Patient navigation to address sociolegal barriers for patients with cancer: A comparative‐effectiveness study

Abstract

BACKGROUND: Sociolegal barriers to cancer care are defined as health-related social needs like affordable healthy housing, stable utility service, and food security that may be remedied by public policy, law, regulation, or programming. Legal support has not been studied in cancer care. METHODS: The authors conducted a randomized controlled trial of patients who had newly diagnosed cancer at a safetynet medical center in Boston from 2014 through 2017, comparing standard patient navigation versus enhanced navigation partnered with legal advocates to identify and address sociolegal barriers. English-speaking, Spanish-speaking, or Haitian Creole-speaking patients with breast and lung cancer were eligible within 30 days of diagnosis. The primary outcome was timely treatment within 90 days of diagnosis. Secondary outcomes included patient-reported outcomes (distress, cancer-related needs, and satisfaction with navigation) at baseline and at 6 months. RESULTS: In total, 201 patients with breast cancer and 19 with lung cancer enrolled (response rate, 78%). The mean patient age was 55 years, 51% of patients were Black and 22% were Hispanic, 20% spoke Spanish and 8% spoke Haitian Creole, 73% had public health insurance, 77% reported 1 or more perceived sociolegal barrier, and the most common were barriers to housing and employment. Ninety-six percent of participants with breast cancer and 73% of those with lung cancer initiated treatment within 90 days. No significant effect of enhanced navigation was observed on the receipt of timely treatment among participants with breast cancer (odds ratio, 0.88; 95% CI, 0.17-4.52) or among those with lung cancer (odds ratio, 4.00; 95% CI,. No differences in patient-reported outcomes were observed between treatment groups. CONCLUSIONS: Navigation enhanced by access to legal consultation and support had no impact on timely treatment, patient distress, or patient needs. Although most patients reported sociolegal barriers, few required intensive legal services that could not be addressed by navigators.

Lung Cancer Patients’ Conceptualization of Care Coordination in Selected Public Health Facilities of KwaZulu-Natal, South Africa

“…The recommended strategies provided by respondents in this study align with several World Health Organization (WHO)-identified actionable priorities to enhance continuity and coordination of care [ 99 ]. The concept of a patient navigator should be considered [ 56 ]. The navigator may also assist with monitoring and facilitating the patient’s care [ 100 , 101 , 102 , 103 ].…”

“…Research focusing on health care delivery has revealed the complexity of coordinating care for people with cancer and proposes some promising interventions [ 54 , 55 ]. Recent studies and reviews on cancer care coordination interventions have found that patient navigation, designated care coordinators, and collaborative care models are among the common approaches implemented [ 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. Multiple barriers to improving the provision of cancer care exist, including lack of social support, financial concerns, and problems with healthcare communications; in this context, effective care coordination is required [ 8 , 12 , 24 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ].…”

Systematic Review of Interventions Addressing Racial and Ethnic Disparities in Cancer Care and Health Outcomes

“…The median number of participants per study was 127 (range, 626). Among the 27 6,7,15,16,[19][20][21][22][23][24][25][26][27][28][29][30][36][37][38][39][40][41][42][43][44][45][46] studies reporting the mean or median age of the participants, the pooled average age was 56 6 12 years. Furthermore, 14 studies reported the insurance status of their participants.…”

“…These initiatives seek to enhance health care accessibility by encouraging early detection and screening, 5 increasing treatment adherence, 6 and eliminating barriers to the efficient delivery and receipt of optimal cancer care. 7 However, there are gaps in our understanding of the most effective design and implementation of interventions that could be widely disseminated to alleviate the burden of cancer-related health disparities, especially among marginalized racial and ethnic groups.…”

Solidifying roles, responsibilities, and the process of navigation across the continuum of cancer care: The Professional Oncology Navigation Task Force

“…Battaglia et al 12 analyzed standard patient navigation versus navigation supported by legal advocacy to specifically address barriers like unstable housing, utility services, and food insecurity. They report that almost all patients in both groups experienced the same levels of distress and needs, received timely care, and reported satisfaction.…”