If We Build It, Can It Be Sustained? An Implementation Science Initiative to Reduce Barriers to Cancer Care via Community-Focused Patient Navigation

Abstract

Within the context of cancer, patient-reported barriers to care disproportionally impact underserved patients. Barriers represent one of the primary drivers of cancer health disparities, contributing to higher cancer incidence, later stage at diagnosis, and higher likelihood of mortality. Patient navigation is an evidence-based intervention designed to reduce cancer health disparities by reducing patients’ barriers to care and improving their access to high quality cancer treatment. Despite their widespread success in enhancing patient outcomes, patient navigation interventions have yet to deliver on their full promise to reduce cancer health disparities, and this is likely due to ineffective program implementation. This dissertation is comprised of three chapters, including a summary of a published article in Cancer (Ver Hoeve et al., 2022; full article in Appendix A) and two stand-alone manuscripts which will soon be submitted for peer-reviewed publication. Chapter 1 summarizes patient navigation implementation and expansion recommendations developed across six comprehensive cancer centers participating in the Merck Foundation’s, Alliance to Advance Patient-Centered Cancer Care. Chapter 2 utilizes an implementation science framework, RE-AIM, to evaluate implementation of a community-focused patient navigation intervention at the University of Arizona Cancer Center. Chapter 3 explores opportunities for patient navigation intervention optimization, highlighting, in particular, barrier resolution likelihood and efficiency. Together, this program of research utilizes implementation science methodologies and intervention optimization strategies to strengthen the effectiveness of evidence-based interventions that reduce cancer health disparities.