Lay patient navigator program implementation for equal access to cancer care and clinical trials: essential steps and initial challenges.

BACKGROUND: Disparities in cancer detection, treatment, and outcomes among racial/ethnic minorities and low-income patients are well documented. One way to reduce these disparities is to use patient navigators to address barriers to care. However, little information about optimal characteristics of navigator programs or considerations for those interested in setting up such programs is available. METHODS: The design and implementation of a patient navigator program for underserved cancer patients in an urban, nonacademic community hospital setting is described. The program, which used lay navigators, was conceived as a component of the Urban Latino African American Cancer (ULAAC) Disparities Project in South Los Angeles, a National Cancer Institute (NCI)-sponsored project to improve cancer care and clinical trial access for minority and low-income patients. RESULTS: Careful initial planning, including input from a community advisory committee, was essential to smooth program implementation. Thirty-one volunteers completed navigator training in the program's first year of operation. Of 135 patients offered navigation services, 75 (56%) accepted, and preliminary feedback from patients, navigators, and providers suggests high levels of satisfaction with navigation. Standardized templates used by navigators and staff to record key information are proving helpful for monitoring quality and outcomes (such as effectiveness in addressing specific barriers to care) and continually improving the program. CONCLUSIONS: The ULAAC program represents a viable model for developing lay navigator programs in community hospitals. Preliminary assessments suggest that the program has a positive effect on minority and low-income cancer patients' experience with care and reduces barriers to care. Additional time and research are needed, however, to fully assess the impact on care and outcomes.

Mini-Mental State and Cognistat performance in an older African American sample.

Ninety-three normal, healthy, community-dwelling African American men and women aged 60 and older completed the Folstein Mini-Mental State Examination (MMSE) and the Cognistat (formerly known as Neurobehavioral Cognitive Status Examination). Results indicated significant age and education effects on MMSE and Cognistat performance. The strength of the effects was less than had been noted in earlier work. Cognistat scores were lower than those reported in the original manual for the test as well as in comparison to an older sample in another study. Explanations were offered in terms of differences in cultural and educational exposure to testing as well as inappropriateness of the norms in the original manual. Age- and education-stratified normative data are presented that should be helpful to clinicians who work with and perform cognitive assessment in the population.