Background: Ethnic minority (EM) populations living in high income countries (HIC) often have poorer cancer outcomes and face additional challenges when accessing cancer care. Patient navigation (PN) programs have been developed to improve outcomes and access to care in populations at risk of cancer health disparities. Patient navigation can address the range of barriers and complexity that EM cancer patients may encounter in their journey through the healthcare system. This study was designed to evaluate and summarise the evidence of the impact of PN on improving the quality of cancer care in EM patients in HICs. This review also aimed to identify key characteristics and components of oncology PN programs that had positive effects in these populations.
Methods: Peer-reviewed literature in the English language (published between January 1990 and June 2023) was searched in the following databases: PubMed, Ovid MEDLINE, PsycINFO, Web of Science, CINAHL, Cochrane Library and Scopus. The search identified studies evaluating oncology PN interventions delivered to adult EM patients during diagnosis and treatment. Cancer screening PN interventions were not included.
Results: The review yielded 18 studies, all conducted in the United States. Constituent minority populations were Hispanic (35.6%), Black American (27.7%), Native American (13.9%) and Asian (1.2%), with breast and cervical as the most common cancer types. Most studies (13) focused on diagnostic resolution primary outcomes. Of the 18 studies identified, 15 reported improvements in cancer care outcomes including more timely diagnostic resolution and reductions in time to treatment, as well as fewer missed clinic appointments and treatment interruptions. Patient navigation also lowered anxiety scores and increased patient satisfaction. There was significant heterogeneity in PN program types and thoroughness of reporting. The majority of studies lacked detailed descriptions of program features targeting EM patients. Despite this, some common core components and culture-centred features of effective PN programs were identified.
Conclusion: This review indicates there is moderate-level evidence to support PN as an effective intervention to improve cancer care among EM patients during diagnostic evaluation, with limited yet encouraging data for improved treatment adherence and palliative care. Although some common key characteristics of effective PN programs were identified, the ability to determine which specific program features are associated with positive outcomes is limited due to the variability in PN programs and inconsistencies in methodology reporting. A framework for a standardised publication reporting guideline for oncology PN studies in EM populations is proposed to address this limited comparability.