Periodic Reporting for period 1 - CANCERLESS (Cancer prevention and early detection among the homeless population in Europe: Co-adapting and implementing the Health Navigator Model)
Reporting period: 2021-06-01 to 2022-11-30
Cancer is one of the leading causes of death in the general population in Europe and the cancer-related mortality is twice as high in people experiencing homelessness (PEH). Structural factors such as barriers to accessing health services as well as individual risk factors such as smoking and alcohol consumption are reasons for the higher risk of cancer in PEH. Therefore, CANCERLESS has been developing the Health Navigator Model (HNM), an evidence-based, patient-centered intervention to a) empower PEH through health education and social support and b) enabling access to primary and secondary cancer prevention through health navigators (HNs). Providing timely and evidence-based prevention strategies, including optimization of health care delivery has the potential to offer a solution to higher cancer mortality in an underserved population. This should help to overcome health inequalities in the selected population group and reduce the cancer burden and associated costs across health and social care systems in Europe. The overarching objective of the CANCERLESS project is to provide person-centered health care services to enable timely access to primary and secondary cancer prevention for PEH. The project will develop the Health-Navigator Model (HNM), pilot test and evaluate it in four countries (Austria, Greece, Spain, UK). To ensure the sustainability of the project, CANCERLESS will share the blueprint for a redesign of integrated cancer care and recommendations for health and social care policies to adopt the HNM across different health and social care systems in Europe. This is should help to overcome health inequalities in the long-term, reduce the cancer burden and associated costs across health and social care systems in Europe. Ultimately, the aim is to contribute to achieving the UN’s sustainable development goal 3.4. “Reduce the premature mortality from non-communicable diseases”.
Within WP1 the overall structure of the project, including responsibilities of each consortium partner, work packages (WP) and tasks of WP leaders and a communication strategy to communicate progress or identify challenges to the efficient implementation of tasks were outlined. So far, three consortium meetings have been held. By now all planned milestones have been met and all deliverables submitted for review. In WP2 the development of a co-adapted Health Navigator Model (HNM), meeting the needs of organizations, health care professionals and people experiencing homelessness (PEH) was accomplished. This was concluded through a systematic scoping review of literature on patient navigation (PN) to define the theoretical foundation of the HNM for PEH. Common scientific guidelines and tools for the cross-national research team were developed to ensure both consistency and quality. Qualitative interviews with PEH and health care professionals (n=69) were then conducted to explore general health care needs and barriers for PEH accessing primary and secondary cancer prevention across the four partner countries and co-adaptation focus group discussions (n=56) were concluded to define the HNM parameters. WP3 involves the pilot implementation of the HNM in four partner countries (Austria, Greece, Spain and the UK). Here development of guidelines and materials for capacity building for Health Navigators (HN) and their translation into the languages of the pilot sites were concluded. Further, pilot implementation plans were developed which describe the implemented methodology per pilot site. The pilot implementation started in June 2022 and will last 18 months. To date, 11 health navigators (HNs) have been trained in the use of the HNM, 243 PEH have participated in the project and more than 650 referrals to various cancer prevention services have been done. WP4 performs the formative and summative evaluation of the HNM pilot implementation. This includes an iterative evaluation in which both quantitative and qualitative data is collected, which provides the first evidence on the clinical utility and effectiveness of the HNM intervention among PEH in Europe. Currently, the evaluation of the HNM intervention is taking place in the form of researcher-administered questionnaires, interviews and focus group discussions. The communication activities (WP6) aim to promote societal knowledge about health inequalities and, in particular, to illustrate the barriers PEH face in accessing cancer prevention and how the HNM works in general. Further, the results will enable further inquiries in this under-researched area and promote science communication to increase awareness and visibility of cancer prevention in PEH. In addition, CANCERLESS is building relationships with decision-makers and civil society organizations and generates local and global alliances to scale-up the HNM derived from the project. WP7 and WP8 ensures the ethics and data protection regulations and that partners comply with these regulations during the whole project cycle. This included successful permissions from local responsible ethical committees, formation of an Ethical Advisory Board as well as registration with ClinicalTrials.gov by the Medical University of Vienna (NCT05406687).
The HNM model has been developed in the course of the CANCERLESS project and presents a novel intervention to foster cancer prevention and early diagnosis among PEH in the European context. The outcomes of this innovative intervention will address the gap in evidence and provide further understanding of feasibility and suitability of navigation models for addressing the needs of this population. This is crucial as PEH are known to experience poor health-related outcomes, and in particular a disproportionate risk of cancer-related mortality. The overall lack of studies performed with PEH is one of the main gaps that the CANCERLESS project aims to address. The evaluation of the data will generate insights about the statistical distribution of the populations regarding different demographics, health status, Patient Reported Experience Measurements (PREMs), and Patient Reported Outcomes Measures (PROMS). Moreover, the evaluation of the intervention will provide evidence on the clinical utility and effectiveness of the HNM intervention among PEH for the first time in Europe. It is expected that the benefits experienced by PEH are an increased quality of life, health promotion and empowerment as well an increase in the use of preventive services in their local contexts. As part of the evaluation, the project also identifies factors facilitating or hampering effective and successful implementation of the HNM intervention. These results will be pivotal to gain insights into the replicability, feasibility and sustainability of the CANCERLESS intervention in the contexts in which the study is conducted and beyond. In addition to this, microsimulations will allow to evaluate the effectiveness of an intervention. The prediction of relevant outputs for this population segment is an unexplored field of the State of the Art (SoA). Synthetic data generation, which is part of microsimulations, is also a novel procedure in the field. These data-driven approaches have not been applied to PEH yet and could yield exciting scientific results that may advance the SoA.