Abstract
Background
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.
Methods
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.
Findings
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.
Conclusions
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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Biography
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.
Biography
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.
Biography
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.
Biography
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.
Biography
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.
Biography
Mechelle Sanders, BS, is a Research Coordinator in the Department of Family Medicine at the University of Rochester.
Biography
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.
Biography
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.
Biography
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.
Biography
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.
Article info
Publication history
Accepted:
October 28,
2013
Received in revised form:
October 25,
2013
Received:
May 20,
2013
Identification
Copyright
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
