Abstract C07: A patient-centered approach to a cancer care delivery innovation for low-income patients: Medical-legal partnership with patient navigation
Authors: Ko Naomi Y. , Bak Sharon , Han Ann , Nelson Kerrie , Gunn Christine , Bergling Emily , Castano Maria , Noel Vanesa , Festa Kate , Wang Na , Turner Wanda , Morton Samantha , Flacks JoHanna , Battaglia Tracy A. 
Published: May 2016

Abstract
Background: Disparities in cancer outcomes for low-income, racial/ethnic minority patients are worsening, partly due to delays in care delivery. Patient-centered innovations in care delivery that address these barriers are necessary to improve care for vulnerable populations.
Methods: We used a community-engaged approach to implement a randomized controlled trial for at-risk cancer patients with delays in care. We conducted focus groups with the target population and created a Patient Advisory Group and Community Advisory Board to ensure stakeholder input. With these advisory groups and a Scientific Advisory Board, we designed an intervention that represented a collaboration between patient navigation and a public interest lawyer from Medical-Legal Partnership | Boston (MLP). Each intervention patient is discussed with MLP lawyers to identify a level of legal need, and to support role-appropriate advocacy by the patient navigator. Control subjects receive the standard of care navigation services provided to patients at the institution. Eligible subjects include patients at an urban academic safety net hospital diagnosed with breast or lung cancer within 30 days and who speak English, Spanish or Haitian-Creole.
Results: To date, we have enrolled 115 breast cancer patients (79% non-White, 72% public insurance) of the target enrollment of 374 patients. Research assistants survey patients at baseline, 3, 6 and 12 months to capture patient-centered outcomes, including: a) a 15-item survey capturing socio-legal barriers under the five I-HELP categories (Income, Housing, Employment, Legal Status and Personal Stability), b) the Cancer Needs Distress Inventory (CaNDI), c) Distress Thermometer, d) the Communication and Attitudinal Self-Efficacy survey (CASE) and e) the Patient Satisfaction with Interpersonal Relations with Navigator (PSN-1). Clinical outcomes including time to first treatment and receipt of quality treatment are extracted from medical records at 6 and 12 months.
Conclusions: We demonstrate how a diverse group of stakeholders engage in patient-centered cancer care delivery research. Our study will investigate whether legally-enhanced patient navigation improves delivery of cancer care as measured by patient-centered and clinical outcomes.
ClincialTrials.gov identifier: NCT02232074.
Citation Format: Naomi Y. Ko, Sharon Bak, Ann Han, Kerrie Nelson, Christine Gunn, Emily Bergling, Maria Castano, Vanesa Noel, Kate Festa, Na Wang, Wanda Turner, Samantha Morton, JoHanna Flacks, Tracy A. Battaglia. A patient-centered approach to a cancer care delivery innovation for low-income patients: Medical-legal partnership with patient navigation. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C07.