Leveling the playing field: the personal coach program as an innovative approach to assess and address the supportive care needs of underserved cancer patients.

Supportive care addresses informational, social, emotional, spiritual, physical, and practical needs that impact the lives of patients and their families. Accessing supportive care services is particularly challenging for patients facing significant financial and social barriers. This report discusses the Personal Coach Program (PCP), which provides specially trained coach navigators of supportive care for cancer patients, with special focus on those facing the above-mentioned barriers. The PCP was piloted with 63 patients treated at the Princess Margaret Hospital in Toronto, Ontario, Canada. Patients faced barriers of language, poverty, culture, social isolation, and literacy. Triangulation was used to compare and contrast multiple sources of quantitative and qualitative evaluation data. Identifying appropriate patients for referral to the PCP was a major challenge. Six categories of unmet needs were identified: practical factors related to daily living, cancer information, emotional support, interaction with the healthcare team, problems with physical health,and factors related to family and friends. Many significant barriers to supportive care and unmet needs are not identified by time-pressured clinical staff in cancer clinics. The PCP helped to identify needs and to improve ability to access services. Participants were highly satisfied with the program and believed it had positive implications for both physical and emotional health. Based on these results, a demonstration model for a supportive-care program is proposed as an integral component of care for all cancer patients, including those at risk for underservice.