BACKGROUND: Patient navigators have been shown to reduce cancer disparities among racial/ethnic minorities by improving timely diagnosis and treatment of cancer. We sought to determine if race/ethnicity and language concordance of patients and their navigator improved time to diagnostic resolution of breast and cervical cancer screening abnormalities. METHODS: Demographic data on patients and navigators from the Boston Patient Navigation Research Program were used to assess concordance by race, ethnicity, and language. Kaplan-Meier survival curves and Cox proportional hazards regression models examined the association of race/ethnicity and language concordance on time to definitive diagnosis of cancer screening abnormalities. All analyses were performed separately for breast and cervical groups. RESULTS: There were 1257 patients and 23 navigators in this study. In the breast group (n=655), 44% of patient-navigator pairs were concordant by race/ethnicity and 75% were language concordant. In the cervical group (n=602), 70% of patient-navigator pairs were race/ethnicity concordant and 87% were language concordant. There was no association with race/ethnicity concordance and time to diagnostic resolution for the breast group, aHR 1.19 (95% CI: 0.97, 1.46) or cervical group, aHR 1.23 (95% CI: 0.99, 1.53). However, in the stratified analysis, race/ethnicity concordance was associated with timelier resolution for minority women with breast and cervical cancer screening abnormalities but not for Whites. For cervical cancer screening abnormalities resolving in less than 90 days, language concordance was also associated with timelier resolution, aHR of 1.46 (95% CI: 1.18, 1.80) but there was no association in the breast group. In the subgroup analysis of Spanish concordance there was also an association of timelier resolution for those with cervical cancer screening abnormalities resolving in less than 90 days. CONCLUSION: Patient-navigator race/ethnicity concordance is associated with timelier diagnostic resolution of breast and cervical cancer screening abnormalities among minority women. Language concordance is also associated with timelier resolution in participants with cervical cancer screening abnormalities despite the availability and use of interpreters. Given poorer cancer outcomes among minority women, the use of patient navigators that are diverse by race/ethnicity and multilingual may help address barriers to care and improve health outcomes among low-income minorities.

La littérature indique qu’il y a un problème de surreprésentation de personnes noires dans le système de justice criminelle canadien. Ce problème serait notamment la manifestation d’un racisme systémique anti-NoirEs (RSAN) dont les origines remontent aux époques coloniale, esclavagiste et ségrégationniste du pays. Les Impact of Race and Culture Assessments (IRCAs), des rapports présentenciels spécialisés, sont une initiative émergente visant à faire reconnaître les impacts du RSAN afin de mitiger la peine des justiciables noirs au Canada. Ce mémoire a pour objectif de documenter les discours et pratiques autour de l’utilisation des IRCAs. Plus spécifiquement, il vise à (1) détailler le processus de production des IRCAs et leur présentation au tribunal ; (2) mettre en lumière les avantages et les désavantages d'utilisation des IRCAs et (3) faire état de l’impact des IRCAs sur la pratique judiciaire. L’analyse thématique de données d’entretiens semi-dirigés menés entre 2018 et 2022 auprès de 35 avocats-criminalistes de pratique privée et de service oeuvrant à Toronto a permis de constater que les rapports IRCAs sont bien connus et appréciés des avocats torontois. Toutefois, les résultats suggèrent également qu’il reste de nombreux obstacles à pallier afin de faire reconnaître leur valeur auprès du plus grand nombre, d’harmoniser leur utilisation à l’ensemble du pays et de les rendre accessibles à tous ceux qui en ont besoin. Un doute demeure quant à la véritable portée que peut avoir une telle initiative lorsque l’intention ultime est de réformer un système entier. / Literature shows that there is a problem of over-representation of Black people in the Canadian criminal justice system. Among other factors, this issue is linked to systemic antiblack racism (SABR), the causes of which can be traced back to the country's colonial, slavery and segregationist history. Impact of Race and Culture Assessments (IRCAs) are specialized pre-sentence reports and an emerging initiative aimed at recognizing the impacts of SABR in order to mitigate the punishment of Black offenders, in Canada. This masters aims to document the discourse and practices surrounding the use of IRCAs. More specifically, it aims to (1) detail the process of producing an IRCA and presenting it to the court; (2) highlight the advantages and disadvantages of using IRCAs; and (3) report on the impact of IRCAs on court practice. Thematic data analysis of semi-structured interviews conducted between 2018 and 2022 with 35 private practice and duty criminal lawyers working in Toronto found that IRCAs reports are well known and appreciated by Toronto lawyers. However, the results also suggest that there are still many obstacles to overcome in order to ensure that their value is widely recognized, that their use is harmonized across the country, and that they are accessible to all those who need them. Doubts remain as to the true scope of such an initiative when the ultimate intention is to reform an entire system.