National Cancer Institute   U.S. National Institutes of Heath
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Patient Navigator

Background Information
Racial and ethnic disparities in health care and mortality have been well documented, but remain poorly understood. In particular, cancer treatment trials, prevention trials and surveillance programs suffer from a disproportionately low rate of accrual and a high rate of dropouts of ethnic minorities. Throughout the United States, a significant number of medically underserved low-income and/or minority populations, whether urban or rural, continue to be disenfranchised from the health care institutions that provide cancer care and research within their communities.

These patients experience numerous barriers to entry, small and large, as they struggle to understand the highly complex nature and the inherent structural barriers of the U.S. health care system, while attempting to deal with the emotional and physical aspects of their health concerns and needs. The barriers these patients experience include poverty, lack of transportation, illiteracy, cultural frames of reference that inhibit seeking care, fear of the exam and cancer, staff attitudes, language barriers and cultural misunderstanding by staff. Often, out of frustration and misunderstanding, patients attempting to "navigate" the numerous obstacles on their own give up and drop out of seeking or continuing care.

Obviously some of these barriers cannot be overcome by one NCI program, but through the NCI Patient Navigator Program, a number of the larger societal barriers can be lowered and a significant number of those barriers specific to each individual can be resolved through personal, one-on-one assistance throughout the continuum of cancer services. Therefore, the creation of the Patient Navigator Program will help patients maneuver around barriers that might otherwise seem insurmountable.

Additionally, because of the barriers encountered by these patients, oncologists in these institutions have difficulty in starting, developing and sustaining research programs partially due to lack of trust in and understanding of the research system often resulting in a high drop-out rate. Thus, the populations that these institutions primarily serve, largely minority, ethnic and/or low-income, do not readily benefit from the rapid progress being made in cancer research and continue to bear an unequal burden of disease due to this cycle of low participation.

A challenge for the NCI is to assist these unique patient populations and their oncologists to the point of becoming active and effective participants and partners in cancer prevention, screening, care and clinical research trials, leading to the improvement in the diagnosis and treatment of cancer and the reduction of health disparities among different segments of the American population.