title: Feasibility of a psychosocial and patient navigation intervention to improve access to treatment among underserved breast cancer patients.
abstract: OBJECTIVE
  Medically underserved women with recently diagnosed breast cancer face a number of significant obstacles that impact the timeliness and quality of their care. The Breast CARES (Cancer Advocacy, Resources Education and Support) intervention combined patient navigation with telephone counseling to guide newly diagnosed breast cancer patients in overcoming treatment barriers. The study aimed to learn more about the types of barriers encountered by the participants. The study also sought to understand the relationship between patient-reported barriers and patient-reported psychosocial distress in underserved women recently diagnosed with breast cancer.
  
  
  METHODS
  Data were analyzed using a mixed-methods approach. Participants were assessed pre- and post-intervention. Psychosocial measures included cancer-related distress, depression, anxiety, social support, and quality of life. Case notes and responses to process evaluation questions were used to determine whether the CARES intervention adequately addressed the needs of the participants.
  
  
  RESULTS
  The mean age of participants (N = 20) was 54 years (SD = 12.5), 40% were Hispanic, 70% were unemployed, 50% were uninsured, and 20% were mono-lingual in Spanish. Qualitative analysis revealed four categories of barriers: psychosocial, medical, logistical, and communication. Similarities and differences existed between the PN and TC regarding how barriers were addressed. Post-intervention psychosocial scores indicate a decrease in depression and cancer-related distress and an increase in social support. The participants reported that participation in the Breast CARES program helped them overcome financial barriers (73%), transportation problems (60%), and communication barriers with medical staff (73%).
  
  
  CONCLUSIONS
  This study demonstrates the unique and complementary roles for PNs and TCs in overcoming barriers to treatment adherence faced by underserved breast cancer patients.
authors.affiliation: University of Colorado Denver, Downtown Campus, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, USA, shannon.madore@ucdenver.edu.
authors.forename: Shannon
authors.initials: S
authors.lastname: Madore
authors.forename: Kristin
authors.initials: K
authors.lastname: Kilbourn
authors.forename: Patricia
authors.initials: P
authors.lastname: Valverde
authors.forename: Evelinn
authors.initials: E
authors.lastname: Borrayo
authors.forename: Peter
authors.initials: P
authors.lastname: Raich
mesh_terms: D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy*; D003144:Communication Barriers; D003376:Counseling / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D062526:Patient Navigation / Q000379:methods*; D011788:Quality of Life; D012944:Social Support; D017216:Telemedicine / Q000379:methods*; D035862:Vulnerable Populations / Q000523:psychology*