Navigation Program Research Articles

Patient engagement in the development and implementation of navigation services: a scoping review protocol

IntroductionPatient navigation, a complex health intervention meant to address widespread fragmentation across the healthcare landscape, has been widely adopted internationally. This rapid uptake in patient navigation has led to a...

Impact of Patient Demographics on Student-Led Patient Navigation Outcomes: A Study of a South Florida Medical School's Patient Navigation Program.

Medical student-run patient navigation (PN) programs enhance healthcare access in underserved communities. This study examines the relationship between patient demographics and PN outcomes in a student-led PN program. Patients with moderate or high-risk health concerns were paired with medical students at health fairs. Statistical analysis evaluates program success and demographic influences. Of 444 patients, 66.4% were female, 47.1% Hispanic White, 49.1% spoke English, and 63.7% earned <300% of the federal poverty level. More than half were uninsured and 52.5% achieved navigation goals. Insurance status and risk level significantly predicted PN outcomes, with "other insurance" and high-risk patients being 1.9 and 1.7 times more likely to complete navigation. The program achieved high completion rates, emphasizing the need for resources such as translators and financial assistance. Risk stratification successfully linked acute cases to resources. Navigation success was consistent, demonstrating the effectiveness of the program across diverse patient groups.

Impact of a first-year medical student patient navigation initiative on healthcare access and students' skills

Background: Medical schools with complex patient populations, characterized by linguistic diversity and uncertain immigration status, face challenges in imparting essential skills in patient care, particularly in understanding healthcare barriers, building rapport, and fostering empathy. A South Florida medical school with a predominantly non-English-speaking and undocumented patient population piloted a Patient Navigation (PN) program within the first-year curriculum to address these challenges. We present the student feedback from the program’s first two years to guide medical schools in simultaneously caring for this unique patient population, with the aim of enhancing medical education. Methods: This program diverged from traditional Patient Navigation approaches by leveraging specialized hospital-associated translation services and collaborating with the Health System's Financial Assistance program. We performed a crosssectional study on student feedback surveys to identify program features significantly associated with a satisfying PN experience, and to provide insights to optimize and refine the program for future implementations. Results: The program engaged 245 out of 306 first-year medical students in PN for 118 patients. Successful contact was established with 55% of patients and 70% achieved their navigation objectives. Satisfaction metrics revealed that students given patients were nearly five times more satisfied than their counterparts. This positively impacts both student experience and patient outcomes, showcasing the program's effectiveness in bridging healthcare disparities. Discussion: The PN program proved successful in linking low-risk patients to follow-up care, offering medical students first-hand exposure to the challenges of care for primarily non-English-speaking and undocumented populations. The initiative aimed to enhance healthcare access for marginalized patients while providing medical students with an immersive understanding of patient-centric care beyond conventional curricular offerings. Key lessons learned include improving communication channels between students and patients, and optimizing community resources for streamlined patient support. Future iterations will prioritize these lessons, emphasizing cultural competence and patient advocacy to enhance both student education and patient care outcomes.

Navigation needs in peritoneal surface malignancy as perceived by patients, caregivers and providers

BackgroundOncology navigation programs offer information and assistance to patients diagnosed with cancer and have evolved significantly along disease-specific care pathways. However, there is limited information on how to prioritize navigation services to meet the unique and complex needs of patients with peritoneal surface malignancies (PSMs). To define the navigation needs of PSM patients, we conducted a survey-based study to quantify the relative importance of various cancer-related stressors as perceived by patients, caregivers, and providers. MethodsA questionnaire was administered to PSM patients or caregivers and providers involved in the care of PSM patients, and the assessed measures of disease or treatment-related stress were compared among subgroups consisting of patients and caregivers vs. providers. ResultsOf the 72 PSM patients and caregivers surveyed, 93.1 % identified stressors related to receiving treatment to be somewhat or extremely challenging. Relative to patients/caregivers, providers tended to significantly over-prioritize the navigation domains of family care, transportation, long-distance travel, financial, insurance, work-related, and legal stress. Our survey data illustrates gaps between the experience of stressors among PSM patients/caregivers and the perceptions of providers. ConclusionsPSM programs should align resources with the navigation needs as experienced by patients and caregivers, while recognizing that providers tend to emphasize logistical considerations over cancer-related emotional distress. PSM-specific navigation pathways could improve the experience and satisfaction level of patients undergoing treatment for this complex condition. SynopsisThe authors report results of a survey provided to peritoneal surface malignancy patients, caregivers and providers. This analysis illustrates gaps between how patients and caregivers experience navigation needs and how providers perceive those needs.

Enhancing Patient Outcomes Through Integrated Education and Navigation Programs at the Breast Cancer Comprehensive Center, National Cancer Institute, Cairo University.

Breast cancer remains a significant global health challenge, particularly in low- and middle-income countries where disparities in healthcare exacerbate the disease burden. The Breast Cancer Comprehensive Center at the National Cancer Institute, Cairo University, has implemented integrated patient navigation and education programs aimed at enhancing patient outcomes and healthcare quality.This study evaluated the effectiveness of these programs involving 2202 participants over 12 months. The methodology included systematic data collection, material preparation, and the application of tailored educational strategies to facilitate the patient's journey from diagnosis to treatment. The study utilized three-phased patient navigation assistance to provide comprehensive support.The programs significantly improved patient satisfaction, with over 90% of participants reporting high levels of contentment with the services received. Key improvements included enhanced understanding of breast cancer (including risk factors, symptoms, importance of seeking early care, and treatment options), reduction in patient anxiety, improved treatment adherence, and streamlined diagnostic and treatment processes. Notably, the use of audio-visual educational tools effectively bridged the literacy gap among patients.The integration of patient navigation and education systems at BCCC-NCI has proven to be a highly effective model for improving breast cancer care. This model not only enhances patient understanding and treatment compliance but also facilitates a more efficient healthcare process. The study underscores the potential for replicating this approach in similar healthcare settings globally, suggesting that such integrations can significantly improve cancer care outcomes.

S61 - Racial/Ethnic Differences in Treatment-Related Barriers and Facilitators Among Patients Initiating Medication for Opioid Use Disorder (MOUD) as Part of Comprehensive Patient Navigation Programs

S61 - Racial/Ethnic Differences in Treatment-Related Barriers and Facilitators Among Patients Initiating Medication for Opioid Use Disorder (MOUD) as Part of Comprehensive Patient Navigation Programs

Framing Access

Abstract To explore the expanding role of libraries in providing internet access and promoting digital literacy, this article examines ten libraries in one state that developed Digital Navigator programs. Representing a mix of small and rural as well as metropolitan and large libraries, the libraries’ efforts offer a different philosophy in dealing with digital divide factors. This research investigates how libraries launched Digital Navigator programs, the processes behind developing them, and how they reflect notions of information access. This investigation analyzes the circumstances and controversies more broadly, which can shape digital information strategies in public libraries.

S63 - Effects of a Comprehensive Patient Navigation Program on High-Cost Healthcare Utilization Among Patients Enrolled in Project HOUDINI LINK (Hospital Opioid Use Disorder treatment INItiation and LINKage to Care)

S63 - Effects of a Comprehensive Patient Navigation Program on High-Cost Healthcare Utilization Among Patients Enrolled in Project HOUDINI LINK (Hospital Opioid Use Disorder treatment INItiation and LINKage to Care)

Care Navigation and Coordination Program on Reducing Hospital Use for Adults with Complex Health and Psychosocial Needs in South West Sydney, Australia.

Complex and siloed health and social service systems can be difficult for people to navigate. The fragmented and poorly linked services leads to ineffective communication between care teams, delayed access to services, concerns regarding quality and safety of patient care, as well as patient frustration and disengagement. Planned Care for Better Health (PCBH) is a community-based care navigation and coordination program for people with complex health and psychosocial needs who are at risk of future hospitalisation. It focuses on early identification and holistic care to remove barriers and improve access to healthcare. By including a persons', family and carers in planning, listening to their needs, supporting the person to achieve their goals, and empowering them to make decisions on their own health, PCBH aims to enhance clients' healthcare experience and reduce preventable hospital utilisation. Building trusting and collaborative relationships with clients, families, carers, and health service providers requires commitment. Acknowledging and addressing psychosocial needs is critical for enhancing health outcomes. Equipping patients with self-management skills and knowledge to navigate and engage support services may generate lasting effects, even post-program enrolment. PCBH is associated with a notable reduction in unplanned hospitalisations and total bed days. However, reduction in ED presentations is similar between the intervention and comparison cohorts. Future initiatives should focus on a shared vision of integrated care, robust leadership, and participative co-creation with service-level stakeholders. Sustained program establishment, a multidisciplinary care coordinator team, and an early creation of robust evaluation strategy must be considered.

The randomized controlled trial (NAVKIDS2) of a patient navigator program created for children with chronic kidney disease

Patient navigators enable adult patients to circumnavigate complex health systems, improving access to health care and outcomes. Here, we aimed to evaluate the effects of a patient navigation program in children with chronic kidney disease (CKD). In this multi-center, randomized controlled trial, we randomly assigned children (aged 0-16 years) with CKD stages 1-5 (including children on dialysis or with kidney transplants), from low socioeconomic status backgrounds, and/or residing in remote areas, to receive patient navigation at randomization (immediate) or at six months (waitlist). The primary outcome was self-rated health (SRH) of participating children at six months, using intention to treat analysis. Secondary outcomes included caregivers’ SRH and satisfaction with health care, children’s quality of life, hospitalizations, and missed school days. Repeated measures of the primary outcome from baseline to six months were analyzed using cumulative logit mixed effects models. Semi-structured interviews were thematically evaluated. Of 398 screened children, 162 were randomized (80 immediate and 82 waitlist); mean age (standard deviation) of 8.8 (4.8) years with 64.8% male. SRH was not significantly different between the immediate and wait-listed groups at six months. There were also no differences across all secondary outcomes between the two groups. Caregivers’ perspectives were reflected in seven themes: easing mental strain, facilitating care coordination, strengthening capacity to provide care, reinforcing care collaborations, alleviating family tensions, inability to build rapport and unnecessary support. Thus, in children with CKD, self-rated health may not improve in response to a navigator program, but caregivers gained skills related to providing and accessing care.

Impact of Socioeconomic Status on Patient Adherence in Managing Renal Masses.

Previous literature suggests socioeconomic status and racial disparities impact management decisions for patients with small renal masses. We aim to build upon these findings and examine how these modalities impact patient adherence to their management plan. This retrospective study analyzed our Kidney Tumor Program database (n = 1476) containing patients from 2000 to 2020. Socioeconomic status was estimated using 2 modalities: Area Deprivation Index and household income. Patients were then evaluated for differences in adherence, nonadherence, and loss to follow-up. Adherent patients completed all recommended appointments within 6 months of their initial follow-up. Nonadherent patients did not complete all recommended appointments within 6 months of their originally scheduled follow-up but eventually did. Patients lost to follow-up were recommended to follow up but never did. Patient adherence was not significantly different across sex or primary treatment method but differed with respect to race/ethnicity. Black patients were significantly more likely to be nonadherent (P = .021) and lost to follow-up (P = .008). After adjusting for race/ethnicity, Area Deprivation Index and income bracket were significantly associated with adherence and loss to follow-up. Patients with a high socioeconomic status had significantly higher rates of adherence (ADI, quartile [Q] 1 vs Q4, P = .038; income, >$120,000 vs $30,000-$59,999, P < .003) and decreased loss to follow-up (ADI, Q1 vs Q4, P = .03; income, >$120,000 vs $30,000-$59,999, P = .002). Our results demonstrate that Black race and low socioeconomic status are associated with decreased adherence and increased loss to follow-up. Possible strategies to target these disparities include financial assistance programming, social determinants of health screening, and nurse navigator programs.

Adaptations to a patient navigation program for follow-up colonoscopy in rural primary care practices.

Patient navigation is a recommended practice to improve cancer screenings among underserved populations including those residing in rural areas with care access barriers. We report on patient navigation programme adaptations to increase follow-up colonoscopy rates after abnormal fecal testing in rural primary care practices. Participating clinics delivered a patient navigation programme to eligible patients from 28 affiliated clinics serving rural communities in Oregon clustered within 3 Medicaid health plans. Patient navigation adaptations were tracked using data sources including patient navigation training programme reflections, qualitative interviews, clinic meetings, and periodic reflections with practice facilitators. Initial, planned (proactive) adaptations were made to address the rural context; later, unplanned (reactive) adaptations were implemented to address the impact of the COVID-19 global pandemic. Initial planned adaptations to the patient navigation programme were made before the main trial to address the needs of the rural context, including provider shortages and geographic dispersion limiting both patient access to care and training opportunities for providers. Later unplanned adaptations were made primarily in response to COVID-19 care suspension and staff redeployments and shortages that occurred during implementation. While unplanned adaptations were implemented to address the contextual impact of the COVID-19 pandemic on care access patterns and staffing, the changes to training content and context were beneficial to the rural setting overall and should be sustained. Our findings can guide future efforts to optimise the success of such programmes in other rural settings and highlight the important role of adaptations in implementation projects.

A system-wide approach to digital equity: the Digital Access Coordinator program in primary care.

The transition to digital tools prompted by the pandemic made evident digital disparities. To address digital literacy gaps, we implemented a system-wide digital navigation program. The Digital Access Coordinator (DAC) program consists of 12 multilingual navigators who support patients in enrolling and using the patient portal and digital tools. We implemented the program in our primary care network which consists of 1.25 million patients across 1211 clinicians. From May 2021 to November 2022, the DACs completed outreach to 16045 patients. Of the 13413 patients they reached, they successfully enrolled 8193 (61%) patients in the patient portal. Of those patients they enrolled, most patients were of Other race, Hispanic ethnicity, and were English-speaking (44%) and Spanish-speaking patients (44%). Using our embedded model, we increased enrollment across 7 clinics (mean increase: 21.3%, standard deviation: 9.2%). Additionally, we identified key approaches for implementing a digital navigation program. Organizations can support patient portal enrollment, a key part of digital health equity, by creating and prioritizing digital navigation programs.

Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care

BackgroundBlack individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale.MethodsWe are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions.DiscussionPrimary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities.Trial registrationNCT06401174

Caregivers and legal barriers: Navigating care of a family member diagnosed with cancer.

11034 Background: Caregivers of patients with cancer are vital for coordinating care, but the extent to which they encounter social and legal barriers is unknown.We performed a nationwide analysis of a legal navigation program to assess caregiver utilization of services. Methods: This is a retrospective analysis of caregivers who used the Triage Cancer Legal &amp; Financial Navigation Program for legal navigation services on behalf of a family member with cancer or for questions regarding caregiver responsibilities. Triage Cancer is a national nonprofit that provides free education on legal and practical issues impacting patients with cancer. We gathered demographic, financial, disease-site, and legal navigation data and implemented Poisson regression models to explore factors associated with each type of primary legal concern that prompted a call for assistance. Results: We examined calls from 553 caregivers between 2021-23 for family members with cancer who were 54% male, 44% aged 40-64y, 51% White, 26% employed, 32% on employer-sponsored insurance, and 42% with income &lt;$50k. Most prevalent cancer types were hematologic (23%), CNS (14%), GI (10%), and breast (9%). A majority of caregivers sought assistance with 1 (51%) or 2 (35%) legal barriers. Most common primary issue was health insurance (34% - including issues related to insurance options, navigation, appeals), followed by financial (22% - financial assistance, housing), disability (15% - insurance applications, claim appeals), other (18% - estate planning, wills, advanced directives; life insurance; family law; education; COVID), and employment (10% - time off, working through treatment, returning to work, job loss, job search, unemployment benefits). Compared to reference groups, caregivers of Black patients (RR 2.2) were more likely to call for financial barriers, patients aged 40-64y (RR 3.4) for disability insurance, uninsured individuals (RR 5.6) for health insurance, and those with income between $50-100k (RR 3.1) or patient age 0-39 (RR 5.2) for employment-related difficulties. Conclusions: This study highlights the social and legal navigation undertaken by caregivers of patients with cancer. It underscores an urgent need for accessible legal navigation that considers the caregiver alongside the patient as one family unit undergoing care. [Table: see text]

Patient navigation as an effective way to increase breast, cervical, and colorectal cancer screening among immigrants in the US: A systematic review.

e22501 Background: Immigrants undergo recommended cervical, breast, and colorectal cancer screening at a lower frequency than U.S.-born patients and face unique language, educational, and cultural barriers. The delay or lack of screening has known implications in the presentation of breast, cervical, and colorectal malignancies, including worse staging at diagnosis. To address the disparity in cancer screening that immigrants experience, various interventions have been studied, including patient navigation (PN) programs. This systematic review aims to determine whether PN increases cervical, breast, and colorectal cancer screening in immigrant populations. Methods: A systematic literature search was conducted using PubMed, Scopus, and Web of Science to identify English-language articles published from January 2000 to November 2023 examining the role of patient navigators in encouraging routine breast, colorectal, and cervical cancer screening among immigrant populations in the United States. For the articles that met the inclusion criteria, details of patient navigation programs and uptake or change in cancer screening behaviors were extracted. Results: We screened 2196 articles, 53 of which met criteria for review, and 18 articles were ultimately included in the analysis. PN programs increased breast, cervical, or colorectal screening within immigrant populations compared to the control or alternative intervention in all 18 studies. In 7 out of 18 (38.9%) studies, the PN intervention group achieved screening rates similar to or above Non-Hispanic White national average screening rates. Two of those studies occurred in the outpatient setting, which resulted in higher screening rates than community-based settings. Two of those 7 studies that matched the Non-Hispanic White screening rates also had a longer duration of over 4 years. The majority of PN programs included educational sessions or materials and screening appointment scheduling assistance delivered from members of the same cultural group. Other services included identification and assistance with overcoming barriers, insurance assistance, reminders, transportation, and accompaniment to screening appointments. Of the 18 studies included, rural areas were underrepresented, and the training of patient navigators was not always described. Conclusions: Our review suggests that PN programs are effective at increasing cancer screening rates among immigrant populations, and certain aspects of PN programs, including outpatient settings and longer navigation duration, may help to further increase screening rates.

Effect of a comprehensive cancer care pathway and a navigation cancer program on breast cancer care in a middle-income country.

e13536 Background: Breast cancer (BC) is the most common cancer in women globally and in Colombia, with around 16.000 new cases estimated in 2022. Mortality associated with BC has decreased for 2 main reasons: screening that leads to early diagnosis and improved treatment of BC. However, BC related mortality remains stable in Colombia, with a 5-year overall survival of 74%, lower than other countries on the continent. This difference could be explained, among other things, by delays, barriers, and fragmentation of cancer care. Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC) is an institution designed for comprehensive cancer care, with specialized patient care through cancer clinics dedicated to a single disease (breast cancer, lung cancer, etc.). Every cancer clinic is associated with a cancer navigation program and has clinical care pathways with metrics that seek to monitor and reduce the time to diagnosis and treatment, among others. This study aims to describe the results of the comprehensive breast cancer care program and cancer navigation support in time to breast cancer diagnosis and treatment access. Methods: This descriptive study was carried out by retrospective reviewing of the navigation database from the breast cancer unit of the CTIC, sociodemographic information, clinical characteristics, and time to diagnosis (from first appointment to pathology report) and treatment were collected and described. A comparison between patients with comprehensive and fragmented care was done. Results: Since August 2022, 600 patients with confirmed breast cancer have been evaluated by the BC clinic, 401 (66.8%) patients were admitted through the cancer navigation program, 436 (72.6%) cases presented with a previously established diagnosis of breast cancer, and 164 (27.3%) were the novo cases. Of the novo cases, 37 (23.3%) cases received comprehensive care from diagnosis, with a time to diagnosis of 14 days, and time to treatment of 30.5 days, patients who did not receive comprehensive care presented a time to treatment of 68.1 days. Conclusions: A comprehensive cancer care and support from a navigation program significantly reduce the time to treatment in breast cancer patients. A comprehensive care model in Colombia has the opportunity to generate a better opportunity for access to diagnosis (14 days) and treatment (30.5 days) compared to the time to treatment data reported in the high-cost account (CAC) (27 and 52 days respectively). [Table: see text]

Molecular and genomic testing in Native American patients with metastatic lung and colorectal cancers: A retrospective chart review.

e23136 Background: The Native American (NA) population has the poorest cancer survival of all racial groups in the U.S. A long history of research misconduct has caused many tribal communities to hold unfavorable views toward genomic data collection. Routine molecular and genomic testing is standard of care for most metastatic lung and colorectal cancers but the frequency of such testing in NA patients is unknown. Many NA patients have limited financial resources and must rely on coverage for health care from an Indian Health Service, Tribal Health Service, or Urban Indian Health (ITU) program. However, ITU programs do not operate their own cancer treatment services and must refer their patients elsewhere for such care. Methods: A Native American Navigation program (NANP) was established at the Stephenson Cancer Center (SCC) in Oklahoma to promote cancer health equity and provide high-quality cancer care by facilitating access to care for ITU patients from across the state. The NANP interfaces with ITU programs to obtain approvals for care as well as to coordinate clinical and supportive services, such as transportation or food assistance. We conducted a retrospective chart review of patients referred from an ITU program to the SCC NANP in Oklahoma from 1/2014 to 6/2023. Among patients with metastatic colorectal cancer (CRC), we investigated the frequency of testing for KRAS, NRAS, BRAF as well as MSS/MSI. In patients with metastatic non-small cell lung cancer (NSCLC), we identified the frequency of EGFR, ALK, ROS1, and PD-L1 testing. Results: A total of 305 NA patients were referred to SCC for colorectal and lung cancers. Of these, 68 patients had metastatic disease and qualified for molecular and genomic testing per National Comprehensive Cancer Network guidelines. The mean age of our cohort was 63 with a male-to-female ratio of 1.6:1. Most (85.3%) patients eligible for testing had testing for at least one biomarker. In patients with metastatic CRC, 100% received MSS/MSI as well as KRAS testing and the frequency of NRAS and BRAF testing was 69.6% and 84.8% respectively. In patients with metastatic NSCLC, the frequency of EGFR, ALK, and ROS1 testing was 95.8%, 87.5%, and 79.1%, with PD-L1 testing frequency being 83.3%. Conclusions: The overall frequency of molecular and genomic testing in these navigated NA patients (85.3%) was comparable to the range reported in the general population (66-90%). By facilitating access to cancer care, programs such as the NANP may help NA patients receive appropriate testing to guide treatment. Larger studies are needed to further assess the role of navigation programs in reducing cancer disparities by facilitating access to appropriate molecular and genomic testing for NA patients with metastatic cancers.

Enhancing the patient journey to clinical trial enrollment with navigation to optimize accrual: A pilot study for a pragmatic multicentre, stepped wedge, cluster randomized controlled trial (The CTN Pilot Trial).

11093 Background: Clinical trials are essential to the advancement of clinical therapies, yet accrual rates remain disappointing. Multiple challenges lead to less than 5% of cancer patients enrolled onto clinical trials. The Clinical Trials Navigator (CTN) program was established to assist patients and health care professionals identify appropriate clinical trials for patients. Methods: Between March 2019 to January 2024, a novel navigator-assisted clinical trials search program was offered to Canadian patients. Three non-medical navigators were trained to receive referrals, review medical information, and search five different clinical trial search engines. Eligibility criteria was scrutinized. A second review of the clinical trial list was conducted by two physicians. The final curated list of clinical trials was provided to patients and their oncologist. Results: A total of 373 patients were referred to the CTN program during the study period. A unique clinical trial search was performed for each patient yielding a median of only one potentially eligible trial per patient. Clinical trial enrolment occurred in 3.2% of patients in our database which translates to a 19% rate of successful enrolment of those referred to a trial by the CTN. Most patients (78%) were referred to clinical trial sites that conducted more than 100 clinical trials at any time. Compared to the Canadian cancer statistics, lung, lymphoma, pancreatic and brain cancers were overrepresented in referrals to the CTN program while prostate cancer was underrepresented. Type of cancer played a significant role in the likelihood of a successful referral (p &lt; 0.01). Lung cancer was the most frequently reported cancer that resulted in referrals and breast cancer showed a lower frequency of referrals. The cancer type, stage and number of lines of prior therapy were not significantly associated with the patient enrollment onto a clinical trial. An increase in survival of referred patients from last analysis from 3.0 months to 5.3 months. Conclusions: The CTN program is a successful tool to identify clinical trials for cancer patients and can improve clinical trial accrual, as almost one fifth of patients (19%) who were referred to a clinical trial were enrolled. Ongoing iterative changes to the program to improve these metrics are underway and efforts to improve implementation of the CTN program across Canada are ongoing.

Integration of patient navigation into clinical operations of an outpatient cancer center.

e23091 Background: Recognizing the critical importance of expanding access to high-quality, integrated cancer care, Dana-Farber Cancer Institute’s (DFCI) Cancer Care Equity Program developed a multi-year plan to integrate a centralized, systems-based patient navigation (PN) program focused on supporting adult medical oncology patients from historically marginalized groups. The goal was to proactively address patients’ socio-economic, emotional, and structural barriers to attending medical appointments and adhering to cancer treatment plans through care coordination, physical accompaniment, and resource provision. Methods: Inclusion of the new program in DFCI’s operating goals supported prioritization of the work across the cancer center. A multidisciplinary workgroup developed standard operating procedures grounded in evidence-based approaches while leveraging existing clinical operations. The Freeman Navigation Model informed PN scope of work with a focus on historically marginalized communities. DFCI’s Community Health Needs Assessment guided the decision to prioritize patients from zip codes with significant disparities related to social determinants of health. Utilization of electronic health records for PN documentation ensured effective communication with care teams and enabled accurate and consistent data collection and reporting. Alignment of the program’s measurement strategy with national PN metrics and development of a data dashboard allowed for ongoing monitoring and evaluation. Results: The program was implemented sequentially in five cancer treatment centers: gastrointestinal, breast, thoracic, and gynecologic oncology as well as hematologic malignancies. 517 patients were contacted and 1,736 barriers to cancer care were addressed at time of analysis. Preliminary findings from the first cancer treatment center suggest a decreased no show rate in the second year of the program. Conclusions: The multidisciplinary approach to integrating an evidence-based PN program into clinical operations supported general adoption among care teams and timely replication across cancer types. The infrastructure developed for the program could potentially support implementation of Centers for Medicare and Medicaid Services reimbursement for PN services. Next steps include confirming preliminary findings in a larger sample, conducting a cost-benefit analysis, and expanding the program across the clinical enterprise. [Table: see text]