Navigation Services Research Articles

Partnering with People with Lived/Living Experience of Mental Health and substance Use in Participatory Evaluation of an integrated virtual navigation support service for people experiencing substance use challenges.

Introduction/Background: This presentation shares how the Mid-West Toronto-Ontario Health Team (MWT-OHT) in Toronto, Canada involved patients and partners in the design, implementation, and evaluation of the “In Your Corner Program” to support people with substance use challenges. The experience of embedding the voices of people with living/lived experience in co-designing and evaluating the program will be shared.
 Who is it for? The “In Your Corner” program represents the actualization of key recommendations from people with lived/living experience with substance use challenges in MWT-OHT that identified a need for service navigation supports that helps to close transition gaps. The ‘In Your Corner’ program necessitated the MWT-OHT to take a collaborative, team, and consensus-based approach to coordinating services across the region, re-designing care pathways that better meet the needs of a dynamic and diverse population within the constraints of existing resources and structures.
 Who did you involve & engage with? The MWT-OHT brings together partners across health and social sectors in the mid-west downtown region of Toronto Canada to work together for better, more integrated care. In 2019, MWT-OHT completed co-design work with people with living/lived experiences of substance use and mental health focused on improving the care experience and outcomes for people with challenges related to substance use. The In Your Corner program was implemented in 2021 through a 5-month implementation funding and extended for an additional 4 months through in-kind support from implementation partners. During this time, a participatory evaluation approach was employed with partners as well as clients and providers of the program to inform next steps, scale, and sustainability.
 What results did you get? What impact did you have? Initial implementation findings of the program demonstrated that the model of care capitalizes on existing programs and was able to create a more robust scaffolding for integrated care for the clients served by the program. The opportunity to embed Peer support workers into the model was highlighted along with the need for follow-up supports over a longer period. The program was a first step toward working together with people with living and lived experiences from design to evaluation from a partnered approach that is hoped to be embedded in how the MWT-OHT approaches all initiatives.
 What is the learning for the international audience? The learnings from this program demonstrates the processes and supports needed to meaningfully embed the voices of patients and providers from design phase through implementation, evaluation, and scale at various points in the journey from a systems perspective. Considerations for scale are important, as well as minimizing and preventing tokenism and supporting true partnering.
 What are the next steps? Next steps identified from the co-design evaluation sessions with clients and providers of the In Your Corner Program have informed how to leverage, change, and scale the program to reach more people in the region with substance use challenges. More importantly, this process has become a blueprint for the MWT-OHT in how to embed the voices of patients, families, and caregivers in the designing and evaluating initiatives.

“Now I am calm because they guide you:” A mixed-method exploratory study of the service needs and experiences of Latine kinship caregivers in Washington State

Although kinship care is a mainstay across many Latine cultures, few studies have examined the experiences of Latine kinship caregivers, a group of caregivers who may be subject to a unique combination of stressors including language barriers, immigration, and racism. Using a sample of 736 kinship caregivers (Mage = 58.9, 89.8 % women) who participated in a statewide survey of kinship caregiver needs and navigator services in Washington State, this mixed method, exploratory study compares the challenges and unmet needs of Latine (n = 60) and non-Latine (n = 676) kinship caregivers and examines how kinship navigator programs address the unique needs of Latine kinship families. While bivariate analyses suggested Latine and non-Latine caregivers experience similar challenges and unmet needs, a series of linear and logistic regression models indicated that, compared to non-Latine caregivers, Latine caregivers (1) were more likely to report parent deportation as a circumstance leading to kinship care, (2) had lower annual incomes, (3) were more likely to report an unmet medical need for their child, and (4) had a greater number of children under age 18 living in their home, on average. A content analysis of two focus groups (total n = 7) consisting of Spanish-speaking, Latine kinship caregivers suggested that while navigator programs adeptly addressed their legal and mental health issues, these kinship families still experienced economic hardship and struggled to navigate immigration issues. Altogether, findings highlight the need for services that accurately reflect the unique challenges and needs experienced by Latine kinship families.

CULTURALLY TAILORED INTERVENTION EFFICACY TO PROMOTE BREAST CANCER SCREENING AMONG AMERICAN INDIAN WOMEN

Abstract Purpose The purpose of this project was to develop and evaluate the feasibility and effectiveness of the Mobile Web App Breast Cancer Screening (wMammogram) intervention among American Indian (AI) women. Method: Using a randomized controlled trial design, 122 AI women (40-70 years old) were recruited and randomly assigned to the wMammogram group (n=62) to receive culturally and personally tailored multimedia messages through a mobile web app along with health navigator services or the control group (n=60) to receive a printed educational brochure. Outcome measures included mammogram receipt, intention to receive breast cancer screening after the intervention, and satisfaction with and perceived effectiveness of the intervention. Result: A significantly higher proportion of women who received the intervention (42%, 26/62; p<.01) completed mammograms by the 6-month follow-up compared with the control group (20%, 12/60). The wMammogram group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22, p<.001), increase in knowledge (t120=-4.75, p<.001), and satisfaction with the intervention (t120=-3.61, p<.001). The wMammogram group also expressed greater intention to receive a mammogram in the future when it is due (100%, 62/62 vs. 85%, 51/60) and were more willing to recommend the intervention they received to their friends (98.4%, 61/62 vs. 90%, 54/60) compared with the brochure group. These differences were statistically significant. Conclusion Based on our results, a mobile web app-based intervention combined with health navigator service was a feasible, acceptable, and effective intervention mechanism aimed at promoting breast cancer screening in AI women.

Navigation Services and Urban Sustainability

The rise of socio-technical systems in which humans interact with various forms of Artificial Intelligence, including assistants and recommenders, multiplies the possibility for the emergence of large-scale social behavior, possibly with unintended negative consequences. In this work, we discuss a particularly interesting case, i.e., navigation services’ impact on urban emissions, showing through simulations that the sum of many individually “optimal” choices may have unintended negative outcomes because such choices influence and interfere with each other on top of shared resources. To prove this point, we demonstrate how the introduction of a random component in the path suggestion phase may help to relieve the effect of collective and individual choices on the urban environment in terms of urban emissions.

Preliminary Outcomes and Adaptation of an NDBI for Spanish-Speaking Families

Naturalistic, Developmental, and Behavioral Interventions (NDBIs) are an empirically supported intervention approach for young autistic children and their families. Spanish-speaking (SS) Latinx families have been underrepresented in autism intervention research, limiting our understanding of whether NDBIs are aligned with Latinx family values and belief systems. This study piloted a parent-mediated NDBI, Project ImPACT, within outpatient services for SS Latinx families. We aimed to examine the preliminary impact of Project ImPACT on family and child outcomes while using the Ecological Validity Model to evaluate program adaptations made by bilingual clinicians. Results from 15 families indicated good treatment completion and high satisfaction, alongside significant increases in child social communication skills and parent self-efficacy in supporting their child’s development. Mixed-methods data examining program adaptations indicated the need to provide additional information related to autism, bilingual language development, and service navigation, as well as adaptations to language and metaphors used in the program.

ENHANCING URBAN VEHICULAR NAVIGATION: IMPROVING CLASSICAL TOPOLOGICAL MAP MATCHING THROUGH RAY-CASTING

Abstract. Navigation is of paramount importance for land vehicles as it enables efficient and accurate movement from one location to another. Whether it is for personal navigation, commercial transportation, or emergency services, reliable navigation systems play a crucial role in ensuring safety, optimizing routes, and enhancing overall operational efficiency. This paper presents the integration of classical Topological Map Matching (TMM) with the Global Navigation Satellite System (GNSS) and the Inertial Navigation System (INS), addressing the limitations of relying solely on road centerlines. A novel solution is proposed, leveraging the ray-casting algorithm to determine the predicted position’s area and employing a two-stage kinematic update process for enhanced positioning accuracy. The solution’s efficacy is evaluated through tests conducted on simulated GNSS outages within a road experiment conducted in the City of Toronto, demonstrating substantial improvements compared to the classical TMM approach. Notably, the proposed method achieved a considerable 82.33% reduction in RMS positioning error and a 33.71% improvement in maximum positioning error during the longest GNSS outage. By overcoming the limitations of classical TMM algorithms, this research contributes to the advancement of navigation and tracking systems, with future work focusing on practical implementations and optimization for diverse navigation scenarios.

JSMNET: IMPROVING INDOOR POINT CLOUD SEMANTIC AND INSTANCE SEGMENTATION THROUGH SELF-ATTENTION AND MULTISCALE FUSION

Abstract. The semantic understanding of indoor 3D point cloud data is crucial for a range of subsequent applications, including indoor service robots, navigation systems, and digital twin engineering. Global features are crucial for achieving high-quality semantic and instance segmentation of indoor point clouds, as they provide essential long-range context information. To this end, we propose JSMNet, which combines a multi-layer network with a global feature self-attention module to jointly segment three-dimensional point cloud semantics and instances. To better express the characteristics of indoor targets, we have designed a multi-resolution feature adaptive fusion module that takes into account the differences in point cloud density caused by varying scanner distances from the target. Additionally, we propose a framework for joint semantic and instance segmentation by integrating semantic and instance features to achieve superior results. We conduct experiments on S3DIS, which is a large three-dimensional indoor point cloud dataset. Our proposed method is compared against other methods, and the results show that it outperforms existing methods in semantic and instance segmentation and provides better results in target local area segmentation. Specifically, our proposed method outperforms PointNet (Qi et al., 2017a) by 16.0% and 26.3% in terms of semantic segmentation mIoU in S3DIS (Area 5) and instance segmentation mPre, respectively. Additionally, it surpasses ASIS (Wang et al., 2019) by 6.0% and 4.6%, respectively, as well as JSPNet (Chen et al., 2022) by a margin of 3.3% for semantic segmentation mIoU and a slight improvement of 0.3% for instance segmentation mPre.

‘You have to go hunting for information’: Barriers to service utilization among expectant and parenting youth with experience in foster care

AbstractUnique service needs exist for expectant or parenting youth with foster care histories (EPY) and their families. Informed by Critical Ecological Systems Theory (CEST), this exploratory qualitative study presents findings from an inductive content analysis of in‐depth interviews and focus groups with EPY and service providers. The study included nine in‐depth face‐to‐face interviews with service providers (n = 5) and EPY (n = 4) as well as five focus groups with service providers (n = 23) and three with EPY (n = 7) to identify the characteristics of service providers, agencies and systems that may act as barriers to service utilization among EPY with a foster care history (n = 10) or juvenile justice history (n = 1). Service provider characteristics included negative attitudes towards EPY and/or those with child welfare experiences. Agency characteristics included a lack of workforce diversity, employee turnover, lack of training about diverse communities, restrictive enrolment processes and eligibility requirements, lack of childcare and transportation and limited accessibility of services. System characteristics included a lack of up‐to‐date information about existing services, territorialism, funding sources that do not prioritize interagency collaboration and a lack of communication/coordination among agencies. Implications include hiring and retaining a diverse workforce, providing training about diverse communities and implicit biases concerning young parents, developing navigation services specifically for EPY and developing processes for sharing data and communicating across systems that interact with EPY.

Efficiency assessment in European air traffic management—A fundamental analysis of data, models, and methods

The European air traffic management system is characterized by its dynamic and diverse nature. To effectively address future challenges, it is crucial to enhance efficiency and resilience within the system. As an integral part of the air traffic system, air navigation services operate as natural monopolies and are subject to regulatory measures. While operational and academic studies regularly address performance benchmarking, no comparative analysis is currently evaluates the different approaches. This paper introduces a fundamental analysis for evaluating the technical efficiency of air traffic control at the air navigation service provider (ANSP) level. Our research encompasses the development of an economic model, the application of various analytical methods, and the careful selection of units for evaluation. Our findings demonstrate that the standard Data Envelopment Analysis (DEA) method is highly effective. Additionally, we emphasize that not all ANSPs shall be included in the analysis, and we caution against incorporating monetary inputs and outputs in the model.

Dementia care navigation: A systematic review on different models and their prevalence

AbstractBackgroundDementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented widely but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing models, and to synthesise evidence regarding their implementation and impacts.MethodsThe review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN model, defined as a service in which non‐clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst.ResultsWe included 13 papers (six studies). All models were US‐based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well‐being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages.ConclusionsDCN models have the potential to effectively provide non‐clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar stablished outcome measures are required.

Abstract A122: Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability

Abstract Background: The rapidly growing population of older adults and racial/ethnic minorities with cancer necessitates innovative patient navigation strategies to address their unique needs. Our Enhanced Vulnerable Elders Navigation (EVEN) Program aims to increase the capacity to deliver high-quality, evidence-based oncology patient navigation services at a comprehensive cancer center, with the goal of improving equity in cancer care delivery. Methods: Based on a comprehensive needs assessment, the EVEN Program comprises three main domains: health information technology infrastructure enhancements, navigation workflow standardization, and stakeholder engagement. The primary outcome measure is time to treatment initiation. A quasi-experimental design compares outcomes of older adults with cancer who receive enhanced navigation during the implementation period to outcomes of historical controls (matched by age, race, and ethnicity) who received standard navigation during the lead-in "pre-implementation" period. We hypothesize that the EVEN Program will improve the timeliness of cancer treatment initiation among vulnerable older adults. Univariate and multivariable analyses using cox regression models will adjust for patient and health system factors. Logistic regression will assess the likelihood of treatment delay between the standard navigation and EVEN groups. Process metrics across multiple domains will be analyzed at 6-month intervals over 2 years. Qualitative interviews with program stakeholders will provide nearly real-time feedback on program implementation. Baseline Data Approximately half of newly diagnosed cancer patients (N>3000) seen at our institution's main campus in 2021 received navigation services, and at least half of those patients are estimated to be 65+. Patient navigators addressed language/communication barriers (17% of navigated patients) and social determinants of health (15%); they facilitated communication and emotional support (45%) and routinely made referrals to clinical care team members (39%) and for resource coordination (37%), such as interpreters, social work, financial counseling, and external resources. Most navigator contacts were in person (61%), followed by phone calls (34%). We found wide variation in time to initial cancer treatment across cancers, suggesting opportunities for improvement in care coordination. Conclusion: Our multi-component enhanced patient navigation program is conceptually grounded, innovative, with the potential to reduce cancer disparities among older adults from vulnerable populations. Our multidisciplinary project team includes expertise in geriatric oncology, implementation of patient navigator programs, health equity, community partnerships, and patient navigators with over 30 years of experience in compassionate coordination of cancer care. If proven feasible and effective, the EVEN Program has the potential to scale to our entire enterprise, other health delivery systems nationally, and long-term, to improve equitable cancer care for underserved older adults with cancer. Citation Format: Ana Tergas, Annette Mercurio, Lauren Cai, Lorena Gaytan, Marianne Razavi, Deborah Lefkowitz, Chrissy Kim, Terry Hernandez, Steven Morales, William Dale, Narissa Nonzee. Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability [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 A122.

Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention

ObjectiveDespite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for...

Enhanced GNSS Reliability on High-Dynamic Platforms: A Comparative Study of Multi-Frequency, Multi-Constellation Signals in Jamming Environments

The global navigation satellite system (GNSS) signals are vulnerable to disruption sources, such as signal jamming. This, in turn, can cause severe degradation or discontinuities of the GNSS-based position, navigation, and timing services. The availability of multi-frequency signals from multi-constellation GNSS systems, such as Galileo and GLONASS, along with the modernization of GPS with multi-frequency signals, has the potential to increase the immunity of GNSS-based navigation systems to signal jamming. Despite various studies completed on the utilization of multi-frequency and multi-constellation global navigation satellite system (GNSS) signals to resist receiver jamming, there is still an urge to further investigate this concern under different circumstances. This paper presents an experimental evaluation of the advantages of the employment of multi-frequency multi-constellation GNSS signals for better GNSS receivers’ performance during signal jamming situations for high-dynamic platforms such as aircraft/drones. Additionally, the study examines the effects of both simulated and real jamming signals on all possible combinations of the GPS, Galileo, and GLONASS signal frequencies and constellations. Two airplane trajectory routes were built, and their corresponding RF signals were generated using the Spirent and Orolia GNSS signal simulators. The results indicated that the GPS multi-frequency-based solution maintains reliable positioning performance to some extent under low jamming scenarios. However, the combination of GPS, Galileo, and GLONASS signals proved its ability to provide a continuous and accurate positioning solution during both low and high jamming scenarios.

Abstract A025: Empowering Latinas to obtain genetic services: Comparing precision cancer prevention strategies

Abstract Purpose: Precision cancer prevention strategies are critical for addressing the complex interplay of adverse social determinants of health (SDOH) and elevated biological risks for breast cancer (BC) among Latinas and other marginalized communities. FQHC-community-academic partnerships may have particularly high potential for operationalizing these strategies and reducing population-level disparities through enhancing genetic counseling and testing (GCT) and subsequent cascade testing/personalized care. Objective: To present emerging results from a RCT comparing the effectiveness of two precision cancer prevention strategies on increasing GCT among Latinas and networks with elevated biological and adverse SDOH risks. Methods: Latinas Lideres en Salud (LaLiSa) is an ongoing RCT is situated in a 14-site federally qualified health center (FQHC) in Chicago. This unique FQHC has a comprehensive GCT program, as part of its integration with an academic medical center. Eligibility criteria for patients include: 1) identification as Latina, Hispanic, Chicana, etc.; 2) age of 18+ years old; 3) personal or family history of BC or related cancers (e.g., ovarian); 4) no previous GCT uptake; and, 5) no prior volunteerism. Patients are randomly assigned to participate in one of two 3-week phone-based interventions from a community agency. Both interventions offer personalized BC education, SDOH screening and navigation, and free/low-cost GCT services. “Educate” offers education on risk reduction (diet, exercise). “Empower” offers skills training on sharing precision cancer prevention information with family and other network members, who can also be eligible for SDOH navigation and GCT services. Data collection includes two surveys (baseline, post-intervention) for relevant covariates and use of study/navigation records for GCT uptake. Results: Of 299 patients approached, 89 participants have enrolled in the RCT (42 educate, 45 empower), with 89% retention. Approximately 55% are 50+ years old, 85% prefer Spanish, 65% have less than a high school education, and 64% have Medicaid/Medicare. For BC and SDOH risks, 17% are cancer survivors, 81% have financial stress and 42% have other competing SDOH risks (intimate partner violence, housing instability, transit instability). No significant arm differences exist. About 76% have initiated GCT referrals and 43% of participants have received GCT services, including 70% who have been identified as having elevated hereditary risk. Empower participants have been more likely to obtain GCT services than Educate participants, (51% vs. 33%, aOR = 5.44, 95%CI[1.45, 20.40], p=.01) after adjusting for age and self-reported social desirability. Discussion: Emerging data suggest the feasibility of precision cancer prevention strategies through FQHC-community-academic partnerships. Empower approaches may be more effective for enhancing at-risk Latinas’ GCT uptake than Educate approaches, when combined with SDOH navigation and free/low-cost GCT services. Limitations concern generalizability due a small, non-probability based sample. Citation Format: Paola Torres, Carolina Bujanda, Celeste Charchalac-Zapeta, Juanita Arroyo, Pamela Ganschow, Vivian Pan, Nathan Stackhouse, Sage J. Kim, Araceli Lucio, Yamilé Molina. Empowering Latinas to obtain genetic services: Comparing precision cancer prevention strategies [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 A025.

Challenges and Opportunities in a Resource Desert: Las Vegas Boot Camp Translation

AbstractBackgroundThe state of Nevada has the 3rd fastest growing rate of Alzheimer’s disease and related dementias (ADRD) in the country with a 30.6% projected increase between 2020 and 2025. Growth in ADRD is complemented by growth in the diversity of residents, particularly in Las Vegas, where the growth of minoritized populations outpaces national rates. Nevada is 30% Hispanic/Latino (H/L) and Las Vegas is 33% H/L. Among the challenges presented by this growth, Nevada is characterized as a ‘neurology desert’, lacking the necessary specialists to meet the state’s care demands and lacking the traditional infrastructure for care and research referral. In order to better understand local experiences seeking care and address communication barriers, we applied the Boot Camp Translation model for the Las Vegas H/L community.MethodWe identified 14 community members to participate in our ADRD BCT through community connections, targeted email blasts, and social media. BCT members ranged in age from 23 to 62 (M = 43, SD = 13.74), were majority female (10/14) and H/L (11/14), and most (10/14) were connected to local non‐profit organizations serving H/Ls, those with ADRD, and/or older adults.ResultBCT members identified messages to increase AD awareness that reflected love, “respeto” (respect), resilience, and connection; messages targeted younger and middle‐age adults and community organizations: 1) “Amar es saber” (“To love is to know”), which encourages discussions among family members; 2) “The community cares. Let’s talk.”; and 3) “Podemos afrontar el Alzheimer juntos.” (”We can face Alzheimer’s disease together.”). BCT members identified our resource desert as a key challenge to message‐based calls to action. As reflected by their messages, they also highlighted opportunities for community members to engage and support message dissemination.ConclusionThe Las Vegas BCT effectively identified messages, challenges, and opportunities to increasing AD knowledge and research engagement. Many BCT members joined our community advisory board; they emphasize the need for ongoing advocacy in the state, Spanish‐language resources, and an online presence that simplifies and supports navigation of services and information.

Abstract C137: Action-based modeling for national Indigenous cancer care partnerships: Patient navigation services, health policy, and sustainability

Abstract Cancer-specific, Indigenous led patient navigation systems are often a gap for Indigenous communities. These communities often face greater cancer health disparities and increased mortality due to late-stage diagnoses. Early detection and navigation are key to life-saving treatment. This quality improvement study shares the foundations for implementation of an Indigenous/rural patient navigation program. The discussion shapes planning and evaluative efforts for the build out of a memorandum of understanding from an NCI-Designated cancer center’s Indigenous cancer service arm (Northeast) towards expansion to an Indigenous community-driven university-based Native American budget and policy institute (Southwest). Program development centers Indigenous underpinnings of wampum agreements, Pueblo cane agreements, tribal sovereignty, and governance. Findings include translational modeling of Indigenous based cancer focused patient navigation successes, robust cross-training collaborations, inter-tribal resource building, incorporation of virtual patient navigation, grass-root partnerships, Indigenous-led community outreach, and health policy development. Citation Format: Carmela M. Roybal, Rodney C. Haring. Action-based modeling for national Indigenous cancer care partnerships: Patient navigation services, health policy, and sustainability [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 C137.

Cross-sector learning collaboratives can improve post-diagnosis care integration for people with young onset dementia

Introduction:Post-diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, health care, and social care sectors. The aim of this project was to test the feasibility and effectiveness of a learning collaborative implementation strategy for improving the cross-sector integration of care for people with YOD.Methods:We conducted a longitudinal mixed-methods process evaluation, and recruited one representative from three Australian aged care organisations, three disability care organisations, and three organisations contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six-module online education package incorporating written resources, webinars, collaboration, and expert mentoring. Participants identified gaps in services in their region and barriers to care integration, and developed a shared plan to implement change. Normalisation Process Theory was applied to understand acceptability, penetration, and sustainability of the implementation strategy, as well as barriers and enabling factors.Results:Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (Mean = 39.67, standard deviation = 9.84) and did not change by the end (Mean=39.67, standard deviation = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action toward integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative.Discussion:Learning collaboratives hold promise as a strategy to improve cross-sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change.

The Use of Navigators to Increase Patient Portal Enrollment among Patients in a Federally Qualified Health Care System.

To describe the training, preliminary results, and lessons learned from using patient navigators to increase the enrollment of low-income patients in a health system-supported and electronic health record-linked patient portal. Patient navigators (n=4) were trained to assist patients in a federally qualified health center to enroll in and use patient portals. Patient navigators were stationed at 3 clinic locations. Data from the electronic health record system (Epic) were used to compare MyChart patient portal activation rates and use among patients for the 8 months before and after patient navigation services were offered. Navigators offered 83% of eligible patients with activation assistance. Sixty-four percent of the patients (n=1062) offered MyChart enrollment assistance accepted help. Seventy-four percent of assisted patients with no prior MyChart enrollment activated their accounts during that clinic visit. The primary reason for declining MyChart assistance was a lack of access to or comfort with technology. Patient portal activation increased during the 8 months when navigators were at the clinics (51%) compared to the previous 8 months (44%). Most new users viewed lab results and read a message [χ2(1)=49.3, p<.001], with significant increases evident for African Americans [44% before, 49% during; χ2(1)=40.4, p<.001] and Latinx patients [52% before, 60% during; χ2(1)=6.15, p=.013]. Study results suggest that using patient navigators is feasible and beneficial for increasing patient enrollment in the Federally Qualified Health Centers context. However, patient-, clinic-, and system-level factors were identified as barriers and should be addressed in future research studies.

Abstract A026: Expanding access to oncology navigation in rural Appalachia with a volunteer support model

Abstract Background: Despite the benefits of patient navigation as an evidence-based practice for reducing health disparities in underserved communities, widespread implementation has proved challenging. Cost often limits the number of navigators a cancer center can hire and thus their depth of coverage, resulting in high caseloads or limited availability, particularly in rural-serving clinics. Successful utilization of college student volunteers to expand capacity in health clinics has been previously reported yet has not been extended to support oncology navigation. We employed implementation science methodology to determine barriers, facilitators, and implementation strategies for patent navigation to be supported by student volunteers in a community cancer center serving rural Appalachia. Methods: Leveraging Context-Driven Co-Design (CD2), we conducted clinic observations and key informant co-design sessions with a user-centered design context assessment form previously developed by our team. Co-design sessions were audio-recorded and transcribed. CFIR guided data collection and thematic analysis with inductive coding to identify contextual barriers and facilitators to include in the translation table and implementation model. Co-design sessions prioritized contextual factors in the implementation model, intervention adaptations to optimize fit, and implementation strategies to address the remaining friction, while iteratively refining the model. Results: We observed the radiation oncology and hematology oncology clinics in an Appalachian community cancer center. We conducted 7 key informant interviews with an oncologist, a cancer center director, a radiation oncology nurse, a hematology oncology nurse, a social worker, a financial navigator, and a patient. Facilitators included need (high caseload, patient population, transportation and information barriers), mission alignment (maximize patient support), and culture (high team cohesion). Barriers included available resources (physical space, time), work infrastructure (qualifications, maintaining clinic efficiency, role delineation), and access to knowledge and information (guidance and training). Implementation strategies selected were a rigorous volunteer screening process, training sessions designed and executed by volunteer organization leadership, a comprehensive training curriculum, and consideration of staff limitations (physical space, time, caseload, work infrastructure). Conclusion: The final proposed implementation model utilizes student volunteers to support oncology navigation adapted to contextual factors at a community cancer center serving rural Appalachia. This model extends navigation services in underserved, rural communities and can be leveraged in other similar oncology settings to support health equity. The American Cancer Society Community Access to Resources, Education, and Support (ACS CARES program) will be launching student volunteers to support navigation in a four-site pilot study in September 2023 utilizing the findings from this study to enhance implementation. Citation Format: Bonny B. Morris, Charlotte Waugh, Adam Hege, Maggie Anderson, Woods Curry, Allison Benton, Ronny Bell, Chandylen Nightingale. Expanding access to oncology navigation in rural Appalachia with a volunteer support model [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 A026.

Abstract PR004: Pilot study examining a proactive, culturally-tailored model of patient navigation on satisfaction with care

Abstract Patient navigation seeks to improve cancer outcomes by overcoming barriers to care among populations experiencing disparities. Since its introduction in 1990, numerous models of patient navigation have been introduced in different clinical locations, but without clear comparisons between them. We conducted an observational pilot study of cancer patients receiving treatment at the Fred Hutchinson Cancer Center from April 2021-October 2022 to investigate the impact of a newly introduced model of patient navigation, characterized by proactive, longitudinal care with a focus on cultural or racial concordance and communication among Black, American Indian or Alaska Native, Asian or Pacific Islander, and Hispanic or Latino individuals, on patient-reported outcomes. We recruited patients age ≥18 years within 3 months of their first cancer-related clinic visit and invited them to complete online surveys at baseline and 3 months after enrollment. We sought to recruit n=160 for baseline assessments and of those, n=120 to also complete follow up assessments. Outcomes included patient satisfaction with cancer-related care, perceived stress, healthcare discrimination, trust in physicians, resilience, and whether clinical trials were discussed. Patients receiving the newer longitudinal navigation model were compared to those receiving the standard, acute model of navigation support and to patients receiving no navigation using descriptive statistics, including mean and standard deviations (SD) for scores on summary scales for each metric. We identified 1,122 cancer patients eligible for navigation services. Of those, 827 were invited to participate by email and 295 received targeted telephone and email recruitment. A total of 118 completed both the baseline and follow-up surveys (proactive navigation n=5; acute navigation n=17, and no navigation n=96). Median age was 51 years, 13% were Black, 8% were American Indian or Alaska Native, 3% were Asian or Pacific Islander, 12% were Hispanic or Latino, 57% were non-Hispanic White. Satisfaction with care improved by 4 points among patients receiving proactive navigation but did not change for patients in the acute or no navigation groups. The proportion of individuals reporting healthcare discrimination decreased among those who received proactive navigation, while no changes in perceived stress, resilience, or trust in physicians were seen across all groups. Four of 5 individuals receiving proactive navigation reported having discussed clinical trials options, compared to 1 and 0 of those receiving acute or no navigation, respectively. Our new proactive patient navigation model may improve satisfaction with cancer care, a key outcome proposed by the National Cancer Institute Patient Navigation Research Program. Additional fully powered studies using this new model of navigation are warranted to assess its potential to improve clinical and patient reported outcomes for diverse patients. Citation Format: Jean A. McDougall, Vida Henderson, Yaw A. Nyame, Elizabeth Carosso, Katherine J. Briant, Citlali Gomez Acosta, Anne Devine, Jason A. Mendoza, Casey Lion. Pilot study examining a proactive, culturally-tailored model of patient navigation on satisfaction with care [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 PR004.