title: Recruiting newly referred lung cancer patients to a patient navigator intervention (PACO): lessons learnt from a pilot study.
abstract: OBJECTIVE
  The incidence of and survival from lung cancer are associated with socioeconomic position, and disparities have been observed in both curative and palliative treatment for lung cancer. 'Patient navigation' is valuable in addressing health disparity, with timely treatment and transition to care. We conducted a pilot study to test the feasibility of a patient navigator program (PAtient COach) for newly diagnosed lung cancer. We present the trial, the findings from the pilot study and discuss factors that might have affected recruitment rates.
  
  
  METHODS
  We invited 24 lung cancer patients referred for chemotherapy to the Oncology Department at Herlev University Hospital, Denmark, to participate in the pilot study. To be eligible, patients had to live alone, have no formal education beyond secondary school, have one or more comorbid conditions, have a performance status of 1 or 2 or be over 65 years of age. The patient navigators targeted four phases of treatment: planning, initiation, compliance and end of treatment.
  
  
  RESULTS
  Six months after the start of the study, we had recruited only six patients, due mainly to inherent patient resistance and because only 50% of eligible patients were invited. Of the 18 patients who did not wish to participate, 13 agreed to fill in a baseline questionnaire. The most frequent reason given for not wanting to participate was a belief that a patient navigator would be of no benefit.
  
  
  CONCLUSIONS
  The pilot study met a number of internal and external obstacles to patients' recruitment. The study provides insight into the barriers to recruitment of socially disadvantaged cancer patients to clinical trials and will inform future trial designs.
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Trille Kristina
authors.initials: TK
authors.lastname: Kjær
authors.affiliation: b Department of Oncology , Herlev Hospital, University of Copenhagen , Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Mellemgaard
authors.affiliation: b Department of Oncology , Herlev Hospital, University of Copenhagen , Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Stensøe Oksen
authors.affiliation: c Department of Patient Support and Community Activities , Danish Cancer Society , Denmark.
authors.forename: Bo
authors.initials: B
authors.lastname: Andreassen Rix
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Randi
authors.initials: R
authors.lastname: Karlsen
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.|d Department of Oncology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.affiliation: a Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Susanne Oksbjerg
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D062526:Patient Navigation; D018579:Patient Selection; D010865:Pilot Projects; D012017:Referral and Consultation