Advancing equity in cancer care: a pilot explanatory mixed methods study of a racially, ethnically, and linguistically concordant model of patient navigation

TL;DR

A new patient navigation model that matches patients with navigators of similar race, ethnicity, or language improves cancer care satisfaction and reduces discrimination.

Contribution

This study introduces and evaluates a racially, ethnically, and linguistically concordant patient navigation model to address cancer care disparities.

Findings

Patients in the RELC PN model showed a 4.2-point increase in satisfaction with care.

Discrimination based on race decreased from 40% to 20% in the RELC model.

RELC PN patients were more likely to discuss clinical trials (80%) compared to traditional PN (17%) and no PN (20%).

Abstract

Disparities in cancer outcomes persist among systemically marginalized patients. A new racially, ethnically, or linguistically concordant (RELC) model of patient navigation (PN) was piloted at Fred Hutchinson Cancer Center in 2019. An explanatory mixed-methods observational study assessed patient-centered outcomes of RELC PN, traditional PN, and no PN. Patients from these models completed surveys at baseline and follow-up to measure changes in satisfaction, discrimination, resilience, stress, trust, and discussion of clinical trials. Interviews with patients receiving RELC PN were analyzed using thematic analysis. A total of 118 participants completed surveys. Satisfaction with care improved by 4.2 points (SD 7.0) on an 18-item 5-point Likert scale for those receiving RELC navigation, with no change in traditional or no PN groups. Discrimination based on race dropped from 40% (n = 2) to 20% (n = 1) in the RELC model. A higher proportion of RELC PN patients (80%; n = 4) discussed clinical trials compared to traditional PN (17%; n = 3) and no PN (20% n = 19). Thematic analysis of 29 interviews indicated the model was crucial in overcoming racism, improving trust, and empowering patients. This study highlights the potential of RELC PN to improve patient satisfaction, increase participation in clinical trials, and reduce experiences of discrimination.

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