A mixed-methods evaluation of a patient navigation program for breast and cervical cancers in Rwanda

Rwanda faces challenges in delivering effective cancer care due to limited patient access and a fragmented healthcare system. Rwanda faces challenges in delivering effective cancer care due to limited patient access and a fragmented healthcare system. This study evaluated the pilot phase of the Digitally Enabled Cancer Patient Navigation (DCPN) program, implemented to improve continuity of care for breast and cervical cancer patients by navigating them through complex cancer care pathways. The DCPN program had two components: (1) a digital platform connecting five major cancer care hospitals and (2) facility-based patient navigators who assisted patients through their care journey. This mixed methods study included in-depth semi-structured qualitative interviews with patient navigators, hospital staff, and patients, and analyzed thematically based on the Consolidated Framework for Implementation Research (CFIR), to understand program experiences, strengths, and challenges. A retrospective quantitative analysis was used to assess DCPN’s impact on diagnosis and treatment initiation timelines. The program demonstrated adaptability to both national health system structures and local facility needs. However, the broad scope of navigator duties led to workload concerns. The digital application promoted inter-facility collaboration but faced limitations in terms of user adoption and integration. While the mean time to pathology report generation was similar between groups (16 days for DCPN vs. 15 days for control), only 7% of DCPN patients received results within five days, compared to 35% in the control group. However, DCPN significantly improved treatment initiation timelines: mean time to treatment initiation was 28 days in the DCPN group versus 82 days in controls. Moreover, 84% of DCPN patients began treatment within 60 days of diagnosis, compared to 58% without navigation. The successful implementation of a DCPN pilot program significantly improved treatment initiation timelines in resource-limited settings by improving coordination and navigation across cancer care services. These findings underscore the value of integrated digital and human support models in strengthening continuity of care in LMICs. Key contributors to success included adaptability, interfacility communication, and navigator training. Future research should address navigator workload, access barriers, and mental health support to develop a sustainable and scalable model that can improve clinical outcomes.