Patient navigator study: Addressing cancer screening barriers and increasing adherence among LGBT persons

Objective: To develop and evaluate a culturally-targeted patient navigation curriculum aimed at increasing cancer screening among lesbian, gay, bisexual and transgender (LGBT) persons.

Methods: In-depth interviews (N = 42) were conducted with providers and medical directors of LGBT-serving clinics, and LGBT persons who were non-adherent to screening guidelines. Data were analyzed to identify general and LGBT-specific barriers and facilitators to screening. An expert panel review, a learner verification trial, and the scientific literature were used to adapt an existing Health Systems Navigation curriculum to address barriers to cancer screening among LGBT persons.

Results: LGBT-specific barriers to cancer screening included mistrust of the health care system (69%) and experiences with discrimination in health care setting (31%). Patient navigation was viewed as an acceptable strategy for reducing barriers to screening (74% agreement). The adapted curriculum includes 9 modules focused on knowledge about LGBT populations and cancer screening needs, cancer risk and protective factors, behavior change approaches, and accessing care.

Conclusions: The Patient Navigator Study findings are consistent with previous reports of institutional and individual-level barriers to screening. This study's findings were used to develop a patient navigator curriculum which will be used to enhance the cultural competency of health educators and lay patient navigators serving LGBT populations. Using a medical standardized patient approach, the feasibility and effectiveness of the curriculum will be evaluated through the training of health educators and lay patient navigators. The final curriculum will be presented and results from the training trials will be discussed during the presentation.