Factors Associated with Patient Navigators' Time Spent on Reducing Barriers to Cancer Treatment by ProQuest


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Factors Associated with Patient Navigators’ Time
Spent on Reducing Barriers to Cancer Treatment
Chyongchiou J. Lin, PhD; Karen A. Schwaderer, RN, BSN, OCN; Keith H. Morgenlander, MPH;
Edmund M. Ricci, PhD; Laura Hoffman, BS; Elaine Martz, BS; Raymond H. Cosgrove; and
Dwight E. Heron, MD

  Financial support: This study was funded through a 5-year                     IntroductIon

  grant from the Radiation Research Program in the Cancer                              tudies indicate that individuals from racial and
  Disparity Research Program of the National Cancer Institute                          ethnic minority groups and economically disad-
  (grant #1 U56 CA105486, entitled UPMC McKeesport/Radia-                              vantaged populations in the United States are at
  tion Oncology Community Outreach Group).                                      increased risk of cancer and cancer-related death.1,2 In
                                                                                Pennsylvania, the cancer incidence and mortality rates
  Patient navigator programs were established to mitigate                       and the extent of racial and ethnic disparities in treatment
  barriers to cancer care, especially among underserved                         are higher than the U.S. average.3 For this reason, the
  populations in 3 community hospitals in western Pennsylva-                    Cancer Disparities Research Partnership (CDRP) within
  nia. This study was designed to determine and compare the                     the Radiation Research Program of the National Cancer
  time spent to enroll patients recently diagnosed with any                     Institute (NCI) began to sponsor patient navigation pro-
  type of cancer, the characteristics of enrolled patients, the                 grams at community hospital sites in Pennsylvania.
  types of barriers to treatment and the time it took patient                       Patient navigator programs are innovative case man-
  navigators to address barriers. At enrollment, 253 (85%) of                   agement and outreach programs in which healthcare pro-
  299 enrollees reported barriers, most frequently problems                     viders, social workers and other trained individuals acting
  with insurance and out-of-pocket expenses (31.5%) and                         as “navigators” help patients overcome barriers to receiv-
  transportation (24.6%). Navigators spent an average of 2.5                    ing education about and care for cancer and cancer-related
  hours per patient. They spent significantly more time helping                 problems. As there are known cultural differences among
  uninsured than insured patients and helping patients at the                   racial and ethnic groups in attitudes and behaviors regard-
  inner-city site. The most time was spent on financial problems                ing health and disease, it is essential that navigators be
  (169 minutes), transportation problems (74 minutes), end-of-                  able to address culturally specific health beliefs.4 The most
  life issues (65 minutes), arrangement for dependent care                      well-known patient navigator program was developed and
  (60 minutes), scheduling of appointments (34 minutes) and                     promoted by Dr. Harold Freeman at the Harlem Hospital
  assistance with activities of daily living (24 minutes). Over-                in the early 1990s, and it targeted education and screening
  all, financial barriers were the most often reported and the                  for breast cancer.5,6 Since that time, patient navigator pro-
  most time consuming. Patient navigators assisting cancer                      grams have evolved rapidly, and models of patient navi-
  patients, especially the poor and underserved, will require                   gator programs have become more clearly formulated.4,7-9
  significant time to address patients’ financial and other bar-                Among existing programs, some navigators are lay com-
  riers to care. This information will be helpful in the allocation             munity members, while others are professional nursing or
  of staff time and case loads for future programs.                             social services staff.10 In most cases, patient navigator pro-
                                                                                grams have been established at academic research hospi-
  Key words: race/ethnicity n cancer n barriers
                                                                                tals. Few have been implemented in community hospitals.
                                                                                Patient navigator programs can be disease- or population
© 2008. From the Department of Radiation Oncology (Lin, Heron), Divi-
sion of Hematology/Oncology, Department of Medicine (Morgenlander),
                                                                                specific. Although many programs exist, patient naviga-
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