The purpose of this study was to evaluate the feasibility of incorporating chronic disease navigation using lay health care workers trained in motivational interviewing (MI) into an existing mammography navigation program. Primary-care patient navigators implemented MI-based telephone conversations around mammography, smoking, depression, and obesity. We conducted a small-scale demonstration, using mixed methods to assess patient outcomes and provider satisfaction. One hundred nine patients participated. Ninety-four percent scheduled and 73% completed a mammography appointment. Seventy-one percent agreed to schedule a primary care appointment and 54% completed that appointment. Patients and providers responded positively. Incorporating telephone-based chronic disease navigation supported by MI into existing disease-specific navigation is efficacious and acceptable to those enrolled.
We found a mismatch in readiness to address community health priorities. Although health centers have programs to address health issues, community awareness of programs is limited and barriers to engaging in care persist. The model provided a useful tool for engaging communities into shared program planning.
Multiple data collection methods can yield important data about community health priorities and barriers; areas of difference and similarity between methods are especially useful in guiding health promotion efforts and opportunities.
Urgently needed interventions to reduce disparities in breast cancer treatment should take into account obstacles inherent among immigrant and indigent populations and complexities of multidisciplinary cancer care.
Background
Shared decision-making (SDM) related to test preference has been advocated as a potentially effective strategy for increasing adherence to colorectal cancer screening yet primary care providers (PCPs) are often reluctant to comply with patient preferences if they differ from their own. Risk stratification advanced colorectal neoplasia (ACN) provides a rational strategy for reconciling these differences.
Objective
To assess the importance of risk stratification in PCP decision-making related to test preference for average-risk patients and receptivity to use of an electronic risk assessment tool for ACN to facilitate SDM.
Design
Mixed-methods, including qualitative key informant interviews and a cross-sectional survey.
Participants
PCPs at an urban, academic safety-net institution.
Main Measures
Screening preferences, factors influencing patient recommendations, and receptivity to use of a risk stratification tool
Key Results
Nine PCPs participated in interviews and 57 completed the survey. Despite an overwhelming preference for colonoscopy by 95% of respondents, patient risk (67%) and patient preferences (63%) were more influential in their decision-making than patient comorbidities (31%; P<0.001). Age was the single most influential risk factor (excluding family history), with <20% of respondents choosing factors other than age. Most respondents reported that they would be likely to use a risk stratification tool in their practice either “often” (43%) or sometimes (53%).
Conclusions
Risk stratification was perceived to be important in clinical decision-making yet few providers considered risk factors other than age for average-risk patients. Providers were receptive to the use of a risk assessment tool for ACN when recommending an appropriate screening test for select patients.
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