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Effect of Patient Navigation Services on Cancer Treatment Attendance among Patients in Nigeria

Abstract

Cancer treatment requires patients to attend multiple appointments for diagnosis, surgery, chemotherapy, radiotherapy, follow-up assessment, and other forms of care. However, maintaining regular attendance may be challenging for many cancer patients in Nigeria because of high treatment costs, transportation difficulties, long distances to oncology centres, complex treatment schedules, inadequate information, prolonged waiting times, fragmented referral pathways, and limited social support. Missed treatment appointments may result in delays in receiving appropriate care, interruptions in treatment schedules, disease progression, and poorer health outcomes. Patient navigation services provide individualized support to help cancer patients understand their treatment plans, coordinate appointments, overcome healthcare-system barriers, access available resources, and remain engaged with oncology services. Against this background, this study investigates the effect of patient navigation services on cancer treatment attendance among patients in Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and the Donabedian Model of Healthcare Quality. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors, with patient navigation serving as an enabling intervention that may facilitate continued access to cancer treatment. The Health Belief Model explains how patients' perceptions of cancer severity, treatment benefits, barriers, and cues to action may influence their attendance at recommended treatment appointments. The Donabedian Model explains how healthcare structures and processes influence healthcare outcomes, with patient navigation representing a supportive care process and treatment attendance serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how patient navigation services may influence cancer treatment attendance in Nigeria. The study will adopt a quantitative quasi-experimental or prospective cohort research design. The study population will comprise adult cancer patients receiving treatment at selected public and private oncology centres in Nigeria. A multistage sampling technique will be used to select states, local government areas, oncology centres, treatment units, and eligible cancer patients. Patient navigation services will be measured using indicators such as access to a designated patient navigator, frequency of navigation contacts, appointment scheduling assistance, treatment coordination, patient education, referral support, transportation assistance, financial-resource linkage, communication with healthcare providers, follow-up contacts, and assistance with addressing treatment-related barriers. Cancer treatment attendance will be assessed using indicators such as attendance at scheduled treatment appointments, attendance within the recommended treatment period, number of attended appointments, missed appointments, delayed appointments, treatment interruptions, attendance at chemotherapy or radiotherapy sessions where applicable, attendance at follow-up consultations, and loss to follow-up. Data will be collected using structured questionnaires, patient navigation records, oncology treatment records, appointment registers, hospital medical records, referral records, and follow-up documentation. Descriptive statistics will be used to summarize patients' demographic and clinical characteristics, navigation-service exposure, and treatment attendance patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of patient navigation services on cancer treatment attendance. Where a quasi-experimental design is adopted, treatment attendance among patients receiving structured navigation services may be compared with attendance among patients receiving usual care. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that patient navigation services have a significant positive effect on cancer treatment attendance among patients in Nigeria. Patients receiving structured navigation support are expected to demonstrate higher attendance rates, fewer missed appointments, fewer treatment delays, and lower rates of loss to follow-up than patients without access to navigation services. Patient navigators may help patients understand treatment schedules, coordinate appointments, address transportation and financial barriers, provide reminders, facilitate communication with healthcare providers, and connect patients with available social and financial support. Navigation may be particularly beneficial for patients undergoing lengthy and complex treatment regimens that require repeated visits to oncology centres. However, high treatment costs, inadequate oncology services, transportation challenges, shortages of trained patient navigators, long distances to treatment facilities, and limited availability of cancer medicines or equipment may continue to affect attendance. The study therefore expects accessible, structured, and adequately supported patient navigation services to contribute significantly to improved cancer treatment attendance in Nigeria. The study is expected to contribute to the literature on patient navigation services, cancer treatment attendance, oncology care, healthcare utilization, treatment adherence, continuity of care, cancer support services, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Institute for Cancer Research and Treatment, state ministries of health, oncology centres, hospitals, cancer-care professionals, patient-support organizations, development partners, and policymakers regarding strategies for improving attendance and continuity of cancer treatment. The study will also provide evidence-based recommendations for integrating patient navigation into cancer-care programmes, training and deploying patient navigators, strengthening appointment scheduling and reminder systems, improving transportation and financial support, enhancing patient education, strengthening referral coordination, and developing sustainable navigation services to support cancer patients throughout their treatment journey in Nigeria.

Keywords: Patient navigation services, cancer treatment attendance, cancer patients, oncology care, treatment adherence, healthcare utilization, continuity of care, appointment attendance, patient support, Nigeria, public health.