Insights from a Patient-Centered Lung Cancer Navigation Program in a Low-Resource Community

Abstract

Barriers to cancer care, including transportation and Internet insecurity, are of special concern in low-resource communities. A patient-centered, telehealth-based, barrier-focused lay navigator program may mitigate such barriers. We share insights from a quality improvement project wherein we developed and delivered a lay navigator program in a low-resource community in the Mojave Desert. We identified 68 patients scheduled for lung cancer detection/management at our institution, 55 of whom completed a barrier assessment, enrolled in the program, and could be evaluated. Participants were predominantly older (76%), White (84%), had a cancer diagnosis at enrollment (69%), and lived in socioeconomically disadvantaged neighborhoods. Thirty-three (60%) patients had ≥1 barrier, the most common being transportation (31%), Internet (24%), and financial (24%) concerns. These barriers were more frequent among patients with a lung cancer diagnosis at enrollment. Crisis-focused and after-hours encounters were more frequently initiated by older and advanced cancer patients. Transportation and Internet concerns were significantly associated with missed appointment rates. While the scope of our findings is limited, the delivery of a telehealth-based, barrier-focused lay lung navigator program in this low-resource setting was feasible. Neighborhood context and barrier resource planning are important for the implementation of similar programs within our institution’s clinical practice network.