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Impact of patient navigation on timely cancer care: the Patient Navigation Research Program.

ABSTRACT: Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness.The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center- and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided.The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73%) and publically insured (40%) or uninsured (31%). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95% confidence interval [CI] = 1.23 to 1.84; P < .001)) and treatment initiation (aHR = 1.43; 95% CI = 1.10 to 1.86; P < .007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care.Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up.

SUBMITTER: Freund KM

PROVIDER: S-EPMC4072900 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Impact of patient navigation on timely cancer care: the Patient Navigation Research Program.

Freund Karen M KM Battaglia Tracy A TA Calhoun Elizabeth E Darnell Julie S JS Dudley Donald J DJ Fiscella Kevin K Hare Martha L ML LaVerda Nancy N Lee Ji-Hyun JH Levine Paul P Murray David M DM Patierno Steven R SR Raich Peter C PC Roetzheim Richard G RG Simon Melissa M Snyder Frederick R FR Warren-Mears Victoria V Whitley Elizabeth M EM Winters Paul P Young Gregory S GS Paskett Electra D ED

Journal of the National Cancer Institute 20140617 6

<h4>Background</h4>Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness.<h4>Methods</h4>The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers ...[more]

PMID: 24938303

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Project description:Despite growing popularity of patient navigation (PN) as a means to improve cancer care quality and reduce cancer-related disparities, there are few well-designed controlled trials assessing the impact of PN on patient outcomes like satisfaction with care. The present controlled study examined effect of PN on satisfaction with cancer-related care.Patients who presented with a symptom or abnormal screening test (n?=?1788) or definitive diagnosis (n?=?445) of breast, cervical, colorectal, or prostate cancer from eight Patient Navigator Research Program sites were included in one of two groups: intervention (PN) or comparison (usual care or usual care plus cancer educational materials). Trained patient navigators met with intervention group participants to help them assess and identify resources to address barriers to cancer diagnostic or treatment care. Using a validated instrument, we assessed participants' satisfaction with their cancer diagnostic or treatment care up to 3 months after diagnostic resolution of a cancer-related abnormality or within 3 months of initiation of cancer treatment.Overall, patients reported high satisfaction with diagnostic care and cancer treatment. There were no statistically significant differences between PN and control groups in satisfaction with cancer-related care (p?>?0.05). Hispanic and African American participants were less likely to report high satisfaction with cancer care when compared to White patients. Middle-aged participants with higher education, higher household income, private insurance, owning their own home, working full-time, and those whose primary language is English had higher satisfaction with cancer-related diagnostic care.PN had no statistically significant effect on patients' satisfaction with cancer-related care. Further research is needed to define the patient populations who might benefit from PN, content of PN that is most useful, and services that might enhance PN.clinicaltrials.gov identifiers: NCT00613275 , NCT00496678 , NCT00375024 , NCT01569672.

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Impact of patient navigation on timely cancer care: the Patient Navigation Research Program.

Publications

Impact of patient navigation on timely cancer care: the Patient Navigation Research Program.

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