- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02232074
Socio-legal Services for Underserved Populations Through Patient Navigation to Optimize Resources During Treatment (SUPPORT)
Project SUPPORT (Socio-legal Services for Underserved Populations Through Patient Navigation to Optimize Resources During Treatment)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Differences and delays in the delivery of cancer care lead to more advanced cancer at the time of diagnosis and ultimately to more deaths for low-income and minority communities. Our group helped develop a patient-navigation model using lay health workers to address patient barriers and coordinated cancer-care services, leading to more timely care. Despite the fact that patient navigation is now a standard required by the Commission on Cancer, the investigators' research shows that delays in care persist for our low-income patients with socio-legal barriers. Socio-legal barriers are defined as social problems related to meeting life's most basic needs that are supported by public policy or programming and thus potentially remedied through legal advocacy/action (e.g., unsafe/unstable housing, unlawful utility shutoffs, or job termination). Direct feedback from cancer patients suggests a critical need to address socio-legal barriers in order to achieve quality care for all. To expand the current impact of patient navigation on quality care for low-income patients, the investigators will partner with patients, key community stakeholders, and the Medical-Legal Partnership (MLP)|Boston, the founding site of a nationwide program assisting healthcare teams in addressing socio-legal barriers to health. Under direction from a Patient Advisory Group and a Community Advisory Board, the investigators will conduct a study to compare standard navigation with an MLP navigation intervention enhanced by legal support for low-income cancer patients.
The investigators will enroll 374 low-income, racially diverse, newly diagnosed cancer patients. Half will receive standard navigation, i.e., a lay navigator integrated into the healthcare team who provides one-on-one patient contact to address traditional system barriers to care. The other half will receive MLP navigation, i.e., standard navigation enhanced by legal support including:
- a full socio-legal needs assessment and care plan in consultation with MLP; and
- legal assistance for eligible urgent legal needs. We will compare each group on all outcomes.
Compared to standard navigation, we expect that addressing socio-legal barriers to care with MLP navigation will improve patient-reported outcomes and lead to more timely care delivery. Because of widespread national availability of patient navigation and MLP programs at hospitals serving vulnerable patients, this intervention can be quickly replicated to improve patient experience and survival.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02118
- Boston Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Newly diagnosed breast and lung cancer patients
- Within 30 days of patient being informed of diagnosis
- Receiving cancer care at Boston Medical Center
- No history of cancer treatment in past 5 years
- No cognitive impairments
- Over 18 years of age
- Speak English, Spanish or Haitian Creole
Exclusion Criteria:
- Patient informed of cancer diagnosis >30 days
- Patient under 18 yrs. of age
- Primary language something other than English, Spanish or Haitian Creole
- Undergoing treatment for concurrent cancer
- Patient has history of cancer or has received cancer treatment within the last 5 years
- Institutionalized/cognitive impairment (such as: dementia or metabolic, medication or drug induced), given the unique challenges to their treatment decision making/adherence and the fact that the intervention would not include the patient directly, but rather the family.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Patient navigation enhanced with legal support
In addition to receiving standard navigation, patients will be connected with a Patient Navigator who is partnered with a lawyer from Medical-Legal Partnership to provide personalized assistance with regard to social-legal barriers.
|
|
No Intervention: Standard patient navigation
These patients will receive standard patient navigation which will work to ensure that services are coordinated amongst medical personnel, while also addressing patients' needs.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of Participants Initiating Treatment Within 90 Days of Diagnosis Among BREAST Cancer Participants
Time Frame: Receipt of 1st treatment within 90 days from diagnosis
|
The receipt of timely care will be defined as initiation of care within 90 days, as this the shortest delay that has been shown to consistently affect mortality The time element was calculated from date of diagnosis (Time0) to date of treatment initiation (Time1) .The date chosen for the Time1 variable depends on the recommended care plan for each patient, as derived from the chart abstraction and based on patient presentation.
|
Receipt of 1st treatment within 90 days from diagnosis
|
Proportion of Participants Initiating Treatment Within 90 Days of Diagnosis Among LUNG Cancer Participants
Time Frame: Receipt of 1st treatment within 90 days from diagnosis
|
The receipt of timely care will be defined as initiation of care within 90 days, as this the shortest delay that has been shown to consistently affect mortality The time element was calculated from date of diagnosis (Time0) to date of treatment initiation (Time1) .The date chosen for the Time1 variable depends on the recommended care plan for each patient, as derived from the chart abstraction and based on patient presentation.
|
Receipt of 1st treatment within 90 days from diagnosis
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Distress Thermometer at 3 Months for BREAST Cancer Patients
Time Frame: 3 months after enrollment
|
Distress will be assessed through patient interviews utilizing the Distress Thermometer (DT) instrument with a scale from 0 (no distress) to 10 (extreme distress).
Lower values are more favorable.
|
3 months after enrollment
|
Distress Thermometer at 3 Months for LUNG Cancer Patients
Time Frame: 3 months after enrollment
|
Distress will be assessed through patient interviews utilizing the Distress Thermometer (DT) instrument with a scale from 0 (no distress) to 10 (extreme distress).
Lower values are more favorable.
|
3 months after enrollment
|
Distress Thermometer at 6 Months for BREAST Cancer Patients
Time Frame: 6 months after enrollment
|
Distress will be assessed through patient interviews utilizing the Distress Thermometer (DT) instrument with a scale from 0 (no distress) to 10 (extreme distress).
Lower values are more favorable.
|
6 months after enrollment
|
Distress Thermometer at 6 Months for LUNG Cancer Patients
Time Frame: 6 months after enrollment
|
Distress will be assessed through patient interviews utilizing the Distress Thermometer (DT) instrument with a scale from 0 (no distress) to 10 (extreme distress).Lower values are more favorable.
|
6 months after enrollment
|
Cancer Needs and Distress Inventory at 6 Months for BREAST Cancer Patients
Time Frame: 6 months post-enrollment
|
Patient needs were assessed through patient interviews utilizing the Cancer Needs Distress Inventory (CaNDI) instrument.
The CaNDI is a 38-item self-report instrument that rates need and distress level in the past two weeks using a 5 -point Likert scale where 1=not a problem to 5=very severe problem.
For this analysis, the mean total score is reported with the minimum value=1 and the maximum value=4.10.
Lower values are more favorable.
|
6 months post-enrollment
|
Cancer Needs and Distress Inventory at 6 Months for LUNG Cancer Patients
Time Frame: 6 months post-enrollment
|
Patient needs were assessed through patient interviews utilizing the Cancer Needs Distress Inventory (CaNDI) instrument.
The CaNDI is a 38-item self-report instrument that rates need and distress level in the past two weeks using a 5 -point Likert scale where 1=not a problem to 5=very severe problem.
For this analysis, the mean total score is reported with the minimum value=1 and the maximum value=2.3.
Lower values are more favorable.
|
6 months post-enrollment
|
Patient Satisfaction With Navigation at 6 Months Among BREAST Cancer Patients
Time Frame: 6 months post-enrollment
|
Patient's satisfaction assessed through the Patient Satisfaction with Interpersonal Relationship with Navigator Measure (PSN-1) questionnaire.
Each question of the 9-item instrument has a 5 point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).
Responses are summed for a total score.
The higher the score, the higher patient's satisfaction with navigation.
The minimum value=9 and the maximum value=45.
Higher values are more favorable.
|
6 months post-enrollment
|
Patient Satisfaction With Navigation at 6 Months Among LUNG Cancer Patients
Time Frame: 6 months post-enrollment
|
Patient's satisfaction assessed through the Patient Satisfaction with Interpersonal Relationship with Navigator Measure (PSN-1) questionnaire.
Each question of the 9-item instrument has a 5 point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).
Responses are summed for a total score.
The higher the score, the higher patient's satisfaction with navigation.
The minimum value=9 and the maximum value=45.
Higher values are more favorable.
|
6 months post-enrollment
|
Self-efficacy for BREAST Cancer Patients at 6 Months
Time Frame: 6 months post-enrollment
|
Self-Efficacy will be assessed through patient interviews utilizing the Communication and Attitudinal Self-Efficacy (CASE).
The CASE is a 12-item instrument that rates self-efficacy in three domains: (1) seeking and obtaining information, (2) understanding and participating in care, and (3) maintaining a positive attitude.
Total scores range from 12 to 48.
A higher score is more favorable, indicating a positive attitude and strong self-efficacy.
|
6 months post-enrollment
|
Self-efficacy for LUNG Cancer Patients at 6 Months
Time Frame: 6 months post-enrollment
|
Self-Efficacy will be assessed through patient interviews utilizing the Communication and Attitudinal Self-Efficacy (CASE).
The CASE is a 12-item instrument that rates self-efficacy in three domains: (1) seeking and obtaining information, (2) understanding and participating in care, and (3) maintaining a positive attitude.
Total scores range from 12 to 48.
A higher score is more favorable, indicating a positive attitude and strong self-efficacy.
|
6 months post-enrollment
|
Number of Participants Receiving Radiation Within 365 Days of Cancer Diagnosis
Time Frame: Measured at 12 months
|
The receipt of quality care is defined as receiving radiation to the breast within one year of a breast cancer diagnosis if: under the age of 70, estrogen or progesterone tumor positive and had breast conserving surgery.
|
Measured at 12 months
|
Distress Thermometer at 12 Months for BREAST Cancer Patients
Time Frame: 12 months after enrollment
|
Distress will be assessed through patient interviews utilizing the Distress Thermometer (DT) instrument with a scale from 0 (no distress) to 10 (extreme distress).
Lower values are more favorable
|
12 months after enrollment
|
Distress Thermometer at 12 Months for LUNG Cancer Patients
Time Frame: 12 months after enrollment
|
Distress will be assessed through patient interviews utilizing the Distress Thermometer (DT) instrument with a scale from 0 (no distress) to 10 (extreme distress).
Lower scores are more favorable.
|
12 months after enrollment
|
Cancer Needs and Distress Inventory at 12 Months for BREAST Cancer Patients
Time Frame: 12 months post-enrollment
|
Patient needs were assessed through patient interviews utilizing the Cancer Needs Distress Inventory (CaNDI) instrument.
The CaNDI is a 38-item self-report instrument that rates need and distress level in the past two weeks using a 5 -point Likert scale where 1=not a problem to 5=very severe problem.
The mean total score is reported.
|
12 months post-enrollment
|
Cancer Needs and Distress Inventory at 12 Months for LUNG Cancer Patients
Time Frame: 12 months post-enrollment
|
Patient needs were assessed through patient interviews utilizing the Cancer Needs Distress Inventory (CaNDI) instrument.
The CaNDI is a 38-item self-report instrument that rates need and distress level in the past two weeks using a 5 -point Likert scale where 1=not a problem to 5=very severe problem.
The mean total score is reported.
|
12 months post-enrollment
|
Patient Satisfaction With Navigation at 12 Months Among BREAST Cancer Patients
Time Frame: 12 months post-enrollment
|
Patient's satisfaction assessed through the Patient Satisfaction with Interpersonal Relationship with Navigator Measure (PSN-1) questionnaire.
Each question of the 9-item instrument has a 5 point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).
Responses are summed for a total score.
The higher the score, the higher patient's satisfaction with navigation.
The minimum value=9 and the maximum value=45.
Higher scores are more favorable.
|
12 months post-enrollment
|
Patient Satisfaction With Navigation at 12 Months Among LUNG Cancer Patients
Time Frame: 12 months post-enrollment
|
Patient's satisfaction assessed through the Patient Satisfaction with Interpersonal Relationship with Navigator Measure (PSN-1) questionnaire.
Each question of the 9-item instrument has a 5 point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).
Responses are summed for a total score.
The higher the score, the higher patient's satisfaction with navigation.
The minimum value=9 and the maximum value=45.
Higher scores are more favorable.
|
12 months post-enrollment
|
Self-efficacy for BREAST Cancer Patients at 12 Months
Time Frame: 12 months post-enrollment
|
Self-Efficacy will be assessed through patient interviews utilizing the Communication and Attitudinal Self-Efficacy (CASE).
The CASE is a 12-item instrument that rates self-efficacy in three domains: (1) seeking and obtaining information, (2) understanding and participating in care, and (3) maintaining a positive attitude.
A higher score indicates a positive attitude and strong self-efficacy.
Total scores range from 12 to 48.
A higher score is more favorable, indicating a positive attitude and strong self-efficacy.
|
12 months post-enrollment
|
Self-efficacy for LUNG Cancer Patients at 12 Months
Time Frame: 12 months post-enrollment
|
Self-Efficacy will be assessed through patient interviews utilizing the Communication and Attitudinal Self-Efficacy (CASE).
The CASE is a 12-item instrument that rates self-efficacy in three domains: (1) seeking and obtaining information, (2) understanding and participating in care, and (3) maintaining a positive attitude.
A higher score indicates a positive attitude and strong self-efficacy.
Total scores range from 12 to 48.
A higher score is more favorable, indicating a positive attitude and strong self-efficacy.
|
12 months post-enrollment
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Tracy A Battaglia, M.D., M.P.H, Boston Medical Center
- Study Director: Sharon Bak, M.P.H, Boston Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- H-32599
- RSG-13-368-01-CPPB (Other Grant/Funding Number: American Cancer Society)
- AD-1304-6272 (Other Grant/Funding Number: Patient-Centered Outcomes Research Institute)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Cancer
-
University of Michigan Rogel Cancer CenterRecruitingCancer Liver | Cancer Brain | Cancer Head &Neck | Cancer PelvisUnited States
-
Cellworks Group Inc.RecruitingCancer | Relapsed Cancer | Refractory CancerUnited States
-
UNC Lineberger Comprehensive Cancer CenterHyundai Hope On WheelsRecruitingCancer | Pediatric Cancer | Survivorship | Cancer MetastaticUnited States
-
Vanderbilt-Ingram Cancer CenterNational Institutes of Health (NIH)Active, not recruitingAdvanced Cancer | Relapsed Cancer | Refractory CancerUnited States
-
City of Hope Medical CenterNational Cancer Institute (NCI)CompletedStage III Pancreatic Cancer | Stage IIA Pancreatic Cancer | Stage IIB Pancreatic Cancer | Stage IV Gastric Cancer | Stage IVA Colorectal Cancer | Stage IVA Pancreatic Cancer | Stage IVB Colorectal Cancer | Stage IVB Pancreatic Cancer | Stage IIIA Gastric Cancer | Stage IIIB Gastric Cancer | Stage IIIC Gastric... and other conditionsUnited States
-
MiRXES Pte LtdRecruitingBreast Cancer | Gastric Cancer | Colorectal Cancer | Pancreatic Cancer | Esophageal Cancer | Ovarian Cancer | Prostate Cancer | Thoracic Cancer | Liver CancerSingapore
-
Sidney Kimmel Cancer Center at Thomas Jefferson...CompletedStage I Breast Cancer | Stage I Uterine Corpus Cancer | Stage II Uterine Corpus Cancer | Stage III Uterine Corpus Cancer | Stage II Breast Cancer | Stage IIIA Breast Cancer | Stage IIIB Breast Cancer | Stage IA Breast Cancer | Stage IB Breast Cancer | Stage IIA Breast Cancer | Stage IIB Breast Cancer | Stage... and other conditionsUnited States
-
Massachusetts General HospitalNational Comprehensive Cancer NetworkCompletedGastric Cancer | Pancreatic Cancer | Esophageal Cancer | Rectal Cancer | Colon Cancer | Hepatobiliary CancerUnited States
-
University of California, San FranciscoBristol-Myers Squibb; PfizerTerminatedStage IIIA Rectal Cancer | Stage IIIB Rectal Cancer | Stage IIIC Rectal Cancer | Metastatic Colorectal Adenocarcinoma | Metastatic Colon Adenocarcinoma | Metastatic Rectal Adenocarcinoma | Stage IIIA Colon Cancer | Stage IIIB Colon Cancer | Stage IIIC Colon Cancer | Stage IV Colon Cancer | Stage IV Rectal... and other conditionsUnited States
-
Johns Hopkins UniversityNational Cancer Institute (NCI); National Institute on Minority Health and...Enrolling by invitationCancer | Advanced Cancer | End Stage Cancer | MalignancyUnited States
Clinical Trials on Patient navigation enhanced with legal support
-
Boston Medical CenterBoston University Clinical Translational Science InstituteCompleted
-
Boston UniversityNational Center for Research Resources (NCRR)CompletedCigarette Smoking
-
University of Texas Southwestern Medical CenterMichael E. DeBakey VA Medical Center; Parkland Health and Hospital SystemCompletedCarcinoma, Hepatocellular | Liver NeoplasmsUnited States
-
University of ArizonaAmerican Cancer Society, Inc.WithdrawnRenal Cell Carcinoma | Hepatocellular CarcinomaUnited States
-
Chinese University of Hong KongCompletedRandomized Controlled Trial | OsteotomyHong Kong
-
Abramson Cancer Center at Penn MedicineActive, not recruiting
-
Johns Hopkins UniversityMU-JHU CARECompletedBreast Feeding | HIV-infection/Aids
-
Kaiser PermanenteNational Institute of Mental Health (NIMH); Emory University; University of Toronto and other collaboratorsCompletedPerinatal DepressionUnited States
-
Medical University of South CarolinaNational Institute of Nursing Research (NINR); National Institutes of Health...CompletedPsychosocial Problem | Caregiver Burnout | Family Research | Food Allergy in ChildrenUnited States