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Impact of an Innovative Patient Navigation Project in Nigeria: Preliminary Results

Background: Cancer patients in Nigeria are known to present late and have poor awareness of their disease. Among the factors which limit early presentation are aversion for orthodox medicine due to perceived complexity of health institutions, and belief in superiority of traditional medicine. Patient navigation has been shown to improve patient treatment adherence. There is limited evidence on the impact of PN in Nigeria, and other resource-limited settings. Aim: Study sought to introduce a hospital-based patient navigation program (PNP) and evaluate its impact. Methods: PNP was initiated at the University of Uyo Teaching Hospital in June 2016 with focus on breast cancer patients. A young, male public health officer, who spoke the local language was recruited and trained to guide cancer breast patients through the hospital. Training focused on hospital services, sensitive communications, patient management process, confidentiality and resource identification. The service was announced to the hospital community, and his contact information was advertised. Patients and hospital community could contact the navigator via phone calls and text messaging. Impact data collection included services provided, patient characteristics and feedback on services. Data analysis included descriptive statistics and thematic analysis. Results: In the first year of the PNP (June 2016-17), 202 breast cancer cases were seen, and 137 connected with the navigator; service utilization rate was 67.8% (137/202). More patients in the PNP received diagnosis within 90 days of their first visit, 58.4% (80/137) presented with stage 4 disease, and 20 had mastectomy. Most patients had low income and low education. Two patients died after completing three courses of chemotherapy. Finance, transportation and poor social support were the most common barriers to access. Health care providers positively reviewed the PNP, often saying that “it made their work” and “added value to hospital care and cancer management”. Physicians who did not speak the local language often used the navigator as a translator. Most patients echoed “God bless you” in prayers offered to appreciate the navigator. They agreed that the PNP reduced some barriers to hospital service utilization, although 32 patients (23%) expressed frustration over unmet expectations financial support from the navigator. Physicians who manage other cancers have started referring patients to the PNP since its initiation. Conclusion: This evaluation showed that PNP program was well used and led to improvements in breast cancer patient management. It proves that patient navigation is feasible in a resource-limited setting. Funding to sustain and expand the program is a limitation. More patient satisfaction and outcome studies are needed to evaluate PNP impact.