Using a Mixed-Methods Case Study Design to Explore, Evaluate, and Enhance a Cancer Patient Navigator Program.

Background. Successful strategies for addressing inequalities in cancer care are greatly needed as critical racial/ethnic and socioeconomic cancer burden disparities persist in the United States. Patient navigation programs are a promising approach to reducing cancer care disparities. Methods. A mixed-methods evaluation was conducted to systematically collect, analyze and share information about the context, activities, and early impacts of the University of Pittsburgh Medical Center (UPMC) Cancer Centers' Minority Outreach Pilot Program (MOPP), a newly implemented cancer patient navigator intervention. The dissertation applies and integrates two evaluation frameworks: (1) the Centers for Disease Control and Prevention (CDC) Framework for Program Evaluation, which provides an organizing structure and standards for conducting sound public health program evaluation, and (2) the RE-AIM framework, which helps to focus the evaluation on issues that are both relevant to stakeholders and critical to assessing the public health impact and generalizability of interventions. The evaluation employs a case study design that includes qualitative (e.g., program document review and informal and semi-structured interviews) and quantitative (e.g., descriptive statistical analysis of program database) methods to examine MOPP development and implementation. Results. The MOPP evaluation provided valuable qualitative and quantitative data related to program implementation achievements and challenges. Additionally, the evaluation produced useful products (e.g., logic model and data reporting templates) and led to immediate small-scale enhancements (e.g., database modifications). Results from the program evaluation suggest that MOPP is generally being implemented as planned. However, findings also called attention to key issues that should be monitored closely within the MOPP program, and, perhaps, within the larger patient navigation movement. These key issues include: the challenges of effectively navigating patients with substance abuse and the need to address the emotional burden of patient navigator work. Conclusion. The public health significance of the evaluation lies in its potential to strengthen MOPP's impact on reducing cancer care disparities in the UPMC patient population. In addition, publication of the evaluation research will contribute to the growing evidence base for cancer patient navigator interventions and address the need to develop the literature on patient navigation.