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Translating Research Into Practice (TRIP): A Toolkit for Implementing a Patient Navigation Program

TRIP is the brainchild of the Boston Breast Cancer Equity Coalition, a partnership of cancer survivors, clinicians, researchers, and nonprofit organizations formed in 2014 in response to persistent Boston-wide disparities in breast cancer mortality. In response to evidence that screening, prevalence, and incidence rates are not significantly different between Black and white women in Boston, the Coalition hypothesized that delays in starting treatment were contributing to the disparities.

The coalition identified three evidence-based strategies to address delays in care:

Patient navigation: Patient navigation programs are shown to decrease treatment delays.

Screening for social needs: The impact of social determinants of health (SDoH) are disproportionately borne by racial, ethnic, and language minority and low-income women. Screening for and addressing SDoH have been shown to improve care delivery.

Shared patient registry: In Boston, approximately 40% of women of color receive breast cancer care at multiple hospitals. Shared patient-level registries have been shown to improve quality care delivery.

In addition to addressing disparities in breast cancer, the TRIP project aimed to showcase the power of community-academic partnerships in providing innovations in information-sharing and systems-level interventions. TRIP aims to disseminate the intervention in various spaces to promote local, regional, and national health equity.

TRIP Resources

The TRIP project designed and implemented several tools in three key areas: tools for patient navigation, social needs assessments, and documentation around suggested language. Social needs assessments ask about patients' needs related to housing, food, finances— any social obstacle creating barriers to high-quality care. Patient navigators screened TRIP patients at baseline and three-month follow-up. Because discussing social needs can lead to shame and stigma, PNs were also offered example scripts and language to assist in having these conversations.

Patient navigation

Social needs assessments

TRIP intervention suggested language/scripts

Implementation Strategies

TRIP used relevant implementation strategies from Powell's 15. TRIP implementation strategies were used to evaluate the fidelity to the intervention protocol, local adoption/sustainability, and acceptability. Training & Support strategies included Empathic Inquiry Training, a program created by the Oregon Primary Health System to help change the narrative around SDoH questions to build conversations and trust among navigators and patients amid these difficult conversations. Quality monitoring was done with REDCap Registry, REDCap is a free, secure, HIPPA-compliant, web-based application designed to support data capture for research studies.

Trainings & Support

Quality Monitoring

  • Enrollment monitoring: The team monitored enrollment monthly and quarterly for adequacy of meeting enrollment goals and ensuring eligibility criteria are met.
  • Follow-up monitoring: The team will monitored the study for completeness of registry and social needs assessment follow-up data on a monthly and quarterly basis.
  • Other metrics of clinical trial performance

Collaboration and Engagement

  • TRIP monthly newsletters with study updates for stakeholders, including principal investigators, patient navigators, researchers, oncologists, patients, etc.
  • Weekly status update emails with up-to-date data on enrollment and social needs assessments
  • BBCEC meetings
  • TRIP quarterly patient navigator meetings
  • Clinical Advisory Panel (CAP), a group of clinical champions who assisted in the implementation of the intervention, supported data, and provided clinical significance to TRIP data findings.
  • Steering committee, a longitudinal advisory panel to provide specific feedback and guidance throughout all study phases.

Evaluation Strategies

During the TRIP program, the research team conducted interviews, observations, focus groups, and cost surveys to determine the viability of the implementation of this patient navigator process from the standpoint of patient navigators themselves, patients, experts, and other stakeholders, as well as from a cost perspective.

Key informant interviews

Observation of patient navigators

Patient navigator focus groups

Cost surveys

Publications

LeClair, A.M., Battaglia, T.A., Casanova, N.L. et al. Assessment of patient navigation programs for breast cancer patients across the city of Boston. Support Care Cancer 30, 2435–2443 (2022). https://doi.org/10.1007/s00520-021-06675-y

Casanova, N. L., LeClair, A. M., Xiao, V., Mullikin, K. R., Lemon, S. C., Freund, K. M., Haas, J. S., Freedman, R. A., Battaglia, T. A., & Translating Research Into Practice (TRIP) Consortium (2022). Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology. Cancer, 128 Suppl 13(Suppl 13), 2649–2658. https://doi.org/10.1002/cncr.33944

Presentations

Additional Navigator Toolkits

BMC Patient Navigation Toolkit Vol 1

BMC Patient Navigation Toolkit Vol 2

BMC Patient Navigation Toolkit Vol 3

This study was funded by the National Center for Advancing Translational Sciences National Institutes of Health through grants U01TR002070 Research into Practice: A Regional Collaborative to Reduce Disparities in Breast Cancer Care. 


Additional funding sources to report include: Harvard Clinical and Translational Science Center (UL1) UL1TR000170, NIH/ NCATS; Tufts Clinical and Translational Science Institute, UL1TR002544, NIH/ NCATS; University of Massachusetts Center for Clinical and Translational Science UL1TR001453, NIH/ NCATS; Boston University Clinical and Translational Science Institute UL1TR001430, NIH/ NCATS and by American Cancer Society # CRP-17-112-06-COUN.