Abstract A18: Cancer patient navigation in the unique social and health care environment of Appalachia: Results from the Appalachia Community Cancer Network (ACCN)
Authors: Lengerich Eugene , Aumiller Betsy , Bencivenga Marcy , Louis Christopher J. , Fleisher Linda , Paskett Electra , Dignan Mark B. 
Published: June 2012

Research Objective: Many cancer patients face substantial barriers to the delivery of effective, coordinated care. Coupled with areas of low socio-economic status, the mountainous region and shortage of cancer care providers present unique challenges to these patients. As a result, cancer patient navigation has emerged as a possible solution to these problems; with its community and organization-focused strategy to alleviate barriers to obtaining timely screening, diagnosis, and treatment. Our study aims were to examine cancer patient navigation in Appalachia and consisted of three main objectives; (1) to assess the extent of cancer patient navigation utilization in Appalachia, (2) to describe the characteristics and functions of patient navigators, and (3) to identify facilitators and barriers to successful navigation adoption and execution in Appalachia.

Study Design: Using a snowball sampling technique that began with program managers of the ACCN, we conducted 29 semi-structured interviews with key informants in Appalachia. Interviewees included patient navigators, representatives from health care and voluntary organizations, and government agencies, including those who do not, but would like to, offer patient navigation. We used a predetermined coding scheme with review by multiple reviewers of audio transcripts to identify patient navigator characteristics, barriers and facilitators to cancer services, and the use of patient navigation across communities. We stratified our analysis into organizations that do and do not currently utilize cancer patient navigation.

Sample: We studied community and organization-based cancer patient navigation programs in Appalachia. Principle Findings: Cancer patient navigation is limited but growing in Appalachia. Our findings suggest that strong cultural networks embedded within the rural regions heighten the need for navigators that have personal relationships with and knowledge of Appalachian communities. Community connection optimizes the navigator's functionality in attaining compliance to cancer treatments by disparate populations. Thus, the most common characteristics of successful patient navigators suggested by the interviewees included “close community connection” and “the ability to work with others”. Moreover, the vast majority of informants were paid, female staff members residing in rural areas. Sixty-five percent of our informants were trained health care professionals, while 35% were lay persons. Interviewees also acknowledged limited coordination of cancer services across health care and non-health care institutions in addition to a lack of cancer treatment resources. This elevates barriers for patients including transportation to appointments, accessing medications, and insurance.

Conclusions: In addition to socio-economic challenges, many Appalachian residents experience increased distances to cancer services, fewer cancer centers, and unique cultural characteristics. The contributions of navigators with strong community affiliations are more positively accepted by local residents. Navigators exhibiting these characteristics also promote more efficient use of organizational and community resources. Thus, consideration of this during the creation of a patient navigator program is paramount.

Implications for Policy, Delivery, or Practice: Limited financial resources for patient navigation have halted progress in improving cancer health outcomes. Increased attention in this area will enable organizations to commence patient navigation programs in underserved areas of Appalachia and assist in alleviating barriers to cancer care. Managers of health care and non-health care institutions may also use patient navigation to collaborate more effectively in aligning cancer services for residents.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A18.