An Examination of Barriers to Cancer Care and Their Impact on Time in an Oncology Nurse Navigation Program
Jamie Callahan, BSN-RN, OCN, CBCN; Wendy Haylett, PhD, RN, CPON; Karen Hessler, PhD, FNP-C; Alex Kaizer, PhD; Xinyi Yang, PhD Candidate in Biostatistics
UCHealth, University of Colorado – Anschutz Medical Campus, Colorado School of Public Health
Background: While it is generally recognized that oncology navigation programs can vary in structure, makeup, and domain of care, a common task expected of all navigators is identifying potential or existing barriers to cancer care.1 In AONN+’s exploratory study examining 10 metrics from the initially published list of 35,2 it was found that 5 of the studied metrics were applicable across the 8 study sites, with 1 of those metrics being barriers to care.3
Objectives: This study sought to examine barriers to care identified in an oncology navigation program, and how they may be associated with either navigator time spent (NTS) or with the diagnosis-to-treatment time (DxTT) for a patient newly diagnosed with cancer.
Methods: The study used an observational, correlational quantitative design to retrospectively investigate 79 individual patient barriers across 8 barrier categories identified by oncology nurse navigators and their association with DxTT and NTS for patients with cancer. Data from 633 individual patient cases were collected over 6 months in 2020.
Results: DxTT was significantly associated with patient age and type of cancer. For each decade increase in a patient’s age, treatment start was noted to be 2.23 days later (P = .03). Cancer type was also statistically associated with differences in DxTT (P <.001). DxTT was significantly associated with individual barriers of hearing loss (sooner treatment start when present; 22.25 days vs 40.3 days; P = .043), treatment decisions (later treatment start when present; 50.35 days vs 36.7 days; P = .001), and worry (sooner treatment start when present; 30.01 days vs 41.78 days; P = .007).
Cancer type was also significantly associated with differences in NTS, but no other demographic variables were significant. Six individual barriers and 5 barrier categories were significantly associated with NTS. The individual barriers that increased NTS when present were pain (243 vs 173 minutes; P = .001), transportation (240 vs 173 minutes; P = 0), time off from work/school (212 vs 174 minutes; P = .013), anxiety (232 vs 170 minutes; P = 0), fears (231 vs 172 minutes; P = .001), and worry (212 vs 172 minutes; P = .021). The 5 categories statistically associated with an increase in NTS for each barrier identified within the category were physical barriers (6.87 minutes, P = .023), social concerns (18.99 minutes, P = .001), home/family concerns (25.54 minutes, P = .013), emotional concerns (18.14 minutes, P = .00), and total barriers (5.94 minutes, P = .00). While other individual barriers identified were not significantly associated with NTS, it is noted that when examined together, an average of 5.94 minutes was spent with a navigator for each individual barrier identified regardless of barrier category.
Conclusions: There are demographic elements (age, cancer type) and barriers to care identified that could be useful for navigation programs to consider when assigning caseloads and anticipating NTS. These results can also be used to further identify patients at risk for delays in starting treatment. Taken together, these elements may contribute to a professional acuity tool for oncology navigation and suggest further research is indicated on the impact of individual barriers to cancer care.
- Franklin E, Burke S, Dean M, et al. Oncology navigation standards of professional practice. Clinical Journal of Oncology Nursing. 2022;26(3):E1-E12.
- Academy of Oncology Nurse & Patient Navigators. Standardized Metrics Source Document. https://aonnonline.org/images/articles/standardized_metrics/Metrics-Source-Document.pdf.
- Johnston D, Watson L, Strusowski T, et al. Presentation at 2019 AONN+ Annual Conference. National evidence-based oncology navigation metrics: multisite exploratory study to demonstrate value and sustainability of navigation programs. www.jons-online.com/issues/2019/november-2019-vol-10-no-11/2646-national-evidence-based-oncology-navigation-metrics-multisite-ex ploratory-study-to-demonstrate-value-and-sustainability-of-navigation-pro grams. 2019.