Abstract B038: The effects of coaching and action planning on patient activation and quality of life in vulnerable cancer patients
Authors: Roberts Shelby S. , Wiatrek Dawn , Erb Nicole , Sharpe Katherine 
Published: August 2020

Introduction: The American Cancer Society Patient Navigator Program assists high-need, vulnerable patients in overcoming nonmedical barriers to cancer care with the goal of improving treatment adherence, completion, and patient quality of life.

Methods: In the last year, the American Cancer Society has been implementing a pilot program aimed at increasing the activation and quality of life of patients at 6 navigation program sites nationwide. The sites were selected based on patient need, geographic location, and cancer center type. Navigators completed a 7-part training series focusing on coaching and communication skills and slight modifications were made to the current lay navigation protocol, including addition of the Insignia Health Patient Activation Measure® (PAM®) Survey, a patient satisfaction survey, formal action planning with the patient, and follow-up on the action plan over a period of at least 3 visits. Results are measured by ability of the patient to achieve the set actions in the plan, ability of the patient to overcome or successfully manage nonmedical barriers to care, and change in the patient's activation score. The following results are from the 3 sites in phase 2 of implementation.

Results: After 6 months of implementation, 419 patients have been enrolled in phase 2 of the program. Patients represent 6 different races with African American/Black (40%) and Hispanic/Latino (36%) being most common. Medicaid is the most common form of insurance (42%) and 79% of patients are either insured by Medicaid, Medicare + Medicaid (10%), or uninsured (27%). Patient diagnoses span 32 different cancer types. Early results show positive uptake of the program among navigators and patients with all navigators reporting utilization of new coaching-based training skills, and 95% of patients reporting creating an action plan with their navigator. After their first meeting with the navigator, patients rated their confidence the action plan would work at an average of 8.7/10. Initial patient reactions also indicate a high level of satisfaction with a 4.4/5 average score when asked how much they agreed with the statement: “The navigator made me feel better about my ability to manage my diagnosis and treatment.” 182 patients have completed at least one follow-up visit with the navigator in the first 6 months. These patients set 634 actions with navigators and progress has been made or achieved on 76% of these actions by the first formal follow-up visit. 29 patients have completed the full program with 78% of barriers overcome or successfully managed. 100% of patients completing the program also completed treatment, and the average PAM® score increased by +4.15 points. The project is still ongoing. Final results of the pilot are expected in late 2019.

Conclusion: Navigation with coaching and action planning tailored to the patient's activation level is a successful method to assist vulnerable populations with overcoming nonmedical barriers to cancer care and increasing patient activation.

Citation Format: Shelby S. Roberts, Dawn Wiatrek, Nicole Erb, Katherine Sharpe. The effects of coaching and action planning on patient activation and quality of life in vulnerable cancer patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B038.