title: Lay patient navigator program implementation for equal access to cancer care and clinical trials: essential steps and initial challenges.
abstract: BACKGROUND
  Disparities in cancer detection, treatment, and outcomes among racial/ethnic minorities and low-income patients are well documented. One way to reduce these disparities is to use patient navigators to address barriers to care. However, little information about optimal characteristics of navigator programs or considerations for those interested in setting up such programs is available.
  
  
  METHODS
  The design and implementation of a patient navigator program for underserved cancer patients in an urban, nonacademic community hospital setting is described. The program, which used lay navigators, was conceived as a component of the Urban Latino African American Cancer (ULAAC) Disparities Project in South Los Angeles, a National Cancer Institute (NCI)-sponsored project to improve cancer care and clinical trial access for minority and low-income patients.
  
  
  RESULTS
  Careful initial planning, including input from a community advisory committee, was essential to smooth program implementation. Thirty-one volunteers completed navigator training in the program's first year of operation. Of 135 patients offered navigation services, 75 (56%) accepted, and preliminary feedback from patients, navigators, and providers suggests high levels of satisfaction with navigation. Standardized templates used by navigators and staff to record key information are proving helpful for monitoring quality and outcomes (such as effectiveness in addressing specific barriers to care) and continually improving the program.
  
  
  CONCLUSIONS
  The ULAAC program represents a viable model for developing lay navigator programs in community hospitals. Preliminary assessments suggest that the program has a positive effect on minority and low-income cancer patients' experience with care and reduces barriers to care. Additional time and research are needed, however, to fully assess the impact on care and outcomes.
authors.affiliation: Radiation Oncology, Centinela Freeman Regional Medical Center, Inglewood, California, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steinberg
authors.forename: Allen
authors.initials: A
authors.lastname: Fremont
authors.forename: David C
authors.initials: DC
authors.lastname: Khan
authors.forename: David
authors.initials: D
authors.lastname: Huang
authors.forename: Herschel
authors.initials: H
authors.lastname: Knapp
authors.forename: Deborah
authors.initials: D
authors.lastname: Karaman
authors.forename: Nell
authors.initials: N
authors.lastname: Forge
authors.forename: Keith
authors.initials: K
authors.lastname: Andre
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Chaiken
authors.forename: Oscar E
authors.initials: OE
authors.lastname: Streeter
mesh_terms: D002986:Clinical Trials as Topic; D006297:Health Services Accessibility; D006801:Humans; D008913:Minority Groups; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D010344:Patient Advocacy; D012923:Social Class