Disparities in cancer treatment outcome in racial/ethnic minorities and low-income patients abound. Under the auspices of the National Cancer Institute (NCI) Cancer Disparities Research Program (CDRP), the Urban Latino African American Cancer Disparities Project (ULAAC) investigates and addresses root causes of disparity and offers access to clinical trials for an underserved community. We report the evolution through continuous quality improvement (CQI) mechanisms of a novel infrastructure designed to address barriers to care, supply patient navigation and access to clinical trials (CT).
Material/Methods
Our patient population is 71% Black, 13% Latino with mean family incomes below the poverty level. Infrastructure implemented to address critical patient needs includes training and management of lay patient navigators (LPN), rigorous tracking and focus on solution for barriers to care, clinical trials infrastructure, and ongoing CQI of all aspects of the program. Utilizing feedback from interviews, focus groups and survey instruments; training, barrier identification process, patient satisfaction and CT acceptance practice are critically examined to implement alteration of process to enhance program quality.
Results
Of 68 ethnically and linguistically appropriate LPNs trained (7 training groups), 26 continue to navigate patients. Of 493 patients offered navigation, 297 accepted. Six most prevalent barriers to care are designated in the Table 1. Initially, the mean time to solution identification for barriers was 42 days. CQI process improvement allowed mean time to resolution to fall to one day. Originally, to facilitate clinical trial acceptance, LPN met with patients at initial consultation. However, navigator focus groups revealed that LPN's possessed similar negative bias towards clinical trials as the community at large. Therefore training of LPN was modified from 6 to 9 hours and early LPN patient contact was reintroduced. In 24 months, 29 patients were enrolled in 32 clinical trials. Of 29 patients, 18 accepted navigation. 15/29 patients enrolled in RTOG trials.
Conclusions
The ULAAC program has put into operation an infrastructure designed to deal with the needs of indigent cancer patients. The program's goal to decrease barriers to receiving care while assisting accrual to clinical trials appears facilitated by the lay patient navigation program described. The CQI program allows for essential programmatic adjustments and management.
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