Patient Navigation Program

Principal Investigator: Mona Fouad, MD, MPH, University of Alabama at Birmingham
Co-Investigator: Michelle Martin, PhD, University of Alabama at Birmingham
Program Manager: Nedra Lisovicz, PhD, MPH, CHES
Funding Source: National Cancer Institute (NCI)
Grant Number U54 CA 118948

Patient Navigation began as a pilot project called Community Health Advisors in Action Program (CHAAP), funded by the Avon Foundation, under principal investigator Mona Fouad, MD, MPH. CHAAP was a pilot study that used trained community volunteers to help women who had received an abnormal breast cancer screening or a confirmed diagnosis of breast cancer receive appropriate care and comply with the recommended medical follow-up and/or treatment. 

The pilot program evolved into the Patient Navigation Program entitled Increasing Minority Participation in Clinical Trials (IMPaCT). The IMPaCT Program was implemented in 2006 to provide equal access to clinical trials for low-resource and minority patients by helping them overcome barriers to participation.

IMPaCT has three goals:
  1. educate minority patients with cancer about therapeutic trials;
  2. help recruit minority cancer patients into clinical trials; and
  3. help retain minority cancer patients who are already in cancer clinical trials.  
The IMPaCT project is based on the Community Health Advisor (CHA) and Patient Navigation models, which enable indigenous members of underserved communities who are uniquely knowledgeable about their community’s needs to serve in a leadership capacity as educators, navigators, and local agents of change.

UAB used these successful models, which have proven to be very effective in low-income, underserved African American communities, to train community members as Patient Navigators who identify barriers to participation in clinical trials by African American cancer patients and provide navigation and case-management support to overcome these barriers  The success of our IMPaCT project led to the funding of two additional grants in September 2009 that expanded the model program locally and replicated it nationally. 

The Patient Navigators IMPaCT program was expanded into a consortium of five regional institutions, creating a national network of centers of excellence through NCI-funded cancer centers. The new initiative is entitled Enhancing Minority Participation in Clinical Trials (EMPaCT), and has clear criteria for establishing evidence of minority accrual and retention in clinical trials.  

This program engages National Center on Minority Health and Health Disparities (NCMHD)-funded centers that work to eliminate health disparities, but who have limited opportunity to influence minority recruitment and retention in clinical trials. Combining these two types of National Institutes of Health (NIH)-established centers of excellence via a national network and regional consortia provides a unique opportunity to influence minority participation in clinical trials on a national level.

UAB’s central task for this project is to implement the IMPaCT Patient Navigation model at each of the Cancer Centers—the University of Minnesota, Johns Hopkins Cancer Center, the University of Texas-MD Anderson, and the University of California-Davis Cancer Center. This project provides the opportunity to further refine and evaluate the IMPaCT Patient Navigation project. Importantly, the EMPaCT consortium creates a national infrastructure to assess institutional barriers and develop strategies to increase minority participation in clinical trials. UAB investigators and staff play vital roles in coordinating and evaluating EMPaCT objectives and activities to reduce health disparities. UAB provides training manuals and materials and sends staff members to conduct training sessions at each institution. The UAB Retention and Recruitment Shared Facility participates in data collection, development of patient education materials/communication channels, implementation, and evaluation of other goals identified by consortium members. 

Based on the success of the lay navigator model of IMPaCT, the model was expanded to the Integrated Multidisciplinary Cancer Care Program (IMCCP) in which Patient Navigation services are provided in support of the IMCCP. The IMCCP was created to provide a more efficient coordinated patient care model so that new cancer patients can interface with all the appropriate clinicians during their first visit and have a treatment plan at the end of the day, rather than having to schedule numerous appointments for consultations and tests over a period of days or even weeks (fragmented care serves as a large barrier to patients for whom transportation issues and time away from work or family pose considerable problems, e.g., minorities and elders).  

An IMCCP patient care coordinator refers each new patient to a Patient Navigator who makes contact and administers a needs assessment prior to the first appointment.  The Patient Navigator determines if there are any barriers (transportation, financial, insurance, etc.) that might prevent the patient from getting to the appointment.  If so, the navigator works with social service providers to overcome the barriers and meets the patient at the clinic visit.  For minority patients, the navigator provides a brief educational intervention (using NCI Publication No. 97-2706: What are Clinical Trials All About) in the event the patient may be considered for a therapeutic cancer trial later.  This is an effective way of integrating patient navigation into the existing clinic processes and identifying early those low-resource cancer patients who need assistance, whether they are having standard treatment or participating in therapeutic clinical trial.