Identifying Strengths and Challenges in Cancer Care Delivery on Navajo Nation: A Qualitative Study

Background: On Navajo Nation, cancer is the second leading cause of mortality and a leading cause of premature death. Multiple preventable cancers are diagnosed at later stages than in non-Hispanic Whites (NHWs). Preventable cancers, such as cervical cancer, have higher prevalence than with NHWs (Yazzie, 2018). The healthcare system serving Navajo Nation is complex and fragmented. Although health facilities and health programs are actors along the cancer care continuum, little is understood about cancer care delivery and care coordination from a systemic perspective. This study sought to understand structural barriers and opportunities to improve cancer care delivery on Navajo Nation. Methods: We collected qualitative data through semi-structured interviews with health sector workers who provide care and services along the cancer care continuum regarding what they viewed as the strengths, barriers, and opportunities for improving cancer care for individuals on Navajo Nation. We open coded a subset of the interviews and used content an analysis method with the grounded theory approach (Pope & Mays, 2006) through an iterative process to come up constituent categories that describe the themes that emerged from the dataset. Results: On the basis of category construction and interpretation of the data, we organized the findings from the interviews into several thematic categories represented below: 1) Patient access to care and resources, 2) Communication, 3) Care coordination, and 4) Larger systemic challenges. Together, these are understood through the larger category of the interrelatedness across the cancer care continuum. Conclusion: Although there are significant systemic challenges in providing cancer treatment to individuals living on Navajo Nation, there are also important opportunities to improve cancer care that can be addressed at the health facility level. To relieve the care coordination burden placed on patients, certified mentored Navajo translators and cancer care coordinators could help ensure equitable access to cancer treatment and resources by transforming a champion-based model into a system level change that addresses the challenges in continuity of care, provision of culturally appropriate care, and timely referral, especially in departments that have a higher staffing of short-term providers such as the emergency department and urgent care. Master of Medical Sciences in Global Health Delivery