UCLA

Background: Immigrants with limited English capabilities and limited knowledge about the U.S. health care system may experience challenges in accessing and utilizing cancer care services. Patient navigation programs (PNPs) are emerging as a viable strategy to improve health care at the financial, organizational, social and cultural level. The Patient Navigator Outreach and Chronic Disease Prevention Act (NOA) has the potential to increase the availability of PNPs and to improve timeliness to treatment. Practitioner perceptions of PNPs are missing from the literature, and could provide evidence needed to generate support for the integration and adoption of PNPs at the system level. This dissertation is comprised of two studies that investigate the availability and quality of PNPs in Los Angeles (LA) and Orange County (OC) facilities, and the perceptions of practitioners and navigators serving Southeast Asians.

Methods: Study 1 involved facility-level data collected through two surveys (Short Telephone Questionnaire and Facility Survey) and tumor registry data from the Los Angeles Cancer Surveillance Program. Study 2 used secondary data of transcripts of interviews with practitioners (n=14) and patient navigators (n=9).

Results: Study 1- Survey responses revealed that legislation was not associated with the development and availability of PNPs in LA or OC facilities, but compliance with hospital certification requirements did. The proportion of patients who received surgery within 30 days was higher at pre-NOA period at facilities with PNPs. Unexpectedly, post-NOA median time to surgery after diagnosis increased regardless of the availability of PNPs,

Study 2 - Practitioner perceptions of PNPs highlighted the benefit of PNPs and the need to inform cancer care clinicians and institutions about the value of navigation services to improve patient-physician communication. Navigators were instrumental in helping patients understand the disease and treatment process better, and enabled patients to be more engaged in dialogue with their physicians.

Conclusion: PNPs have evolved into a mechanism for assisting under-resourced communities. Legislation alone needs to be bolstered with institutional program commitment and requirements. Practitioner perceptions of PNPs expressed in this study confirm the need to inform cancer care clinicians and cancer care institutions about the value of patient navigation services.