Original article| Volume 24, ISSUE 1, e155-e162, January 2014

Barriers Reported Among Patients with Breast and Cervical Abnormalities in the Patient Navigation Research Program: Impact on Timely Care



      Patient navigation (PN) is a system-level strategy to decrease cancer mortality rates by reducing barriers to cancer care. Barriers to resolution among participants in the PN intervention arm with a breast or cervical abnormality in the Patient Navigation Research Program and navigators' actions to address those barriers were examined.


      Data from seven institutions (2005–2010) included 1,995 breast and 1,194 cervical patients. A stratified Cox proportional hazards regression model was used to examine the effects of barriers on time to resolution of an abnormal screening test or clinical finding.


      The range of unique barriers was 0 to 12 and 0 to 7 among participants with breast and cervical abnormalities, respectively. About two thirds of breast and one half of cervical participants had at least one barrier resulting in longer time to diagnostic resolution among breast (adjusted hazard ratio [HR], 0.744; p < .001) and cervical (adjusted HR, 0.792; p < .001) participants. Patient- and system-level barriers were most common. Frequent navigator actions were making arrangements, scheduling appointments, referrals, and education.


      Having a barrier resulted in a delay in diagnostic resolution of an abnormal screening test or clinical finding. Health care systems can use these findings to improve existing PN programs or when developing new programs.
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      Mira L. Katz, PhD, is an Associate Professor in The Ohio State University College of Public Health. Her expertise focuses on communication issues associated with cancer prevention and control, with a concentration on improving the health of minority and underserved populations.


      Gregory S. Young, MS, is a biostatistician at The Ohio State University Center for Biostatistics. His expertise is in data capture and management, survival analysis, mixed-effects regression models, and group randomized trials.


      Paul L. Reiter, PhD, is an Assistant Professor in The Ohio State University College of Medicine. His research focuses on improving cancer screening and HPV vaccination rates.


      Tracy A. Battaglia, MD, is an Associate Professor of Medicine and Epidemiology and Director of the Women's Health Unit at Boston University School of Medicine. Her expertise is in women's health with a focus on health disparities.


      Kristen J. Wells, PhD, is an Assistant Professor in the Department of Psychology at San Diego State University. Her research focuses on cancer-related disparities, cancer communication, and survey design.


      Mechelle Sanders, BS, is a Research Coordinator in the Department of Family Medicine at the University of Rochester.


      Melissa Simon, MD, is an Associate Professor in Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine. Her expertise is focused on women's health including female reproductive system cancers, health disparities, and public health policy.


      Donald J. Dudley, MD, is a Professor in the Department of Obstetrics and Gynecology at the University of Texas Health Sciences Center at San Antonio. His expertise is in women's health with a special interest in reducing health disparities.


      Steven R. Patierno, PhD, is a Professor of Medicine and the Deputy Director of the Duke Cancer Institute. His expertise is in cancer causation and carcinogenesis, cancer health disparities, and cancer survivorship.


      Electra D. Paskett, PhD, is a Professor in The Ohio State University College of Medicine and Director of the Division of Cancer Prevention and Control. Her expertise focuses on cancer prevention, early detection and survivorship issues specifically among underserved populations.