Developing a Navigation System for Latinos with Lung or Head-and-Neck Cancer

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DESCRIPTION (provided by applicant): This is a proposal to conduct a one year developmental study designed to provide the information necessary to prepare a successful grant application to conduct a multi-center trial to test the effectiveness of navigation to improve the outcomes of Latino patients with Lung and/or Head-and-Neck (H&N) cancers. Patients with these cancers experience high levels of morbidity that often require careful coordination between multiple medical specialties to receive proper treatment and rehabilitation. Like other medically underserved patients, Latinos are disproportionately lost-to-follow-up or experience avoidable delays during this process. The many cultural, language, and health care access challenges faced by Latinos make the coordination of care especially difficult for cancers with such high morbidity as these. Thus, there is a need to create effective patient navigation programs that can better assist Latino patients and their health care team for these cancers. An in-depth interview design, augmented with medical chart reviews, will be used to obtain information on key barriers from relevant health care professionals, lay-health workers, and Lung and H&N cancer patients at Denver Health. Six key informant interviews will be conducted with health care professionals from the divisions of primary care, pulmonary medicine, otorhinolaryngology, surgery, medical oncology, and radiation oncology. Focus group interviews of 6 members each will be conducted with at least four groups of individuals: 1) patients who have or had Lung cancer, 2) patients who have or had H&N cancer, 3) caregivers of patients who have or had Lung and/or H&N cancer, and 4) lay health-workers who are employed as patient navigators for other cancer patients at Denver Health. Key informants and focus group interviewees will be asked to identify other key individuals that have not been interviewed but that should be included because of their relevant role in the care of these patients. From the list, an additional 8 individuals will be interviewed using one-on-one semi-structured interviews. The final outcome will be a protocol to be tested in a future randomized, controlled trial of a navigation program for cancer treatment and recovery for these patients. Creating effective interventions to reduce cancer treatment disparities among Latinos has significant public health implications given that Lung cancer is the leading cause of cancer death among Latinos and second among Latinas (American Lung Association, 2005).