Abstract 1382: Overcoming disparities with technology-enhanced patient navigation: Implementation of a randomized controlled trial

Background: Fragmented care, limited psychosocial support, and poor symptom management plague some women with breast cancer, especially those with low income, leading to poor health outcomes among disadvantaged groups. To address these disparities a “virtual” navigator system was developed. The efficacy of patient navigation delivered via a web-based knowledge and communication portal to improve adherence, symptom management and quality of life among low-income women undergoing adjuvant breast cancer treatment is being evaluated in a randomized clinical trial with a recruitment goal of 100 patients. Methods: All subjects receive a netbook computer with access to the web-based portal, wireless Internet connectivity, and computer training. The application provides direct links to vetted reliable websites and, for the intervention arm, access to tailored documents, short instructional videos by the study team and at least biweekly navigator (nurse and/or social worker) visits via Skype™ or telephone. Assessments are conducted at baseline, 6 and 12 months after enrollment. Study outcomes include treatment adherence (appointments kept, relative dose intensity and medication possession ratio), fatigue (10 point Visual Analog Scale), distress (Impact of Events Scale) and quality of life (FACT-B.) Results: Barriers to implementation include inadequate connectivity in some rural areas, delivery of computers by supplier, and monthly data limits (5GB) for the wireless service resulting in temporary suspension of service when limits are exceeded (4 control participants to date.) Mean age of the 35 women enrolled as of November 2012 is 47.5 years (SD 9.7); range 24-68. All have incomes < 300% of poverty level and 59% are African American. 44% have a high school education or less. 40% have co-morbid psychiatric diagnoses. About a quarter of participants have little or no computer experience. Compared to control patients, those on the intervention arm are more likely to agree or strongly agree (73% versus 29%) that the portal is easy to use, that they use it frequently and that they have confidence in their ability to use it. Conclusion: Women randomized to the navigational support intervention arm are more likely than control women to use the portal to access information and to feel more confident in their use of the portal. The study will determine if increased access to educational materials and virtual support translates into improved health outcomes. Sponsor: Susan