Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine; UMass Worcester Prevention Research Center
Community Health and Preventive Medicine | Health Services Administration | Health Services Research | Neoplasms | Oncology | Preventive Medicine | Quality Improvement
BACKGROUND: In 2018 Translating Research Into Practice (TRIP), an evidence-based patient navigation intervention aimed at addressing breast cancer care disparities, was implemented across six Boston hospitals. This study assesses patient navigator team member perspectives regarding implementation barriers and facilitators one year post-study implementation.
METHODS: We conducted in-depth qualitative interviews at the six sites participating in the pragmatic TRIP trial from December 2019 to March 2021. Navigation team members involved with breast cancer care navigation processes at each site were interviewed at least 12 months after intervention implementation. Interview questions were designed to address domains of the Consolidated Framework for Implementation Research (CFIR), focusing on barriers and facilitators to implementing the intervention that included 1) rigorous 11-step guidelines for navigation, 2) a shared patient registry and 3) a social risk screening and referral program. Analysis was structured using deductive codes representing domains and constructs within CFIR.
RESULTS: Seventeen interviews were conducted with patient navigators, their supervisors, and designated clinical champions. Participants identified the following benefits provided by the TRIP intervention: 1) increased networking and connections for navigators across clinical sites (Cosmopolitanism), 2) formalization of the patient navigation process (Goals and Purpose, Access to Knowledge and Information, and Relative Advantage), and 3) flexibility within the TRIP intervention that allowed for diversity in implementation and use of TRIP components across sites (Adaptability). Barriers included those related to documentation requirements (Complexity) and the structured patient follow up guidelines that did not always align with the timeline of existing site navigation processes (Relative Priority).
CONCLUSIONS: Our analysis provides data using real-world experience from an intervention trial in progress, identifying barriers and facilitators to implementing an evidence-based patient navigation intervention for breast cancer care. We identified core processes that facilitated the navigators' patient-focused tasks and role on the clinical team. Barriers encountered reflect limitations of navigator funding models and high caseload.
TRIAL REGISTRATION: Clinical Trial Registration Number NCT03514433 , 5/2/2018.
Breast cancer care, CFIR, Patient navigation, Social risk screenings
Rights and Permissions
Copyright © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
DOI of Published Version
Loo S, Mullikin K, Robbins C, Xiao V, Battaglia TA, Lemon SC, Gunn C; TRIP Consortium. Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study. BMC Health Serv Res. 2022 May 21;22(1):683. doi: 10.1186/s12913-022-08090-3. PMID: 35597947; PMCID: PMC9123866. Link to article on publisher's site
BMC health services research
Loo S, Mullikin K, Robbins C, Xiao V, Battaglia TA, Lemon SC, Gunn C. (2022). Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study. UMass Worcester PRC Publications. https://doi.org/10.1186/s12913-022-08090-3. Retrieved from https://escholarship.umassmed.edu/prc_pubs/174
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Community Health and Preventive Medicine Commons, Health Services Administration Commons, Health Services Research Commons, Neoplasms Commons, Oncology Commons, Preventive Medicine Commons, Quality Improvement Commons