Trained Navigators Research Articles

Abstract B167: Genomics and cancer clinical trials navigator training: Results from a systematic review of the literature

Abstract Introduction: Trained cancer navigators have demonstrated success in improving outcomes for cancer patients. Trainings provided by the American Cancer Society and other organizations equip navigators with the knowledge, skills and experience to support patients and address barriers to cancer-related care and survivorship. Racial/ethnic minorities continue to be underrepresented in cancer clinical trials and are less likely to receive genomic counseling and testing. There is a notable gap in the availability of cancer navigator training in genomic and clinical trials. This study used a systematic review of the literature and consultations with Genomics and Cancer Clinical Trial (CCT) experts to inform the development of cancer navigation training curriculum. Methods: Two reviewers searched the PubMed database for peer-reviewed studies published through October 2022. Key MeSH terms included cancer, genetics, and training. An ancestor search of relevant articles was also conducted. Following title screening, eleven articles were selected for abstract and full-text review. Eight articles met all the inclusion criteria from which we extracted the 1) trainee population, 2) theoretical frameworks used, 3) program design and format, 4) curricular components, and 5) outcomes. New Data: Only seven articles on the topic of navigator training in genomics within the context of CCT were identified in the search. Training participants were diverse and were located within the United States and abroad. One training program was developed for bilingual (English/Spanish) navigators, one was tailored for cancer survivors who became navigators and two programs trained navigators for specific cancer types (e.g., colorectal cancer). Social cognitive theory (SCT) was used in two of the training programs. Other adult learning theories and intervention mapping for program development were also used in training development. The process for designing navigator trainings included: conducting discussion groups; interviews and surveys; engaging advisory boards; and adapting the National Human Genomics Research Institute modules and other resources. The curricula components included in-person and web-based; single semester or year-long sessions; formal coursework; lectures; role-playing; video viewing; tours of facilities; demonstrations; short writing assignments; action plans; case studies; story- telling; discussion and networking; assessment/evaluation; and refresher sessions. Modules addressed attitudes, barrier assessment and resolution, knowledge, self-efficacy, and communication. Conclusion: The peer-reviewed literature on navigator training describes some curricular elements that measure and address knowledge about genomics and CCT as well as the skills needed to increase self-efficacy to navigate for genetic studies and cancer clinical trials. However, the field of CCT lacks a consistent and widely used program aimed at training navigators in the integral role of genetics in precision medicine. These findings informed the design of our ACS-funded curriculum. Citation Format: Desiree Rivers, Robina Josiah Willock, Victoria Churchill. Genomics and cancer clinical trials navigator training: Results from a systematic review of the literature [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B167.

Process Evaluation of a Pilot Food Insecurity Resource Navigation Program Integrated Within Pediatric Primary Care: Utilizing RE-AIM to Inform Program Scale-up

Objective: The purpose of this study was to examine the implementation and effectiveness of a novel pediatric food navigation program through a structured, comprehensive evaluation using the RE-AIM framework. Design and Participants: Data were collected from October 2021 through August 2022 for 166 pediatric patients and their families who were screened as food insecure or high-risk for food insecurity and were referred to this pilot food resource navigation program (FRNP). A total of 88 patients’ guardians consented to participate in this FRNP, receiving initial service connection. Participants were contacted via telephone by trained navigators within this health system to assess food security status across three time points (baseline, follow-up 1 [1- <3 months], and follow-up 2 [3-6 months]) and facilitate connection to appropriate community-based resources related to food assistance. Results: In this sample, we had an overrepresentation of Hispanic patients and an underrepresentation of Non-Hispanic Black and White patients relative to the available clinic population. Patients participating in the navigation program showed incremental shifts toward food security from baseline to two follow-up points. Integration within primary care was supported by physician champions across participating clinics and alignment with systemwide, updated universal screening guidelines to support projected increases in families requiring connecting to assistance programs. Through this evaluation, a comprehensive list of community-based food resource programs related to food assistance was integrated into electronic documentation for navigators to alleviate navigator burden and sustain the effect of this FRNP’s implementation. Conclusions: These findings may be used to inform expansion of current programming efforts within this FRNP and to clarify process evaluations of broader health system-based programming. Further research, building on the findings of this pilot study, is needed to examine the longitudinal, causal effect of FRNPs in pediatric food security and long-term health outcomes for replication across health systems nationwide.

Navigation-Based Telehealth Informed Decision-Making for Prostate Cancer Screening in Black Men.

The rapid increase in telehealth has the potential to bring informed decision-making for prostate cancer screening (PCS) at the population level to high-risk individuals. We utilized a global technology platform of electronic health records data repositories (TriNetX) to determine its utility for Navigator-guided decision-making aid for PCS in Black men ages 45-79 years with no history of prostate cancer and PSA testing. Patients from Pennsylvania were invited to participate in a telehealth-delivered informed decision-making session for PCS. Focus groups, social learning theory, visual diagrams, and quantitative data on PCS risks and benefits were used to develop the content of the sessions, which included numerical discussions of risks vs. benefits in Black men. Participants completed several surveys, including baseline demographic and numeracy questionnaires, a one-on-one telehealth session with a trained Navigator, post-Navigation surveys, and an optional follow-up session with a urologist. Eighty-seven participants were consented and recruited. Although the mean numeracy score was only 1.9 out of 6, more than 90% rated as good or excellent that the sessions aided their PCS decision-making skills. This study indicates that Navigation by telehealth offers the ability to assist in informed decision-making for PCS at the population level.

FEASIBILITY OF A COMMUNITY-BASED NAVIGATOR SUPPORT PROGRAM FOR CARE PARTNERS OF SERIOUSLY ILL VETERANS

Abstract We examined the feasibility and satisfaction of a short-term Veterans Health Administration (VHA)-based care partner support intervention delivered by trained navigators during COVID-19 through a single-arm interventional cohort feasibility study of a telephone-based care partner navigation intervention. Navigators (n=9) received the standard state curriculum online from a local community health worker training program plus an additional eight weeks of online role-specific training by the study team. Subsequently, navigators contacted care partners (n=30) of seriously ill veterans weekly via telephone over a 12-week period to assess social and practical needs, and connect care partners to appropriate community-based or VHA resources. All navigators (9 female; 1 male) and 17% of care partners were African-American (83% were Caucasian or other). Care partners were 90% female and 10% male; age range 41 to 80. In this telephone-based support program delivered to care partners by standard-trained navigators across 12 counties, care partners were overall very satisfied (x̄=4.69 out of 5, sd =.77) with their navigator’s responsiveness and social support throughout the 12-week course of the study. Navigators’ confidence increased over time (x̄=8.2 out of 10 (sd=1.14) to x̄=8.78 (sd=.97)), while their self-assessed effectiveness ratings lowered over time as they encountered real-life scenarios (x̄=8.5 (sd=1.43) to x̄=7.89 (sd=.93)). Navigators documented successful connections to services in the VHA and in care partners’ communities. Using remote navigators with minimal but standard training is a feasible and acceptable model of care partner support.

Evaluating the acceptability, usability, and feasibility of a clinic-based genetic testing risk assessment intervention in Black women with breast cancer.

436 Background: Black women diagnosed with breast cancer utilize genetic counseling and testing services less often than White women despite these services having the potential to personalize medical management of breast cancer and identify family members for cascade testing. Lower rates of provider recommendations may be a driver of these disparities, as uptake does not appear to differ by race. The objective of this study was to evaluate the acceptability, usability, and feasibility of a clinic-based genetic risk assessment to facilitate provider recommendations for genetic testing in Black women diagnosed with breast cancer. Methods: A clinic-embedded, race-concordant, trained navigator administered a 15-minute screening tool based on National Comprehensive Cancer Network genetic testing criteria to English-speaking, Black women ≥18 and newly diagnosed with breast cancer. A copy of the results were given to the treating surgeon to facilitate consideration of genetic testing for the patient. However, the decision to recommend genetic testing was left to discretion of the surgeon. After enrollment completion, we conducted semi-structured interviews with a subsample of patients and surgeons who participated in the intervention to elicit their perspectives and experiences. We also used medical record data to determine if surgeons recommended genetic testing to participating patients, and if so, whether they completed it. Results: Between January 2022 and April 2023, 37 patients with a median age of 56.9 years (IQR 15.0-37.5) consented to participate. Surgeons recommended genetic testing to 25/37 patients and 5/37 additional patients were referred outside of this intervention (81.1% total). 12/37 patients (including those who were and were not recommended genetic testing) and 4/4 surgeons completed follow-up interviews. For clinician usability and acceptability, surgeons reported little to no negative impact on their clinic flow. While some found the intervention to be a helpful reminder, others shared it made no discernible impact on their practice, as they reported already incorporating a similar system into their clinic flow. For patient usability and acceptability, some patients found questions on the screening tool difficult to answer and expressed feeling overwhelmed at the time it was administered but the navigator was comforting, reassuring, and informative. Patients, surgeons, and the navigator recommended administering the screening tool prior to the initial appointment with the surgeon and ensuring follow up with patients regarding results. Conclusions: Participating patients and surgeons found this intervention to be feasible and acceptable. Usability challenges warrant further exploration into the logistics of the intervention, including timing, delivery, and medium.

Identifying Risk Factors Associated with Repeated Referrals Within a Pediatric Navigation Program.

Approximately 1-in-5 children have a diagnosed mental, behavioral, and/or developmental disorder or delay by age 8 in the United States. Children with such conditions often require complex, complicated diagnostic and specialty care, making them susceptible to repeated referrals and ongoing unmet healthcare needs. Patient navigation programs (PNPs) are designed to integrate care from primary care providers to community-based services, using trained navigators to help patients and their families manage referrals and connect with referred services. This study examines factors associated with repeated referrals to an active PNP to inform ongoing referral patterns and adaptations to standard navigation support within a large healthcare system in South Carolina (SC). Data is sourced from the inception of the PNP in 2017 through 2022, including 15,702 referrals. Overall, 71.07% had no repeated referrals. Children who are older, diagnosed with attention deficit disorder(s), behavioral concerns, depression, multiple referral needs, and insured by Medicaid were found to be most susceptible to repeated referrals. Conversely, children who are non-Hispanic Black, were referred at a well-child visit, and are primarily insured by private insurance or Tricare were least likely to have repeated referrals. Children who are insured by Medicaid are more likely to be younger, identify as non-Hispanic Black, Hispanic, or another race/ethnicity, and have multiple needs at time of initial referral, identifying a potentially compounded risk for those who hold multiple risk factors to experiencing repeated referrals. Findings may inform adaptations to this PNP model to adjust navigator protocol for at-risk populations and equitably optimize referral-to-service connection.

Integrating Smoking Cessation Into Low-Dose Computed Tomography Lung Cancer Screening: Results of the Ontario, Canada Pilot

IntroductionLow-dose computed tomography screening in high-risk individuals reduces lung cancer mortality. To inform the implementation of a provincial lung cancer screening program, Ontario Health undertook a Pilot study, which integrated smoking cessation (SC). MethodsThe impact of integrating SC into the Pilot was assessed by the following: rate of acceptance of a SC referral; proportion of individuals who were currently smoking cigarettes and attended a SC session; the quit rate at 1 year; change in the number of quit attempts; change in Heaviness of Smoking Index; and relapse rate in those who previously smoked. ResultsA total of 7768 individuals were recruited predominantly through primary care physician referral. Of these, 4463 were currently smoking and were risk assessed and referred to SC services, irrespective of screening eligibility: 3114 (69.8%) accepted referral to an in-hospital SC program, 431 (9.7%) to telephone quit lines, and 50 (1.1%) to other programs. In addition, 4.4% reported no intention to quit and 8.5% were not interested in participating in a SC program. Of the 3063 screen-eligible individuals who were smoking at baseline low-dose computed tomography scan, 2736 (89.3%) attended in-hospital SC counseling. The quit rate at 1 year was 15.5% (95% confidence interval: 13.4%–17.7%; range: 10.5%–20.0%). Improvements were also observed in Heaviness of Smoking Index (p < 0.0001), number of cigarettes smoked per day (p < 0.0001), time to first cigarette (p < 0.0001), and number of quit attempts (p < 0.001). Of those who reported having quit within the previous 6 months, 6.3% had resumed smoking at 1 year. Furthermore, 92.7% of the respondents reported satisfaction with the hospital-based SC program. ConclusionsOn the basis of these observations, the Ontario Lung Screening Program continues to recruit through primary care providers, to assess risk for eligibility using trained navigators, and to use an opt-out approach to referral for cessation services. In addition, initial in-hospital SC support and intensive follow-on cessation interventions will be provided to the extent possible.

Pilot Evaluation of the Family Bridge Program: A Communication- and Culture-Focused Inpatient Patient Navigation Program

ObjectiveChildren with low income and minority race and ethnicity have worse hospital outcomes due partly to systemic and interpersonal racism causing communication and system barriers. We tested the feasibility and acceptability of a novel inpatient communication-focused navigation program. MethodsMultilingual design workshops with parents, providers, and staff created the Family Bridge Program. Delivered by a trained navigator, it included 1) hospital orientation; 2) social needs screening and response; 3) communication preference assessment; 4) communication coaching; 5) emotional support; and 6) a post-discharge phone call. We enrolled families of hospitalized children with public or no insurance, minority race or ethnicity, and preferred language of English, Spanish, or Somali in a single-arm trial. We surveyed parents at enrollment and 2 to 4 weeks post-discharge, and providers 2 to 3 days post-discharge. Survey measures were analyzed with paired t tests. ResultsOf 60 families enrolled, 57 (95%) completed the follow-up survey. Most parents were born outside the United States (60%) with a high school degree or less (60%). Also, 63% preferred English, 33% Spanish, and 3% Somali. The program was feasible: families received an average of 5.3 of 6 components; all received >2. Most caregivers (92%) and providers (81% [30/37]) were "very satisfied." Parent-reported system navigation improved from enrollment to follow-up (+8.2 [95% confidence interval 2.9, 13.6], P = .003; scale 0–100). Spanish-speaking parents reported decreased skills-related barriers (−18.4 [95% confidence interval −1.8, −34.9], P = .03; scale 0–100). ConclusionsThe Family Bridge Program was feasible, acceptable, and may have potential for overcoming barriers for hospitalized children at risk for disparities.

ReUnidos: Farmworker Skin Cancer Health Navigation Program.

113 Background: Farmworkers are at increased risk for skin cancer because of occupational exposure to sun and pesticides. In 2017/2018, Farmworker Justice conducted the Unidos community mobilization project to raise skin-cancer awareness and promote skin-cancer care access in farmworker communities. Unmet needs were identified in follow-up care coordination for patients who screened positive for a suspicious skin lesion. We undertook this ReUnidos study to document the incidence of skin cancer in the farmworker community and to evaluate the benefits of a health-navigator program to facilitate follow-up care. Methods: Participants (primarily Latinx) are screened in the community setting by volunteer dermatologists. Those who screen positive for suspected skin cancer are invited to participate in the study. They are assigned a trained navigator who addresses the importance of evaluating the lesion, the details of the diagnostic process, and any questions the subjects have. The navigators also help arrange travel, scheduling of appointments, interpretation services, and any other supports needed during the care journey. Data are collected on the number of biopsies performed, diagnoses, time from screening to diagnosis, skin cancer staging, time to treatment, as well as satisfaction with and perceived effectiveness of the navigator program. Outcome measures are extracted from chart review and final semi-structured interviews of both subjects and navigators. The project seeks to screen 1,000 community members. Approximately 2% are expected to screen positive for a suspicious lesion and require follow-up care. Results: To date, 16 health navigators have been trained and 6 screening events have been conducted in Northern San Diego County by Vista Community Clinic. A total of 126 adult participants have been screened, with 47% identifying as farmworkers. One participant screened positive for a potential skin cancer and has consented to the study. Conclusions: Community-based screenings linked to health-navigation programs may be effective tools to increase access to skin-cancer care among farmworkers. A telemedicine screening model is also being investigated for a second site in upstate New York to expand rural skin screening access. This model may also be useful in care coordination for other malignancies in farmworker communities such as lung cancer and lymphoma, which have also been linked to occupational pesticide exposure.[Table: see text]

Developing a Youth Contraception Navigator Program: A Human-Centered Design Approach

PurposeTo determine key elements of a contraception navigator program that provides a personalized approach to overcoming patient-specific barriers by a trained navigator in central Indiana. MethodsA human-centered design approach was used to engage adolescents and community stakeholders in co-design sessions. Sessions incorporated techniques, such as divergent brainwriting and journey maps, which led to the exploration of various themes that were ultimately used to inform key elements of the contraception navigator program. ResultsAdolescents aged 15–17 years (N = 35) and community stakeholders (N = 11) participated in co-design sessions. Analysis verified that the process of obtaining contraception for pregnancy prevention could be intimidating for young people. The importance of language, the presence of stigma, and the knowledge of side effects were all discussed. Essential elements of a contraceptive navigator program included building trust to ultimately co-create a plan that can overcome patient-specific barriers. Having a variety of communication methods available, as well as contraceptive side-effect support, will be essential. DiscussionUsing human-centered design techniques to engage adolescent and community stakeholders can help inform the development of a contraceptive navigator program. A trusted navigator that can address patient-specific barriers to contraception access both before and after contraception is obtained is a key element identified by stakeholders.

Abstract PO-264: Impact of health navigation program on healthy lifestyle and cancer screening in population with significant social determinants of health (SDOH) barriers

Abstract Objective: Assess consumer experience and health impact among under-resourced individuals who were enrolled into longitudinal navigation to address social determinants of health (SDOH) needs and health goals related to cancer primary and secondary prevention. Background: The Yale Cancer Disparities Firewall Project is a multi-tiered initiative to address the social determinants of health (SDOH) and other challenges that prevent at-risk communities from receiving the full benefit of the many available cancer prevention and cancer screening options. A community-facing health navigation program, staffed by community members who have received extensive multidisciplinary training is a central component of this program. Methods: Of the 61 currently enrolled individuals (all of whom are either African American/Black or Hispanic/Latinx), we collected questionnaire data from 24 individuals (39% response rate). In general, participants are enrolled for a minimum of 1 year, but most have been followed for 2 years. Respondents were similar to non-respondents with respect to race (60% were Black/African American vs 61.2%, respectively) and age (mean = 44.8 vs 47.2 years, respectively). Respondents were more likely to be female (85% vs 71.4%, p =.009), Hispanic/Latinx (35% vs 42%), but significantly less likely to be foreign-born (15% vs 26.5 %, p = .021). We assessed satisfaction with assigned navigator(s), uptake of referred services, knowledge gained, health behavior change, and self-rated health (SRH). Results: Per self-report, 79.2% of participants agreed and a further 12.5% somewhat agreed that they were overall satisfied with their experience with the health navigation program. Importantly, two-thirds (66.7%) agreed and a further 20.8% somewhat agreed that they changed their behavior to improve their health and well-being because of the program. Of the 5 health focused services offered, the most commonly reported uptake was physical activity (87.5%), followed by learning how to eat healthier and losing weight. Additionally, one third (33.3%) of participants received assistance with reducing or stopping smoking. In terms of secondary prevention, 62.5% of clients received assistance with cancer screening. Of the 5 SDOH focused services offered, the most common was assistance with finding food to eat (66.7%) followed by assistance with paying utilities (45.8%), a shift from the priority needs at baseline (40% needing food assistance, and 35% with housing concerns), presumably reflecting the additional strains associated with the COVID-19 pandemic. Conclusions: Against the backdrop of COVID-19, these findings suggest that addressing SDOH barriers through individual navigation is an important add-on service when facilitating access to services to maintain healthy lifestyle and adhere to cancer screening guidelines. Although this was a pilot program, we foresee the opportunity to utilize trained non-clinical navigators and/or community health workers and to promote cancer prevention in at risk communities. Citation Format: Monique K. Stefanou, Sakinah C. Suttiratana, Denise Stevens, Eduardo Reyes, Jonathan Colon, Eiman Ibrahim, Roy L. Herbst, Beth A. Jones. Impact of health navigation program on healthy lifestyle and cancer screening in population with significant social determinants of health (SDOH) barriers [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-264.

Abstract 35: Acceptability and Perceived Impact of New Pediatric Patient Navigation Program in Rural Rwanda

Abstract Purpose: Patient navigation (PN) can promote timely access to care and create seamless flow for patients through the care continuum. PN strategies have not been widely studied in low-income countries or among pediatric cancer patients. We report preliminary acceptability and perceived impact among caregivers and healthcare providers of a new pediatric PN program at a rural hospital in Rwanda. Methods: From March 2020, patients diagnosed with nephroblastoma were supported by a trained navigator who conducted in-depth education for caregivers, coordinated all appointments, and proactively identified and addressed barriers to care. Caregivers were surveyed and interviewed at the end of their child's treatment; a focus group discussion (FGD) was held with providers six months after implementation. Interviews and FGD were conducted in Kinyarwanda, transcribed and translated to English. Descriptive statistics and the framework method were used to analyze survey and qualitative data, respectively. Results: At the time of analysis, five patients enrolled in PN had completed treatment. All five caregivers were surveyed; three interviewed. Five providers participated in the FGD. Caregivers found PN helpful in understanding the diagnosis and treatment plan, providing emotional support, and linking them to various providers. Providers observed that treatment processes for nephroblastoma patients have become “smoother,” noting increased adherence to treatment appointments, better care coordination and improved advocacy for social support. While some clinicians worried frequent communications with the navigator would be a burden, caregivers viewed them as a source of motivation to continue treatment, despite numerous challenges. Participants suggested PN be expanded to other diagnoses. Conclusion: Early data from end-users of our new pediatric PN program demonstrated high acceptability. Clinicians highlighted specific process challenges that were resolved with PN; caregivers appreciated the continuous logistical and emotional support. Further analyses will evaluate the impact of PN on outcomes and expansion of the program to other diagnoses. Citation Format: Cam Nguyen, Pacifique Uwamahoro, Esperance Benemariya, Oscar Nsanzimana, Louis Mujyuwisha, Lori Buswell, Leslie Lehmann, Cyprien Shyirambere. Acceptability and Perceived Impact of New Pediatric Patient Navigation Program in Rural Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 35.

Abstract PO-021: A hub and spoke model to improve cancer care quality: Advancing Cancer Care Together (ACCT) for Asian American Medicaid beneficiaries in Orange County, California

Abstract Introduction: Orange County (OC) is home to the third-largest population of Asian Americans in the U.S., including the largest population of Vietnamese outside of Vietnam. While breast, lung and colorectal cancers are the top overall causes of cancer incidence and mortality in OC, unique cancers are prevalent among Asian and Pacific Islanders including liver and stomach cancers. The University of California, Irvine Chao Family Comprehensive Cancer Center (UCI CFCCC) adapted a hub-and- spoke model of care (Elrod &amp; Fortenberry, 2017) to increase efficiency among underserved Asian Americans who continue to experience disparities in screening, early detection, and access to cancer treatment. Methods: Our hub-and-spoke model arranges service delivery assets into a network between community organizations through culturally/linguistically competent and trained community health navigators, OC medicaid primary and specialty care providers for low/moderate complexity patients, and UCI CFCCC for high-complexity cancer treatment. UCI CFCCC serves as the anchor establishment (hub) which offers a full array of services. This is complemented by community providers and care coordinators at local Federally Qualified Health Centers (spokes) which offer culturally-tailored primary prevention services. The community patient navigators (rim) located at community-based organizations, routes patients needing more tailored services to the spokes or hub for screening or treatment. Results: Patient Navigators at OC Herald Center, OC Asian Pacific Islander Community Alliance, and Vietnamese American Cancer Foundation have educated 2,246 Korean, Vietnamese, and Chinese individuals on cancer prevention and screening guidelines. Of those, 320 medicaid members have been routed to KCS Health Centers (Korean-serving FQHC lookalike), Southland Integrated Services, Inc (Vietnamese and Chinese-serving FQHC), or Medicaid community providers for cancer screening and/or follow-up. 64 community providers have been trained on NCCN guideline adherent care for Korean, Vietnamese, and Chinese. UCI CFCCC has developed an algorithm/pathway for Medicaid-serving community physicians to easily refer qualified Vietnamese, Chinese, or Korean patients to the hub for complex care or clinical trials. Conclusions: The current COVID-19 pandemic has exacerbated disparities in screening and early detection, and compounds the uncertainty about the importance of optimizing cancer care quality (i.e. access proportion and timeliness, adherence to guidelines, patient satisfaction). Disparities being highlighted in COVID-19 has shown us the power and need of community engagement models to rapidly catalyze and create unique community-based efforts that strengthen capacities and infrastructures, and promote best practices in cancer prevention and early detection designed to decrease cancer incidence and/or mortality in the communities we serve. Citation Format: Cevadne Lee, Ellen Ahn, Mary Anne Foo, Sherry Huang, Becky Nguyen, Tricia Nguyen, Jacqueline Tran, Robert Bristow, Sora Park Tanjasiri. A hub and spoke model to improve cancer care quality: Advancing Cancer Care Together (ACCT) for Asian American Medicaid beneficiaries in Orange County, California [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-021.

An RCT to Increase Breast and Colorectal Cancer Screening

Adherence to breast and colorectal cancer screenings reduce mortality from these cancers, yet screening rates remain suboptimal. This 2 × 2 RCT compared 3 theory-based interventions to usual care to simultaneously increase breast and colon cancer screening in women who were nonadherent to both screenings at study entry. RCT. Women (n=692) who were nonadherent to both breast and colon cancer screenings and aged 51-75 years were recruited. Enrollment, intervention delivery, and data collection were completed between 2013 and 2017, and data analyzed in 2018. The randomized intervention included the following 4 groups: 3 intervention arms (personally tailored messages using a web-based intervention, phone delivery by a trained navigator, or both) compared with usual care. Women at an average risk for colon cancer were allowed to select either colonoscopy or stool test as their preferred colon cancer screening. Mammography was promoted for breast cancer screening. Outcome data at 6 months included self-report and medical records for screening activity. All intervention arms significantly increased receipt of either a mammogram or stool test compared with control (web: p<0.0249, phone: p<0.0001, web + phone: p<0.0001). When considering receipt of both mammogram and stool test, all intervention arms were significantly different from usual care (web: p<0.0249, phone: p<0.0003, web + phone: p<0.0001). In addition, women who were adherent to mammography had a 4.5 times greater odds of becoming adherent to colonoscopy. The tailored intervention simultaneously supporting both breast and colon cancer screenings significantly improved rates of obtaining one of the screenings and increased receipt of both tests. This study is registered with the clinical trials identifier NCT03279198 at www.clinicaltrials.gov.

A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention.

Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure. Patient-level, randomized trial. Two university-based, tertiary-care children's hospital PICUs. Parents of patients requiring more than 24 hours in the PICU. PICU Supports included adding a trained navigator to the patient's healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers. The primary outcome was percentage of "excellent" responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3-5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3-5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; SE, 4.53; 95% CI, -5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as "extremely" or "somewhat" helpful. Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.

Abstract B034: Improving patient-centered care for inflammatory breast cancer: Strategies for addressing barriers faced by patients, researchers, and providers

Abstract Introduction: Inflammatory breast cancer (IBC) is a rare but the most lethal breast cancer often misdiagnosed as mastitis or dermatitis since majority of cases lack a clinically apparent tumor mass and present with progressive breast erythema and skin edema. Further exacerbating this is its incidence, more often, in premenopausal women who have yet to initiate regular screening, and/or its manifestation in women of color, in whom the signs of disease may be more subtle. Thus, the goal of this research is to understand IBC awareness and knowledge of clinical signs related to diagnosis and treatment amongst the general public, patients, and primary care providers in order to design effective interventions to improve patient care. Methods: Responses (500+ unique) were collected from a facilitated session and representative post meeting interviews including researchers, clinicians, patients, and community stakeholders on open-ended questions related to IBC diagnosis, treatment barriers, and strategies to improve patient care. For thematic analysis, responses were subdivided into patient/community, provider, and organizational level using NVivo 12 Pro qualitative software. Grounded theory shaped both design and analysis. Results: Based on participant responses, barriers at the patient/community level (69.4%) were recognized to be the greatest. The primary factor identified was related to living in a rural community/distance to a treatment center (21.1%). At the organizational level, obstacles included limited or no access to an appropriate treatment center (42.2%), lack of IBC-specific standard of care (20.0%), lack of central source of information about IBC (20.0%) and need for trained patient navigators (8.9%). This analysis highlighted that patients often experience multiple misdiagnoses before finding a physician that correctly recognizes IBC - 79.4% responses indicated a lack of education among primary care providers (79.4%), misdiagnoses due to patients not fitting the typical breast cancer profile (13.1%), and a dearth in communication between physicians and patients (7.5%). This study also identified specific strategies, which included developing culturally tailored IBC media campaign and community-facing patient navigation to address barriers such as social support and care for patients in rural or underserved communities. Conclusions: Taken together, three themes in IBC care were identified- a) barriers to timely diagnosis and treatment, b) strategies for community engagement, and c) the need for provider education. These datasets have led to the development of survey instruments to assess gaps of knowledge during diagnosis and treatment in IBC patients and primary care providers including physicians, physician assistants, and nurse practitioners in the community. Supported by Duke SOM Interdisciplinary Colloquium (GRD); DCI Behavioral and Health Survey Research Core Award (GRD, LF, AT); C-REP 1P20-CA202925-01A12 (GRD, HH, LGS, NB); T32 Surgical Oncology training (WL). Citation Format: Larisa Gerahart-Serna, Whitney Lane, Laura Fish, Anh N Tran, Gayathri R Devi, Holly Hough, Kearston L Ingraham. Improving patient-centered care for inflammatory breast cancer: Strategies for addressing barriers faced by patients, researchers, and providers [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B034.

Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population: A Randomized, Controlled Trial.

Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center-based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list. We conducted a randomized, controlled trial of 401 patients (n=196 intervention and n=205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. A trained navigator assisted intervention participants from referral to waitlisting decision to increase waitlisting (primary outcome) and decrease time from referral to waitlisting (secondary outcome). Time-dependent Cox proportional hazards models were used to determine differences in waitlisting between intervention and control patients. At study end, waitlisting was not significantly different among intervention (32%) versus control (26%) patients overall (P=0.17), and time from referral to waitlisting was 126 days longer for intervention patients. However, the effectiveness of the navigator varied from early (<500 days from referral) to late (≥500 days) follow-up. Although no difference in waitlisting was observed among intervention (50%) versus control (50%) patients in the early period (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (75% versus 25%; hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There were no significant differences in intervention versus control patients who started evaluation (85% versus 79%; P=0.11) or completed evaluation (58% versus 51%; P=0.14); however, intervention patients had more living donor inquiries (18% versus 10%; P=0.03). A transplant center-based navigator targeting disadvantaged patients improved waitlisting but not until after 500 days of follow-up. However, the absolute effect was relatively small.

Choosing Doctors Wisely: Can Assisted Choice Enhance Patients' Selection of Clinicians?

We conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants (N = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator. Introducing patient comments enhanced engagement with the quality information but led to a decline in decision quality, particularly the consistency of choices with consumers' stated preferences. Labeling comments helped erase the decline in decision quality, although the highest percentage of preference-congruent choices was seen in the navigator arm. Engagement with the quality information and satisfaction with choices available were likewise highest in the navigator arm. Findings held for high- and low-skilled decision makers. Thus, navigator assistance may be a promising strategy for equitably promoting higher quality choices in information-rich contexts.

An intervention study to reduce black-white treatment disparities in early stage non-small cell lung cancer.

6560 Background: Racial disparities in the treatment of non-small lung cancer (NSCLC) continue to exist leading to poorer outcomes in African-Americans (AA) compared to Caucasians (C). Our previous multi-institutional prospective cohort study of 386 patients identified a surgical rate in early stage NSCLC of 66% C but only 55% AA (p = 0.05; OR 0.75; 95% CI 0.57-0.99). (Cykert et al JAMA 2010) A 3 year retrospective chart review of all patients with early stage NSCLC at the 3 academic institutions involved in this current intervention study identified 714 patients with early stage NSCLC. Baseline surgical rates 69% for C and 66% for AA. Combined stereotactic body radiation therapy (SBRT) with surgery C 80% and AA 76%. Controlling for co-morbidities, COPD, age and other demographic data, the OR for surgery AA compared to C 0.64 (95% CI 0.43-0.96) and for combined surgery or SBRT AA compared to C 0.61 (95% CI 0.43-0.96). Methods: Patients with a stage I or II NSCLC were identified and randomized to each institution’s standard of care approach or to an ‘intervention’ component utilizing a trained navigator to enhance patient communication and treatment understanding. Results: 244 patients were prospectively recruited into this intervention study. Mean age 65.7 years; 54% women; 89 (34%) AA. The intervention group showed an overall surgical rate of 74% (74.8% C, 71.4% AA; p = 0.6). Combined treatment of either surgery or SBRT increased an ablative treatment to 91.9% for C and 94.1% AA patients (p = 0.5). Logistic regression was performed comparing the intervention group to the baseline group. Results showed that overall treatment improved for both C and AA, the surgical and overall treatment disparity between C and AA was no longer present, while age, COPD, and clinical stage remained significant predictors of treatment. Conclusions: A multifaceted intervention designed to enhance patient communication and treatment understanding removed the surgical and overall early lung cancer treatment disparity between AA and C. Clinical trial information: NCT01687738.

Abstract P4-18-02: Peer navigation for people affected by hereditary breast, ovarian and related cancers: Results from the first six months

Abstract People affected by hereditary breast, ovarian, and related cancers (HBOC) due to a mutation in BRCA, or another gene that increases cancer risk, have unique support and information needs and face medical decisions that differ from survivors of sporadic breast cancer and from people at average risk for these cancers. Finding peers to talk to can be challenging, especially for people living outside of metropolitan areas. FORCE (Facing Our Risk of Cancer Empowered) developed our Peer Navigation Program to provide personalized, expert-reviewed resources and 1:1 support for people affected by HBOC, including breast cancer survivors and people at high risk for breast cancer due to a mutation in BRCA or another gene that increases cancer risk. The program utilizes a custom database that matches individuals seeking support with trained Peer Navigators who have faced similar medical challenges and decisions. Users complete an intake form, providing basic demographic, medical, and geographic information in order to match them as closely as possible to a peer volunteer. The user selects from 21 specific topics of interest to them. This generates a personalized, expert-reviewed resource guide on each selected topics, which individuals can use to make informed, shared decisions with their healthcare providers. Trained Peer Navigators conduct one-hour phone calls with program users to discuss the personalized resources and provide non-judgmental emotional support. Our goal is to match users and complete the navigation process within one week from the time they submitted their intake form. After a navigation session, both the Peer Navigator and the program participant are asked to fill out an evaluation. All Peer Navigator volunteers undergo a written and telephone interview to assure their readiness to help others. Once they pass this screening process, they complete a series of online VolunteerFORCE Academy training webinars and complete a profile form providing information about their demographics, personal and medical situation, and medical decisions. Volunteers receive training on the following: FORCE 101, HBOC 101, Active Listening Skills and Peer Navigation instructions. All webinars have been reviewed and approved by a member of FORCE's Scientific Advisory Board and our Vice President of Education. The webinars stress several important themes, including: encouraging users to discuss information with medical experts, avoiding dispensing of personal or medical advice, and maintaining a non-judgmental perspective. We have 104 trained peer navigators, both male and female, ranging in age from 21 – 73. Both cancer survivors, as well as high-risk individuals are represented. Peer volunteers come from diverse backgrounds and geographic locations, and have made a variety of medical decisions about genetic testing, cancer screening, chemoprevention, and risk-reducing surgeries. The program launched in April 2016. We will present results from post-call evaluation surveys completed from April 1, 2016 through September 30, 2016. Data on most commonly requested topics, user satisfaction, ease of use, and intention to use the information in shared decision-making with their health care provider will be presented. Citation Format: Rezende LF, Cohen S, Rose D, Friedman SJ. Peer navigation for people affected by hereditary breast, ovarian and related cancers: Results from the first six months [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-18-02.