Advancing equity in prostate cancer outcomes using community-facing navigation in the cancer continuum of care.

120 Background: According to the American Cancer Society, prostate cancer is the second most common cause of cancer death in Black men. Between 2014–2018, the prostate cancer incidence rate among Black men was 73% higher than that in white men. Approximately 6,040 Black men are projected to die of prostate cancer in 2022. Many disparities contribute to prostate cancer mortality in Black men, including missed genitourinary (GU) referral appointments. Research has shown that patient navigation can be an effective, evidence-based intervention to improve health outcomes. Improving completion of GU referrals through navigation may advance equity in continuity of care. Methods: An algorithm was integrated into electronic medical records (EMR) to identify Black men eligible for prostate cancer screening in primary care practices of a health system North Carolina. An assessment was adapted for community-facing navigators using existing literature on patient navigation practices. Navigators were trained on culturally responsive prostate cancer education and a plan-do-study-act quality improvement (QI) model. A notice to navigate alert was implemented into the navigation workflow to alert staff of Black men with prostate-specific antigen (PSA) levels of 10 or greater. Results: At baseline, perceived barriers to entering the continuum of care were related to the social determinants of health, as noted by navigators. During the intervention, navigators were alerted of 25 Black men 49 – 74 years of age with PSA levels of 10 and above. Initial PSA results ranged from 10.55 to 101.61 (ng/ml). Twenty-three of them agreed to accept navigation services and were scheduled appointments to follow up with GU. Of the completed appointments, 15 were diagnosed with prostate cancer. Post-intervention, navigators noted barriers to completing GU appointments included health literacy/education, work schedules, transportation, lack of responsiveness to female navigators, the digital divide, social support, and denial of prognosis. Conclusions: Providing Black men with navigation services allowed common barriers to be eliminated, increased GU appointment completion, identified men with prostate cancer at earlier stages, and assisted with earlier initiation of treatment by conducting a warm handoff to clinical navigators. Future studies may seek to understand implementation of the EMR algorithm across all primary care practices, integrating the use of navigators as an intervention, and supplementing culturally—tailored patient education materials to include a digital component.