Abstract A24: Gender differences in barriers experienced by low-income participants of a patient navigator clinical trial

Purpose: Barriers to cancer diagnostic and treatment services are multi-faceted and can be categorized into patient-centered, provider and system-related barriers. These barriers cause delays in care that may lead to poorer health outcomes. The purpose of the study is to test patient navigation as an effective way to reduce barriers to care during these critical times. Patients are recruited and receive medical services at Denver Health Medical Center, an urban safety net hosptial serving minority and uninsured patients in Denver, Colorado.

Methods: The Denver Patient Navigation Research Program (PNRP) is an individual randomized clinical trial of patient navigation for breast, prostate and colorectal diagnostic or cancer treatment patients. As part of this trial, all patients are surveyed upon consent and assessed for experiences with barriers to care during the preceding 12 months. The barriers to care survey assesses 22 potential barriers that include making medical appointments, transportation, financial issues, disability and comorbidities, and communicating with staff, among others. In addition, patients are asked about likeliness of follow-through with medical recommendations. This presentation will discuss the gender-related patient characteristics associated with baseline barriers to care.

Results: To date, we have accrued 480 patients. The median age of the participants is 52 y., 74% are female, 34% married/partnered, 63% reported having a high school diploma or less education, 26% speak primarily Spanish and 76% are non-white. Overall, men experienced more barriers than women in the study. Men reported more difficulty in dealing with financial concerns, being involved in medical decision-making, overcoming barriers related to disability and having complications due to co-morbidities. Women faced more barriers to scheduling appointments, getting to appointments, dealing with fears around the medical condition and facing mistreatment. We will describe differences in race/ethnicity and co-morbidities among men and women. Fifty-one percent of the study participants are hypertensive, 30% have diabetes, over 30% have a history of substance abuse, 30% have been depressed and 23% have COPD. The likelihood of adherence to diagnostic or treatment services and barriers to obtaining follow-up services will also be reviewed in this presentation.

Conclusions: Men and women face similar barriers to care due to lack of insurance and financial difficulties. Other barriers show disparate experiences among men and women. Gender, race/ethnicity, education, language and income are significantly associated with barriers that affect patients' abilities to deal with their healthcare needs.

Research Implications: Interventions tailored to the needs of male and female underserved medical populations are needed for patients to overcome the various types of barriers that lead to delays in care.

Clinical Implications: Better appreciation of barriers to care will aid clinicians in appropriately assessing and guiding patients through cancer screening and treatment.

Acknowledgement of Funding: National Institute of Cancer, U01; CA116903–04