Table 3.
Patient barriers and navigator actions.
| Barrier type | Specific barriers | Navigator actions |
|---|---|---|
| Fear (n = 9) | Fear of dying (n = 4) | Directly contact family (n = 1) and other support systems (n = 1) |
| Needs someone to talk to (n = 3) | Provide emotional support and active listening (n = 5) | |
| Fear of family not being able to cope (n = 1) | Educate patient verbally (n = 1) and educate staff of patient’s special needs (n = 1) | |
| Fear of treatment (n = 1) | Accompany to healthcare services (n = 1) | |
| Communication with medical personnel (n = 9) | Doesn’t understand what asked to do (n = 3) regarding when is next appointment, form of medication to take and nutrition needs to remain CT eligible | Directly contact family (n = 1) and providers (n = 3) |
| Medical forms too complicated (n = 2) | Appointment verification (n = 1) | |
| Difficulty answering provider questions and incorrectly reporting meds (n = 2) | Obtain lab sample from patient (n = 1) | |
| Needs to speak with provider to ask what meds to take for side effects and to schedule appointment (n = 2) | Request records/imaging (n = 1) | |
| Insurance (n = 8) | Can’t afford high co-pay/deductible (n = 1) | Direct contact with patient (n = 1), family (n = 1) and support system (n = 1) |
| Doesn’t understand what insurance covers (n = 1) | Accompany to other services (n = 1); Arrange for financial (n = 1) and medication assistance (n = 2) | |
| No health insurance (n = 1) | Appointment info/verification (n = 1) | |
| Overwhelmed by insurance paperwork for Medicaid, short term disability, and a cancer policy (n = 5) | Helping patient complete paperwork (n = 2); Request records/imaging (n = 1) | |
| Provide documents to healthcare providers (n = 1) | ||
| Transportation (n = 6) | Can’t afford bus/train fare, gas (n = 4) | Direct contact with family (n = 1), other support system (n = 1) and social service (n = 1) |
| Arrange Medicaid transportation for patients (n = 4) and making referrals to social service agencies (hospital social worker, Department of Social Services [DSS], church) (n = 4) | ||
| Helping patient complete paperwork (n = 2) | ||
| Public transport not readily available (n = 2) | Schedule/reschedule appointment (n = 1) | |
| Appointment/info verification, or info seeking/ gathering (n = 1) | ||
| Call to remind patient of appointment (n = 2) | ||
| Perceptions about provider and treatment (n = 4) | Felt doctor giving up on them in CT (n = 2) | Direct contact with family (n = 3), other support system (n = 1) and other healthcare providers (n = 1) |
| Believes treatment medications will make side effects worse (n = 1) | Provide emotional support, active listening (n = 1) | |
| Doesn’t think CT treatment will help (n = 1) | ||
| Medical co-morbidities and disability (n = 4) | Physical weakness (n = 3) | Directly contact family (n = 2) and other healthcare providers (n = 1) |
| Arrange for equipment and supplies (n = 1) | ||
| Accompany to healthcare services (n = 1) | ||
| Co-morbidities-obesity (n = 1) | Make referral for weight management to get weight under control for treatment (n = 1) | |
| Finances (n = 3) | Can not afford household bills (n = 2) | Directly contact social service (n = 1) and other support system resources such as American Cancer Society (ACS), Wal-Mart, and utility companies (n = 1) |
| Arrange for financial assistance (n = 1) | ||
| Can’t afford over the counter supplements needed during treatment (n = 1) | Arrange for financial assistance (n = 1) via product coupons and website to help with cost of ancillary medical products | |
| Housing (n = 2) | Need temporary housing for treatment (n = 2) | Educate verbally about temporary housing options (n = 1) |
| Distribute print/audio-visual materials (hotel list) (n = 1) | ||
| Appointment/info verification, or info seeking/ gathering for housing (n = 1) | ||
| Problem scheduling care (n = 2) | Appointment date/time not convenient (n = 2) | Appointment/info verification, or info seeking/ gathering (n = 2) |
| Other (n = 2) | Navigation of healthcare facility (n = 1) | Accompany to other services (n = 1) |
| Advance directive (n = 1) | Referral to provider (n = 1) | |
| Literacy (n = 1) | Unfamiliar/do not understand medical terms (n = 1) | Helping patient complete medical paperwork (n = 1) |