Abstract A68: What do they do? The art and science of patient navigation among underserved Latina minorities: The significance of language
Authors: Ramirez Amelie G. , Perez-Stable Eliseo J. , Penedo Frank , Talavera Gregory A. , Carrillo J. Emilio , Fernandez Maria , Holden Alan E. C. , Munoz Edgar , Miguel Sandra San , Gallion Kipling 
Published: October 2015

Abstract
Background: Patient Navigation has evolved to reduce cancer health disparities by eliminating barriers to diagnosis, treatment, and survivorship services. Attempts have been made to describe barriers to care and navigator actions. Little attention has been paid to the unique needs of underserved minorities. Here we describe barriers to care reported by Latina survivors in the context of a social-ecological framework, actions taken by navigators to resolve those barriers, and the consequences of those activities.
Methods: We evaluated 399 barriers to care reported by Latinas diagnosed with cancer as part of Redes En Acción: The National Latino Cancer Research Network from July 2008-January 2011. Navigators maintained monthly logs of encounters with patients and recorded reported barriers to care and actions taken to overcome each barrier. Spearman Correlation, Chi-squared analysis and Cox proportional hazards models were used to assess the barriers and actions.
Results: The most common barrier to care was needed Spanish-English translation (55.6%). Personal (e.g. fear) and system barriers (e.g. insurance) accounted for the remainder. 85% of all Latinas reported one or more barriers; 37% reported more than one. Multiple (2+) barriers resulted in slightly longer time to treatment (aHR [adjusted Hazard Ratio]= 0.871; p &lt; .05). However this disappeared when barriers were tallied without translation (aHR=0.964; p=.982). Many barriers not specifically reported to be language-based in nature were resolved by providing translation services in the social-ecological context of the reported problem. This was reflected in significant correlation between patient-reported barriers involving Health Education, Insurance issues, Fear, and Beliefs and navigator actions regarding translation services (all p &lt; .05). For example, of 70 instances of “fear” reported as a barrier to care, 12 (17.1%) were resolved with a translation action.
Conclusions: Barriers reported by Latinas are predominantly linguistic in nature. Multiple barriers appear to result in a delay between diagnosis and treatment initiation; however this effect disappears when accounting for the effects of a language barrier. Health care systems must attend to the special needs of underserved minorities when planning and improving programs.
Citation Format: Amelie G. Ramirez, Eliseo J. Perez-Stable, Frank Penedo, Gregory A. Talavera, J. Emilio Carrillo, Maria Fernandez, Alan E. C. Holden, Edgar Munoz, Sandra San Miguel, Kipling Gallion. What do they do? The art and science of patient navigation among underserved Latina minorities: The significance of language. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A68.