Improving cancer care for underserved populations in an academic and community practice setting: protocol for a community health worker pilot navigation programme

Abstract

Introduction: Delaying cancer treatment following diagnosis impacts health outcomes, including increasing patient distress and odds of mortality. Interventions to promote timely healthcare engagement may decrease patient-reported stress and improve quality of life. Community health workers (CHWs) represent an enabling resource for reducing delays in attending initial oncology treatment visits. As part of an ongoing programme evaluation coordinated by the Merck Foundation, we will implement a pilot navigation programme comprising CHW-conducted needs assessments for supporting patients and their caregivers. We aim to investigate (1) the programme's influence on patients' healthcare utilisation within the period between their first diagnosis and initial treatment visit and (2) the logistic feasibility and acceptability of programme implementation.

Methods and analysis: We will employ a hybrid implementation design to introduce the CHW navigation programme at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. CHW team members will use a consecutive sampling approach. Participants will complete the Problem-Checklist, Chronic Illness Distress Scale and the Satisfaction with Life Domains instruments. CHWs will provide tailored guidance by sharing information available on the Johns Hopkins Electronic Resource databases. The investigators will evaluate patients' time to initial oncology treatment and healthcare utilisation by reviewing electronic medical records at 3 and 6 months postintervention. Bivariate analyses will be completed to evaluate the relationships between receiving the programme and all outcome measures.

Ethics and dissemination: This study's protocol was approved by the Johns Hopkins School of Medicine's institutional review board (IRB00160610). Informed consent will be obtained by phone by the CHW navigator. Dissemination planning is ongoing through regular meetings between members of the investigator team and public members of two community advisory groups. Study plans include collaborating with other experts from the Johns Hopkins Institute for Clinical and Translational Research and the Johns Hopkins Center for Health Equity for ideating dissemination strategies.

Keywords: Adult oncology; ONCOLOGY; PUBLIC HEALTH.

Figure 1

Adapted Andersen’s behavioural model for healthcare utilisation. The CHW navigation programme serves as an enabling resource for promoting appointment-keeping and follow-up (ie, retention). In the model, the time to initial oncology treatment is defined as the time between the patient’s first cancer diagnosis and the start of cancer treatment. Furthermore, healthcare utilisation encompasses the provider’s recommended use of healthcare services, and the number of oncology visits, number of missed oncology visits, mortality, number of hospitalisations, and length of hospital stay are used as a proxy to measure this concept. CHW, community health worker.