Differences and delays in the delivery of cancer care lead to more advanced cancer at the time of diagnosis and ultimately to more deaths for low-income and minority communities. Our group helped develop a patient-navigation model using lay health workers to address patient barriers and coordinate cancer-care services, leading to more timely care. Despite the fact that patient navigation is now a standard required by the Commission on Cancer, our research shows that delays in care persist for our low-income patients with socio-legal barriers. Socio-legal barriers are defined as social problems related to meeting life’s most basic needs that are supported by public policy or programming and thus potentially remedied through legal advocacy/action (e.g., unsafe/unstable housing, unlawful utility shutoffs, or job termination). Direct feedback from cancer patients suggests a critical need to address socio-legal barriers in order to achieve quality care for all. To expand the current impact of patient navigation on quality care for low-income patients, we will partner with patients, key community stakeholders, and the Medical-Legal Partnership (MLP)|Boston, the founding site of a nationwide program assisting healthcare teams in addressing socio-legal barriers to health. Under direction from a Patient Advisory Group and a Community Advisory Board, we will conduct a study to compare standard navigation with an MLP navigation intervention enhanced by legal support for low-income cancer patients.
Our specific aims are to measure the impact of an MLP patient navigation intervention on:
- patient-reported outcomes: distress, needs, and satisfaction;
- clinically relevant outcomes: receipt of timely and quality cancer care: and
- intermediate outcomes: socio-legal barriers to cancer care.
We will enroll 260 low-income, racially diverse, newly diagnosed cancer patients. Half will receive standard navigation, i.e., a lay navigator integrated into the healthcare team who provides one-on-one patient contact to address traditional system barriers to care. The other half will receive MLP navigation, i.e., standard navigation enhanced by legal support including:
- a full socio-legal needs assessment and care plan in consultation with MLP; and
- legal assistance for eligible urgent legal needs. We will compare each group on all outcomes.
Compared to standard navigation, we expect that addressing socio-legal barriers to care with MLP navigation will improve patient-reported outcomes and lead to more timely care delivery. Because of widespread national availability of patient navigation and MLP programs at hospitals serving vulnerable patients, this intervention can be quickly replicated to improve patient experience and survival.