Introduction: Lack of access to care, funding limitations, and cultural and social barriers are challenges that have led to adverse cancer outcomes among breast cancer patients in Nigeria. Patient navigator programs have been an increasingly popular approach to improving cancer care outcomes.1,2 The first patient navigator program was introduced by Harold P. Freeman, MD, a breast surgeon at the Harlem Hospital in New York City.3 He observed a pattern of late-stage presentation in breast cancer patients for whom the primary barrier to early, effective treatment was the inability to access medical care in a timely manner. A patient navigator is a member of the community who has a clear understanding of the local social and cultural issues and is simultaneously aware of the functioning of the healthcare system. Patient navigators have established contacts with the medical team as well as other support services. The navigator accomplishes this most effectively through one-on-one contact with the patient from the time of initial suspicion of cancer diagnosis until a proper diagnosis is confirmed and throughout survivorship and life after cancer.
Aim: To evaluate the perception of breast cancer patients of the quality of patient navigator services at the One-Stop Breast Clinic, Lagos University Teaching Hospital (LUTH), Idi-Araba.
Material and Methods: This was a prospective study done over a period of 1 month in the One-Stop Breast Clinic. Data were randomly collected from breast cancer patients via a questionnaire, including age, marital status, gender, educational status, and patients’ perception of patient navigator services. Ethic approval was obtained from LUTH Health Research Ethics Committee. Data were analyzed using SPSS version 21.0.
Results: A total of 60 patients were reviewed for the study. The mean age was 44 years. Thirty (50%) of the patients were married, 13 (22%) were single, 16 (27%) were divorced, and the remaining patient was not married to the father of their children but resided with him. Thirty-five percent had primary school education and 21.6% had tertiary education. All patients rated reception by patient navigator as excellent (N = 60). They also all agreed that the patient navigator was consistent in service delivery (N = 60). All patients rated the level of communication and interaction by the patient navigator as excellent (N = 60) and agreed that they received help from the patient navigator solving difficulties (N = 60). Some patients (8.3%) stated that they had difficulties with their mobile network when communicating with the patient navigator via her mobile phone. The majority, 57 (95%) of the surveyed patients, rated their overall experience with the patient navigator services as excellent. They all reported that they would use the patient navigator service again and recommend it to others.
Conclusion: The patient navigator service is relatively new in Nigeria, and its impact on reducing morbidity and mortality among cancer patients in our environments needs to be evaluated. Patients’ perception in this survey showed that it is a valuable service in helping patients navigate their way through the often scary and overwhelming treatment of cancer. Some of the services provided by the patient navigator include answer patients’ questions, provide information about treatment guidelines, help patients find qualified doctors, find discounted lodging and travel options and financial assistance programs, support appeals to insurance companies, and connect patients with others in the community who have been through a similar journey.
Recommendations: All institutions and oncology centers in Nigeria should embrace the patient navigation program:
- Patient navigator can also communicate with the patients via e-mail, written notes, and in person
- Partner with the telecommunication industry to provide free access to call to the patient navigator line
- There is a need for more collaboration among various nongovernmental organizations to get support for diagnostic and treatment costs
- Online support groups should be created for all patients via WhatsApp, etc.
- Paskett ED, Tatum C, Rushing J, et al. Racial differences in knowledge, attitudes, and cancer screening practices among a triracial rural population. Cancer. 2004;101:2650-2659.
- Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94:666-668.
- Freeman HP. The origin, evolution, and principles of patient navigation. Cancer Epidemiol Biomarkers Prev. 2012;21:1614-1617.