Fresno Breast Cancer Navigator Pilot Program
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Introduction to the research topics: National and California studies show continuing disparities in breast cancer care and outcomes by race/ethnicity and insurance status. We believe these patterns are also replicated in the Central Valley, particularly among women who receive care from safety-net providers. Breast cancer care is a complex, multi-stepped process with many opportunities to fail to provide care that meets national quality guidelines. Failure to provide complete care is known to be the primary cause of racial/ethnic and insurance disparities in survival. These failures may arise because of characteristics of the health care system, community resources, practitioners, or patients. Our project builds on the navigator model where paraprofessionals, such as community health workers, offer culturally-tailored assistance to women throughout the diagnosis and treatment process to reduce the unequal burden of breast cancer.
 
 
 
 
 
 
 
 Central hypotheses of the research: We propose an 18-month research pilot project in Fresno County to identify barriers to complete breast cancer care and design a navigation service that responds to our diverse community and health system. The pilot will prepare for a larger project that tests health and cost impacts of the service. The project site is University Medical Center, one of four acute care hospitals of Community Medical Centers, the region’s largest provider of health services in Central California. The pilot study will identify the points in the process where disparities in care occur. Where does the process of completing a cancer care program break down for women of color and those without adequate insurance? How can navigators best assist women in completing their care? What new community resources are needed to improve the quality of care? Can the cost-effectiveness of this service be tested?
 
 
 
 
 
 
 
 General methodology: First, medical records will be reviewed for a sample of patients who were determined to have abnormal screening findings. Individual cancer survivors, community organizations, and health practitioners will combine this information and personal experiences to identify barriers to complete care and ways to overcome them by adapting navigator programs from other settings to the Central Valley. Second, we will mount a pilot navigator program to explore its feasibility and acceptability to patients and providers. The pilot program will provide culturally-tailored help to patients in completing cancer care and help us identify other changes in the health system and new community resources that could improve the quality of breast cancer care.
 
 
 
 
 
 
 
 Innovative elements of the project: The project will model a community-participatory approach to adapting breast cancer navigation to the uniquely multicultural and tightly constrained health systems that characterize California and other locales. A unique aspect of this navigator model program is the use of a controlled experimental approach to interpret the results. The project brings together an unprecedented partnership with nationally recognized expertise: Central Valley Health Policy Institute - under the leadership of breast cancer and medical care inequalities researchers, San Joaquin Valley Health Consortium – the region’s leading health program administrator and expert on innovative academic/ community partnerships, and University Medical Center – the primary breast cancer care provider for low-income women in the region.
 
 
 
 
 
 
 
 Community involvement: The project was first envisioned by staff of the participating community-based organizations and the safety-net provider. This community group formed a sixteen-member Steering Committee to guide the project and to formalize further community outreach. The project Concept Paper became the topic of a community-wide discussion at the Central Valley Health Policy Conference in December, 2005. Additional community-based organizations have committed to serve as project partners, informing and participating in all program decisions, and ensuring advocacy awareness and involvement in the effort. These organizations have identified breast cancer survivors who belong to the target racial/ethnic and insurance status groups and who will become lay partners in all decision-making for the project. They will share their own experiences with other project partners through individual and group consultations throughout the project.