Project SUPPORT (Socio-legal Services for Underserved Populations Thru Patient Navigation to Optimize Resources During Treatment)

Differences and delays in the delivery of cancer care lead to more advanced cancer at the
time of diagnosis and ultimately to more deaths for low-income and minority communities. Our
group helped develop a patient-navigation model using lay health workers to address patient
barriers and coordinated cancer-care services, leading to more timely care. Despite the fact
that patient navigation is now a standard required by the Commission on Cancer, the
investigators' research shows that delays in care persist for our low-income patients with
socio-legal barriers. Socio-legal barriers are defined as social problems related to meeting
life's most basic needs that are supported by public policy or programming and thus
potentially remedied through legal advocacy/action (e.g., unsafe/unstable housing, unlawful
utility shutoffs, or job termination). Direct feedback from cancer patients suggests a
critical need to address socio-legal barriers in order to achieve quality care for all. To
expand the current impact of patient navigation on quality care for low-income patients, the
investigators will partner with patients, key community stakeholders, and the Medical-Legal
Partnership (MLP)|Boston, the founding site of a nationwide program assisting healthcare
teams in addressing socio-legal barriers to health. Under direction from a Patient Advisory
Group and a Community Advisory Board, the investigators will conduct a study to compare
standard navigation with an MLP navigation intervention enhanced by legal support for
low-income cancer patients.

The investigators will enroll 374 low-income, racially diverse, newly diagnosed cancer
patients. Half will receive standard navigation, i.e., a lay navigator integrated into the
healthcare team who provides one-on-one patient contact to address traditional system
barriers to care. The other half will receive MLP navigation, i.e., standard navigation
enhanced by legal support including:

1. a full socio-legal needs assessment and care plan in consultation with MLP; and

2. legal assistance for eligible urgent legal needs. We will compare each group on all
outcomes.

Compared to standard navigation, we expect that addressing socio-legal barriers to care with
MLP navigation will improve patient-reported outcomes and lead to more timely care delivery.
Because of widespread national availability of patient navigation and MLP programs at
hospitals serving vulnerable patients, this intervention can be quickly replicated to improve
patient experience and survival.

Inclusion Criteria:

- Newly diagnosed breast and lung cancer patients

- Within 30 days of patient being informed of diagnosis

- Receiving cancer care at Boston Medical Center

- No history of cancer treatment in past 5 years

- No cognitive impairments

- Over 18 years of age

- Speak English, Spanish or Haitian Creole

Exclusion Criteria:

- Patient informed of cancer diagnosis >30 days

- Patient under 18 yrs. of age

- Primary language something other than English, Spanish or Haitian Creole

- Undergoing treatment for concurrent cancer

- Patient has history of cancer or has received cancer treatment within the last 5 years

- Institutionalized/cognitive impairment (such as: dementia or metabolic, medication or
drug induced), given the unique challenges to their treatment decision
making/adherence and the fact that the intervention would not include the patient
directly, but rather the family.