Roadmap to Address Barriers to Care

Many cancer patients encounter challenges that can delay or prevent them from receiving timely or appropriate care. In our current health care environment navigating cancer care services has become increasingly complex. Despite progress that is made to expand access, there are still gaps in the delivery system. The patient’s knowledge and understanding of their diagnosis and proposed plan of care may also create barriers that need to be mitigated. By addressing the barriers through nurse navigation and survivorship programs barriers can be reduced or eliminated and, ultimately, treatment outcomes and the patient’s quality of life improved.

In January 2020, the Commission on Cancer (CoC) introduced the new cancer program standards manual, “Optimal Resources for Cancer Care.” One of the standards, 8.1 Addressing Barriers to Care is intended to help the program identify, develop, and implement a plan to address barriers to care unique to their organization.


The CoC encourages programs to create a multidisciplinary team and culture of collaboration to analyze barriers and synchronize resources to facilitate access to care. Nurse navigators, case managers, physicians and other allied health department representatives should participate in the team activity.

The goal of this standard is for the Cancer Committee, or their designees, to analyze the barrier, conduct a root-cause-analysis of its strengths and identify the sources of barriers or gaps in the delivery of care. The results are then compared to the level of service they wish to achieve or at least to the degree that it improves access to care for their patient population.

Factors that influence the patient’s chances of encountering a barrier may include:

· Age

· Gender and sexual orientation

· Race and ethnicity

· Religion

· Language

· Socioeconomic status

· Community and social environment

· Cultural and family norms and behaviors

· Financial concerns

· Spiritual or end-of-life concerns

· Rural or geographic factors

Once the root-cause-analysis is complete the team can identify the interventions or improvements needed. Then, with Cancer Committee approval and oversight, they implement and monitor the process to determine if the desired result was achieved. At the end of the year the team presents a final written summary of the work conducted that includes metrics related to the outcomes achieved by reducing the chosen barrier.

There are many evidence-based articles in literature today as well as resources and tools to guide this process. Recently the CoC introduced a resource offered by the George Washington University (GW) Cancer Center. This comprehensive roadmap, Implementing the Commission on Cancer Standard 8.1 Addressing Barriers to Care, is available for free download. It includes an overview and framework that can be used by any cancer program to analyze the barriers, identify, and implement interventions and tips on how to partner with community and other cancer control professionals to address and support identified gaps in resources.

In summary, as the age and diversity of our populations increase, so does the potential for cancer patients to encounter barriers to health care. The intent of the CoC standard is for organizations to objectively evaluate their multidisciplinary programs and services and to effectively communicate with the patient regarding their cultural, socioeconomic, and sociodemographic needs. Nurse navigators are in direct contact with the patient and can engage them in conversation and offer personalized teaching and supportive services, so they are able to comply with the treatment program recommended by their provider and derive the best benefit possible from their care.

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