Abstract P6-11-10: Patient reported measures of a breast cancer nurse navigator program in a minority, rural, and economically disadvantaged patient population
Authors: Williams Michael , Nielson Dianne , Dayao Zoneddy , Brown-Glabberman Ursa , Tawfik Bernard 
Published: March 2020

Background: A Breast Cancer Nurse Navigator (BCNN) is a designated nurse specially trained to follow and support patients and their loved ones through their cancer treatment. BCNNs have been shown to improve patient experience, improve quality of life, and reduce delays in care. In 2017, the University of New Mexico Comprehensive Cancer Center (UNMCCC) instituted a Nurse Navigator program aimed at improving the treatment experience of the unique patient population the institution is intended to serve, primarily minority, rural, and economically disadvantaged patients. Approximately 22% of New Mexicans live in rural areas, and New Mexico ranks 49thin the nation in terms of poverty, with 19.7% of the population living below the poverty line. Both of these predispose to across the board poorer health outcomes and poorer cancer outcomes, including a link between poverty and higher cancer mortality. New Mexico is home to over 200,000 Native Americans, making up 10.4% of the state population, and 1 million Hispanics, making up 48% of the state population. Both groups suffer worse outcomes, increased barriers to care, and overall measurably lower quality of life. UNMCCC’s BCNN program aligns with the American Society of Clinical Oncology’s new task force to address the rural cancer care gap.

Methods: Surveys to assess patient satisfaction and services utilized were administered anonymously during regularly scheduled appointments at UNMCCC between April 29 and June 7, 2019 to breast cancer patients, both those under the care of the BCNN and those whose care began prior to the beginning of the program. There were 32 “non-navigated” patients responding, and 54 “navigated” patients. Yes/no questions were converted to binary and Likert Scale questions were converted to scores ranging from 1-5, 1 signifying “Strongly Agree” with 5 signifying “Strongly Disagree.” Results were assessed using two sample T-Tests assuming unequal variances.

Results: Navigated patients more strongly agreed that they were prepared for the beginning of treatment when compared to their non-navigated peers (1.558 vs 2.103, p=.020), and showed a decreased desire for an after treatment summary (.918 vs 1.0, p=.044). They also reported that calls were returned promptly when compared to their non-navigated peers (1.33 vs 1.8, p=.003). Navigated patients were subjectively more likely to agree that office staff were knowledgeable about their treatment plan than the non-navigated patients (1.509 vs 1.806, p=.134). Navigated patients were more likely to agree that the BCNN helped them understand treatment plans (1.549 vs 1.710, p=.437), took their concerns seriously (1.434 vs 1.516, p=.579), and helped manage side effects (1.689 vs 1.923, p=.356).

Conclusions: The navigated patients perceived that their calls were returned more quickly, which improves patient satisfaction and confidence in the treatment plan and care team. Navigated patients also displayed stronger agreement that they were prepared for the beginning of their treatment, which was supported with a decreased desire for an after treatment summary, suggesting that patients felt overall more knowledgeable about their care. There were subjective improvements in all other treatment related metrics that were not statistically significant though likely limited by the small sample size. This study shows that patients in a unique minority, rural, and economically disadvantaged population subjectively report better understanding of and engagement with the health care system when assisted by a BCNN during the treatment of curative breast cancer, an effect which has not been well demonstrated before.

Acknowledgements: Special thanks to Patricia Kuhne and Susan Martinez for their assistance, without which this project would not have been possible.

Citation Format: Michael Williams, Dianne Nielson, Zoneddy Dayao, Ursa Brown-Glabberman, Bernard Tawfik. Patient reported measures of a breast cancer nurse navigator program in a minority, rural, and economically disadvantaged patient population [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-10.