Barrier resolution via patient navigation in the context of cancer care

Patient navigation programs have demonstrated intervention efficacy associated with barrier reduction and health outcome improvements in the context of cancer care. Greater characterization of barriers and barrier resolution likelihoods may support program optimization.

A 3-month longitudinal, non-comparative community-focused (i.e., lay navigator) patient navigation program was implemented at an NCI-designed cancer center between 2018 and 2021. Barriers to cancer care were reported by patients (n = 207) at pre-intervention and re-assessed at post-intervention. Descriptive analyses examined patient-level associations among pre-intervention barriers and post-intervention rates of barrier resolution. Logistic regressions were conducted at the barrier level and patient level to estimate the likelihood of barrier resolution associated with Health Access, Financial, and Psychosocial barrier domains.

Participants reported an average of 3.54 distinct barriers to cancer care. Barriers associated with Health Access and Financial domains were most frequently endorsed. Post-navigation, barriers were found to differ in their resolution rates. At the barrier domain level, resolution rates differed significantly (X²(2) = 7.826, p = 0.02), with Financial barriers significantly less likely (OR = 0.61; 95% CI = 0.41, 0.89) to be resolved. For participants who reported barriers exclusively within the Financial domain, the odds of any of their barriers being "resolved" were approximately 77% lower compared to participants who reported barriers in other domains.

In this community-focused patient navigation program, barriers in the Financial domain proved to be the most difficult to resolve. The amenability of specific barriers to resolution via patient navigation can guide program tailoring and optimization.