Development of a patient navigation intervention for rural patients diagnosed with endometrial cancer: An intervention mapping approach.

Abstract

BackgroundPatient navigation is an equity-focused solution the provides personalized assistance to patients. To be effective, patient navigation needs to address variations across diverse contexts and populations.ObjectivesWe aimed to systematically design a patient navigation intervention for rural individuals with endometrial cancer (EC).DesignWe employed an intervention mapping methodology.MethodsThis multi-step process included conducting a needs assessment, identifying program objectives and outcomes, designing and producing the navigation program, and developing implementation and evaluation plans. We collaborated with an advisory board, who provided iterative feedback on intervention content, structure, and delivery.ResultsThrough our needs assessment, we identified 25 modifiable determinants of rural EC care grouped into five themes: poor patient-provider communication, barriers related to travel burden, lack of quality medical services, lack of/inaccessible supportive care resources, and insurance-related barriers. Our advisory board prioritized 15 determinants. A logic model of change outlined targeted determinants to improve receipt of high-quality treatment and reduce morbidity and mortality. The navigation program was designed to support rural patients from diagnosis through treatment completion. Key elements of the navigation program included rapport-building and longitudinal assessments to identify evolving barriers, address financial and transportation barriers, and provide emotional and informational support. Intervention materials developed included informational patient-facing materials, resource guides for navigators, and navigator scripts. Implementation strategies included clinical champions, a learning collaborative, and ongoing feedback. Our evaluation plan incorporated implementation outcomes (e.g., reach, fidelity, cost, acceptability) and effectiveness measures (e.g., patient-reported outcomes, treatment timeliness).ConclusionIntervention mapping provided a systematic framework for designing a patient navigation program targeting the barriers to care experienced by rural EC patients. Future work will test the intervention to assess feasibility, acceptability, and effectiveness in diverse clinical settings. This approach provides a replicable, evidence-based method to create navigation interventions for addressing the needs of high-risk populations.