The USC Norris Cancer Hospital Community Needs Assessment Report summarizes a survey of 238 patients to evaluate barriers to care. Key findings included that transportation and wait times were the largest barriers. Patients primarily drove themselves for transportation. Counseling services were considered important, especially individual counseling. Half of caregivers had to take time off work for treatment. Most patients were satisfied with hospital hours and days of operation. The report recommends examining solutions to reduce barriers like location of services, wait times, and scheduling conflicts.

1. USC Norris Cancer Hospital Community Needs Assessment Report December 2015
Introduction:
USC Norris Comprehensive Cancer Hospital is a private, non-profit service clinic affiliated with the University Of
Southern California Keck School Of Medicine. Although this is a research hospital, until recently little attention has been
paid to the satisfaction of its patients in relation to care. Biel Consulting completed a Community Needs Assessment in
2013 to evaluate the geographic community surrounding Keck Medical Center of USC. A section of this assessment did
address which was included into the data analysis and collection. However, this data was limited in the scope of
analyzing barriers to care for the patients served at USC Norris Cancer Hospital.
The American College of Surgeons Commission on Cancer is implementing new standards that must be in place
by 2015, requiring a community needs assessment to be implemented to monitor the barriers to care endemic in the
hospital to be reviewed as part of the re-accreditation survey in March 2016.
The recognized challenges observed will be utilized as the foundation in the planning, implementation and evaluation of
the patient navigation program, ultimately promoting best practices for the services provided to USC patients.
Authors:
Ozivefueshe Dimowo, Master of Public Health students of Keck School of Medicine of the University of Southern
California gathered and reviewed data for the Community Needs Assessment as part of their practicum hours. They
were under the supervision of Gwendolyn Lynch, MBA, CTR, CCRP, Cancer Registry Director.
Methods:
Primary Data Collection: This assessment was collected using a convenience sample of patients who were awaiting their
appointment or had finished and were awaiting their prescriptions in all clinical areas. To power the assessment , the N-
(number to ascertain statistical significance) was determined by utilizing the epidemiological information provided by
the Cancer Registry Director. USC Norris Cancer Hospital served 23,815 individual patients in 2014, thus indicating that
409 surveys should be disseminated to yield sufficient power.
The survey questions were curated from the 2013 Community Needs Assessment Report. Qualtrics Analytic
software was utilized to gather the necessary data. Question options categorized on a Likert scale of importance (not
important to very important), yes and no responses, and multiple choice questions.
The surveys were administered on an iPad which patients could use to answer confidentially and anonymously
in outpatient lobbies, radiation oncology clinic waiting areas, day hospital, and USC Norris Cancer Hospital inpatient care
units. There were 238 surveys collected between mid-September and December 2015.
Secondary Data Collection:
Information was used from the 2013 USC Norris Community Health Needs Assessment to gather geographical
information concerning the residency of Norris Cancer Hospital’s clients (Community Needs Assessment, 2015) as a
resource for understanding the barriers identified in the geographical community which were applied to the USC Norris
Cancer Hospital patient population.
1

2. Demographic Profile
Population by Age:
Data Source: Community Needs Assessment, 2015
The majority of the population represented ages 40-65 (48.63%) of the population, followed by participants over the age
of 65 (34.38%), and adults aged 25-39, which represented 12.50%. The age groups least represented in this study were
youth aged 18-25 and those who preferred not to say their age, 9.38% and 3.13% respectively.
Race and Ethnicity:
2
# Answer Bar Response %
1 18-25 22 9.38%
2 25-39 31 12.50%
3 40-65 96 40.63%
4 Over 65 82 34.38%
5 Prefer not to say 7 3.13%
Total 238 100.00%
# Answer Bar Response %
1 White/Caucasian 102 43.16%
2 Black/African American 13 5.26%
3 Asian 40 16.84%
4 Hispanic/ Latino 83 34.74%
5
American Indian or
Alaskan Native
7 3.16%
6
Native Hawaiian/Pacific
Islander
5 2.11%
7 Other: 18 7.37%
8 Prefer not to say 10 4.21%
Total 100.00%

3. Non-Hispanic whites represented the majority of the patients served at NCH in 2012. 43.16% of respondents reported
identifying as non-Hispanic white, followed by Latino/Hispanics, following at 34.74%. 4.21% of the surveyors preferred
not to identify, 16.84% identified as Asian, 5.26% identified as black and 4.21% identified as other. 5.27% of those
surveyed were of Pacific Islander or Native American descent, and 7.37% identified as other. The survey indicates a
disproportionate rate of white patients relative to their population in not only Los Angeles County but also in SPA 7,
which holds a majority Latino/Hispanic population.
Data Source: Showcase
Ninety-three percent of respondents indicated that English was their preferred language, followed by Spanish at 5.2%.
Contrastingly, the surrounding areas have high rates of preferred and/or monolingual Spanish speakers.
3

4. Geographic Location:
Data Source: Showcase
The key delineates the gradient colors that represent population densities of patients served in that area. Areas with a
high density of patients are represented by darker green, while populations living in the light green area are less
represented among populations served by Norris Cancer Hospital. Residents of SPA 3 and 5 were highly represented in
this population.
Survey administered to USC Norris Cancer Hospital Patients:
USC Norris Cancer Hospital Patient Survey Standard 4
What is your sex?
4

5. • Male
• Female
• Prefer not to say
What is your age?
• 18-25
• 25-39
• 40-65
• Over 65
• Prefer not to say
What is your race/ethnicity? (Please select one or more)
• White/Caucasian
• Black/African American
• Asian
• Hispanic/ Latino
• American Indian or Alaskan Native
• Native Hawaiian/Pacific Islander
• Other:
• Prefer not to say
Which of the following best describes your current employment status: (check one)
• Homemaker full time
• Student full time
• Retired
• Employed full time
• Employed part time
• Self-employed full time
• Self-employed part time
• Unemployed for less than 1 year
• Unemployed for more than 1 year
• Not working because of illness or injury
Your zip code is?
5

6. Which of the issues below, if any, made it harder for you to get the cancer care that was needed? Please
select all that apply.
• Don’t know how to access services
• Financial / no insurance / underinsured
• Transportation
• Location of services
• Language barriers
• Appointment scheduling/scheduling conflicts
• Wait times
• Housing
• Lack of social support
• Other (specify):
• None of the above
What is your most common method of transportation to Norris?
• Drive self
• Companion (spouse/friend) provides transportation
• Public transportation (Taxi, train, bus, etc.)
• Walk
• Other:
Based on your experience as a patient, please indicate how important or unimportant you believe the
following cancer support services are for someone diagnosed with cancer. Using a 5 point scale, rank the
following services.
Very
Important
Important
Slightly
Important
Not Very
Important
Indifferent
Individual Counseling
(for patient and/or
family members)
Individual
Counseling
(for patient
and/or family
members)
Support
Groups (for
patient and/or
family
members)
Family
Counseling
Psychiatric
Services
Pastoral
Counseling/Chaplaincy
Support Groups (for
patient and/or family
members)
Individual
Counseling
(for patient
and/or family
members)
Support
Groups (for
patient and/or
family
members)
Family
Counseling
Psychiatric
Services
Pastoral
Counseling/Chaplaincy
6

7. Very
Important
Important
Slightly
Important
Not Very
Important
Indifferent
Family Counseling
Individual
Counseling
(for patient
and/or family
members)
Support
Groups (for
patient and/or
family
members)
Family
Counseling
Psychiatric
Services
Pastoral
Counseling/Chaplaincy
Psychiatric Services
Individual
Counseling
(for patient
and/or family
members)
Support
Groups (for
patient and/or
family
members)
Family
Counseling
Psychiatric
Services
Pastoral
Counseling/Chaplaincy
Pastoral
Counseling/Chaplaincy
Individual
Counseling
(for patient
and/or family
members)
Support
Groups (for
patient and/or
family
members)
Family
Counseling
Psychiatric
Services
Pastoral
Counseling/Chaplaincy
Other
Individual
Counseling
(for patient
and/or family
members)
Support
Groups (for
patient and/or
family
members)
Family
Counseling
Psychiatric
Services
Pastoral
Counseling/Chaplaincy
Does your primary caregiver or spouse, have to take time away from work/other obligations to support
your treatment schedule?
• Yes
• No
Are they employed full time?
• Yes
• No
Are they a full time homemaker/caretaker?
• Yes
• No
Are you satisfied with the hours of operation of the Day Hospital?
• Yes
• No
• Comment:
7

8. Would you be willing to be seen in the Day Hospital for infusion on the day after your
physician visit if you had a minimal wait time?
• Yes
• No
• Comment:
Are you satisfied with the days of the week that the Day Hospital operates?
• Yes
• No
If no, would Saturday appointments be more convenient?
• Yes
• No
Do you know about myUSCchart, our patient portal?
• Yes
• No
How often do you access myUSCchart?
• Never
• Once every 6 months
• Once a Month
• Twice a Month
• Once a Week
• More than once a Week
• Other: (specify)
What information would you like to be available on myUSCchart?
* Thank you for your participation in our survey.*
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9. Survey Results
Quantitative Results:
General Barriers To Care
Which of the issues below, if any, made it harder for you to get the cancer care that was needed? Please select all that
apply.
Transportation and wait times were perceived to be the largest barriers to care for this population. Relative to this area,
the majority of the population must travel across SPAs in order to receive care,, indicating that this is a large barrier for
this population.
Mode of Transportation
9
# Answer Bar Response %
1
Don’t know how to access
services
31 13.16%
2
Financial / no insurance /
underinsured
51 21.05%
3 Transportation 44 18.42%
4 Location of services 81 34.21%
5 Language barriers 38 15.79%
6
Appointment
scheduling/scheduling conflicts
69 28.95%
7 Wait times 81 34.21%
8 Housing 25 10.53%
9 Lack of social support 25 10.53%
10 Other (specify): 25 10.53%
Total 100.00%

10. What is your most common method of transportation to Norris?
There are fewer than average barriers to care than the general population in terms of transportation, as most
have their own, private methods of transportation (89.25%).
Counseling Services
Based on your experience as a patient, please indicate how important or unimportant you believe the following cancer
support services are for someone diagnosed with cancer. Using a 5-point scale, rank the following services.
10
# Answer Bar Response %
1 Drive self 112 47.31%
2
Companion (spouse/friend)
provides transportation
100 41.94%
3
Public transportation (Taxi,
train, bus, etc.)
5 2.15%
4 Walk 10 4.30%
5 Other: 10 4.30%
Total 237 100.00%

11. A majority of the participants considered counseling and support important or very important during the
treatment process (64%), with individual counseling considered the most important factor for this assessment.
Pastoral counseling and chaplaincy was considered the least important factor and type of support during their
treatment process.
Does your primary caregiver or spouse, have to take time away from work/other obligations to support your treatment
schedule?
There was an even distribution of answers for the convenience of scheduling and/or transportation for primary
11
# Question
Very
Important
Important
Slightly
Important
Not Very
Important
Indifferent Response
Average
Value
1
Individual Counseling
(for patient and/or
family members)
136 53 5 21 20 235 1.90
2
Support Groups (for
patient and/or family
members)
88 70 26 24 27 235 2.31
3 Family Counseling 83 72 24 24 29 232 2.35
4 Psychiatric Services 70 77 27 25 33 232 2.45
5
Pastoral
Counseling/Chaplainc
y
53 53 32 44 56 238 2.99
6 Other 19 2 6 9 9 45 3.05
# Answer Bar Response %
1 Yes 124 52.17%
2 No 114 47.83%
Total 238 100.00%
# Answer Bar Response %
1 Yes 114 47.83%
2 No 124 52.17%
Total 238 100.00%

12. caregivers or spouses.
Are you employed full time?
A small majority of patients are not employed fulltime, indicating that they can be seen during work hours.
Are they a fulltime homemaker/caretaker?
The majority of respondents reported that their primary caretaker was not their fulltime caregiver, but likely has other
responsibilities to attend to as well.
Are you satisfied with the hours of operation at the Day Hospital?
Overwhelmingly, those surveyed are satisfied with the hours of operations at the Day Hospital.
Would you be willing to be seen in the Day Hospital for infusion on the day after your physician visit if you had a minimal
wait time?
12
# Answer Bar Response %
1 Yes 63 26.37%
2 No 172 73.63%
Total 235 100.00%
# Answer Bar Response %
1 Yes 212 90.32%
2 No 10 4.30%
3 Comment: 15 5.38%
Total 235 100.00%

13. When surveyed, many denoted that they were not aware of this procedure, and that they would be willing to receive
infusions as an additional therapeutic measure.
Are you satisfied with the days of the week that the Day Hospital operates?
The large majority of patients (83.87%) were satisfied with the scheduling of the Day Hospital.
If no, would Saturday appointments be more convenient?
Many respondents stated that they would not prefer Saturday appointments (58.51%).
Do you know about myUSCchart, our patient portal?
13
# Answer Bar Response %
1 Yes 134 60.67%
2 No 50 22.47%
3 No Comment: 37 16.85%
Total 221 100.00%
# Answer Bar Response %
1 Yes 194 83.87%
2 No 37 16.13%
Total 231 100.00%
# Answer Bar Response %
1 Yes 97 41.49%
2 No 136 58.51%
Total 233 100.00%

14. Two-thirds of participants knew about the patient portal (67.53%), but do not utilize the services (73.12%)
How often do you access myUSCchart?
Qualitative results
What information would you like to be available on myUSCchart?
14
# Answer Bar Response %
1 Yes 128 67.53%
2 No 62 32.47%
Total 190 100.00%
# Answer Bar Response %
1 Never 168 73.12%
2 Once every 6 months 6 2.15%
3 Once a Month 17 7.53%
4 Twice a Month 7 3.23%
5 Once a Week 12 5.38%
6 More than once a Week 2 1.08%
7 Other: (specify) 17 7.53%
Total 229 100.00%

15. As demonstrated in the survey above, patients were able to comment on any other concerns they had that
were not addressed in the survey. A total of 56 additional written comments were received. The sample below
represents a sample of the most requested comments; 10% of all comments dealt with improved explanation
of blood tests, 23% of comments inquired about improved explanation of tests, results, prognosis and plans of
actions, access to files in different formats represented 6% of comments, and appointments and authorizations
represented 32% of commentary. Twenty-Eight percent of commenters stated they didn’t know what could be
improved with the portal service.
Barriers to Examine: The clients stated that their greatest problem is the location of services (34.21%), wait times
(34.21%) and scheduling (28.95%), despite the disinterest in Saturday appointments. There should be another solution
on the 2017 Community Needs Assessment to address potential solutions to patient dissatisfaction.
Conclusion: The participants surveyed were generally satisfied with their experience with USC Norris Cancer Hospital.
Although location of services and wait times were identified as barriers to care for this population, there were generally
positive reviews for this survey. The largest barrier identified was transportation, with the recommendation that further
investigation into which specific community resources requested be assessed. These results will be forwarded to the
Cancer Committee for them to utilize in the development of their navigation program.
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Text Entry
Explanation of terms from blood results
All tests and results ,prognosis,plan of acton
We like the chart. Would be good to access mir scans but understand this can’t be done
copies of all tests posted as PDFs files
Don't know
Apps,authorizations

16. Limitations: Because this was a convenience sample, randomization was not possible. Furthermore, the power N (409)
was not reached for this study to reach statistical significance relative to the population served. This limits the
generalizability of this study; however, there is still important information to be collected from the study conducted.
Many patients did not answer the full survey, and some were unaware of the meaning of some of the questions. There
were also some language barriers with clients who did not have access to the survey in their preferred language. As
explained in the 2013 Community Assessment Survey, questions about community resources and barriers should be
expanded for further analysis (such as a response for alternative solutions to barriers).
16