer screening programs, two studies evaluated breast cancer screenings, and two studies evaluated colorectal cancer screenings. The proposed interventions included patient navigation, case management, and support from staff members along with educational modules, decision counselling sessions, and enhanced primary care. The most consistent improvements in screening adherence were observed in breast and colorectal cancer screenings compared to usual care, particularly through interventions like patient navigation (colorectal cancer: 47.1% vs. 11.8%, p < 0.001) and case management. Further evaluations of interventions and their costs are still needed.

Diabetes Management Using a Patient Navigator in a Native Hawaiian Population: Experiences and Perceptions of the Kilolani Project.

Native Hawaiians (NHs) are a historically oppressed population disproportionately burdened by diabetes and related complications. The Kilolani Project, a patient navigator-centered, chronic disease management program, targets upstream drivers of health among vulnerable NH adult patients with diabetes within an urban academic safety-net clinic. To investigate the impact of the Kilolani Project, we performed a qualitative study to examine patient perspectives. Our goal is to ensure that their values, needs, and priorities drive future navigator-based strategies and healthcare delivery. Fifteen current Kilolani Project patients participated in one of three focus group sessions. Each session followed a semi-structured format with open-ended questions regarding their experiences with the Kilolani Project, patient navigators, and healthcare in general. Iterative transcript readings and coding revealed seven core themes: (1) Humanistic approach, (2) Trusting relationships, (3) Improved access, (4) Trauma-informed care, (5) Self-efficacy, (6) Resilience, and (7) Ethnic concordance. The Kilolani Project created a safe and culturally relevant experience for NH patients. They felt seen, heard, and valued, which resulted in an improved healthcare experience, engagement, and empowerment. Importantly, trust was the cornerstone to building a provider-patient relationship. Such culturally informed approaches are necessary to close the gap in health disparities faced by our NH communities.