Disparities in Patient Navigation Resources in Appalachia

Abstract

Background: The study was conducted in support of an R01-funded project, “Patterns of Patient Care in Appalachia”. Most counties within Appalachia are designated as medically underserved, have sparse health care resources and lack integrated care systems. This study determined the extent of geographical differences among American Cancer Society (ACS) patient navigation resources (navigator and/or cancer resource center) in Appalachia. Specifically, this study investigated if there were barriers to access to ACS patient navigation for cancer care in the Appalachia region of PA, KY, OH, and NC.
Results: Of the cancer care centers and hospitals in the Appalachia region studied, (n=232), web-based data informed that facilities (n=186, 80.0%) did not have ACS patient navigation resources compared to Appalachia cancer care centers and hospitals with ACS PN services = 20%. KY had fewer ACS PN centers (5) compared to PA (20), with Pittsburgh (Allegheny county) containing a noticeable cluster of ACS PN facilities (N = 6 out of 18 total). KY also had the lowest rates (12.5%) of facilities with ACS patient navigators. North Carolina had the highest rate of facilities with ACS patient navigation services compared to OH, KY, and PA (32.2%). The proportion of facilities with ACS PN were proportionately less for facilities located in non-Metropolitan areas (15%) compared to those located in metropolitan areas (26%, chi-square p = 0.0339).
Significance: Two overarching results were identified in this study. Firstly, a large number of cancer care centers in the Appalachian region do not have ACS patient navigator services which enable patients to gain individualized assistance, overcome barriers that hinder access to care and access to information about the illness and services available. Secondly, the lack of standards and curriculum for patient navigators indicates there is considerable variation in level of exposure for each patient navigator.