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Effect of Breast Cancer Navigation Services on Breast Cancer Diagnostic Follow-Up among Women in Nigeria

Abstract

Breast cancer is a major public health concern among women in Nigeria and may result in substantial morbidity and mortality when diagnosis and treatment are delayed. Although early detection through breast health awareness, clinical assessment, imaging, biopsy, and other diagnostic procedures can improve opportunities for timely management, many women experience delays between initial identification of a suspicious breast abnormality and completion of recommended diagnostic investigations. These delays may be associated with limited knowledge, financial constraints, transportation difficulties, fragmented healthcare services, inadequate communication, fear, stigma, and difficulty navigating complex diagnostic pathways. Breast cancer navigation services provide structured assistance to women throughout the diagnostic process by helping them understand recommended procedures, schedule appointments, access healthcare facilities, obtain diagnostic results, receive psychosocial support, and maintain communication with healthcare providers. Against this background, this study investigates the effect of breast cancer navigation services on breast cancer diagnostic follow-up among women in Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and Patient-Centred Care Theory. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence women's utilization and continuity of diagnostic healthcare services. The Health Belief Model explains how women's perceptions of breast cancer susceptibility and severity, perceived benefits of diagnostic follow-up, perceived barriers, and cues to action may influence completion of recommended investigations. Patient-Centred Care Theory emphasizes communication, respect, coordination, shared decision-making, responsiveness, and individualized support as important components of effective cancer care. Collectively, these theoretical perspectives provide a suitable framework for explaining how breast cancer navigation services may influence diagnostic follow-up among women in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women who have been identified with breast abnormalities or referred for further breast cancer diagnostic evaluation at selected healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, oncology centres, and eligible women. Breast cancer navigation services will be assessed using indicators such as availability of patient navigation programmes, navigation enrolment, appointment scheduling assistance, diagnostic procedure coordination, patient education, communication support, transportation or referral assistance where available, financial or social support referral, psychosocial support, follow-up reminders, result communication, and coordination between healthcare providers. Breast cancer diagnostic follow-up will be assessed using indicators such as completion of recommended diagnostic appointments, attendance for breast imaging, completion of biopsy where indicated, receipt of diagnostic results, adherence to referral appointments, time from initial abnormal finding to diagnostic confirmation, completion of recommended investigations, and linkage to appropriate specialist care. Data will be collected using structured questionnaires, patient navigation records, hospital records, diagnostic registers, appointment records, pathology records, referral registers, and relevant cancer-care programme documents. Descriptive statistics will be used to summarize participants' characteristics, navigation-service utilization, diagnostic procedures, and follow-up 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 breast cancer navigation services on diagnostic follow-up. Where a quasi-experimental design is adopted, diagnostic follow-up outcomes among women receiving navigation services may be compared with those receiving standard care, while relevant demographic, socioeconomic, clinical, and healthcare-access factors are appropriately controlled. Diagnostic and model-assumption tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that breast cancer navigation services have a significant positive effect on breast cancer diagnostic follow-up among women in Nigeria. Women who receive structured navigation support are expected to demonstrate higher completion of recommended diagnostic investigations, better adherence to appointments, shorter delays between abnormal findings and diagnostic confirmation, and improved linkage to appropriate specialist services than women without navigation support. Assistance with appointment scheduling, communication, education, transportation, referrals, and follow-up reminders may reduce practical and informational barriers that contribute to diagnostic delays. Navigation services may also improve women's understanding of diagnostic procedures and provide emotional support during an uncertain and potentially stressful period. However, financial constraints, limited diagnostic capacity, shortages of trained patient navigators, geographical barriers, inadequate referral networks, and delays in diagnostic services may continue to affect follow-up. The study therefore expects accessible, coordinated, patient-centred, and adequately supported breast cancer navigation services to contribute significantly to improved diagnostic follow-up among women in Nigeria. The study is expected to contribute to the literature on breast cancer navigation, diagnostic follow-up, breast cancer early detection, cancer care coordination, patient navigation, women's health, oncology services, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, cancer centres, oncology departments, healthcare professionals, women's health organizations, cancer-control programmes, development partners, and policymakers regarding strategies for reducing diagnostic delays. The study will also provide evidence-based recommendations for integrating patient navigation into breast cancer diagnostic pathways, training and deploying patient navigators, strengthening referral and appointment coordination, improving communication with patients, expanding access to diagnostic services, establishing follow-up reminder systems, and linking women with appropriate financial, psychosocial, and specialist support services across Nigeria.

Keywords: Breast cancer navigation services, breast cancer diagnostic follow-up, patient navigation, diagnostic delay, breast cancer, women, cancer care coordination, early detection, oncology services, Nigeria, public health.