Impact of Patient Navigation on Timely Cancer Care: The Patient Navigation Research Program

Freund, Karen M.; Battaglia, Tracy A.; Calhoun, Elizabeth A.; Darnell, Julie S.; Dudley, Donald J.; Fiscella, Kevin; Hare, Martha L.; LaVerda, Nancy L.; Lee, Ji‐Hyun; Levine, Paul H.; Murray, David M.; Patierno, Steven R.; Raich, Peter C.; Roetzheim, Richard G.; Simon, Melissa A.; Snyder, Frederick; Warren‐Mears, Victoria; Whitley, Elizabeth M.; Winters, Paul; Young, Gregory S.; Paskett, Electra D.

doi:10.1093/jnci/dju115

Cited by 227 publications

(218 citation statements)

References 40 publications

(42 reference statements)

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“…A common provider barrier to screening in underserved communities is an inadequate referral mechanism after an abnormal test (46). Patient navigators or community health workers are particularly beneficial for facilitating follow-up and treatment in underserved populations (47).…”

Section: Discussionmentioning

confidence: 99%

Where Can Colorectal Cancer Screening Interventions Have the Most Impact?

Siegel

Sahar

Robbins

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

101

112

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Background: Although colorectal cancer death rates in the United States have declined by half since 1970, large geographic disparities persist. Spatial identification of high-risk areas can facilitate targeted screening interventions to close this gap.Methods: We used the Getis-Ord Gi Ã statistic within ArcGIS to identify contemporary colorectal cancer "hotspots" (spatial clusters of counties with high rates) based on county-level mortality data from the national vital statistics system. Hotspots were compared with the remaining aggregated counties (non-hotspot United States) by plotting trends from 1970 to 2011 and calculating rate ratios (RR). Trends were quantified using joinpoint regression.Results: Spatial mapping identified three distinct hotspots in the contemporary United States where colorectal cancer death rates were elevated. The highest rates were in the largest hotspot, which encompassed 94 counties in the Lower Mississippi Delta

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Section: Discussionmentioning

confidence: 99%

Where Can Colorectal Cancer Screening Interventions Have the Most Impact?

Siegel

Sahar

Robbins

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

101

112

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“…It is incumbent on the medical community to be aware of and make explicit efforts to increase trust and minimize the potential effects of perceived power imbalances (40). Patient/family advisory boards, dialysis team training, and use of patient navigators (41), as one patient suggested, could ultimately improve ACP thorough improved communication and trust.…”

Section: Discussionmentioning

confidence: 99%

Advance Care Planning

Goff

Eneanya

Feinberg

et al. 2015

Clinical Journal of the American Society of Nephrology

102

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Background and objectives More than 90,000 patients with ESRD die annually in the United States, yet advance care planning (ACP) is underutilized. Understanding patients' and families' diverse needs can strengthen systematic efforts to improve ACP.Design, setting, participants, & measurements In-depth interviews were conducted with a purposive sample of patients and family/friends from dialysis units at two study sites. Applying grounded theory, interviews were audiotaped, professionally transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized into major themes and subthemes.Results Thirteen patients and nine family/friends participated in interviews. The mean patient age was 63 years (SD 14) and five patients were women. Participants identified as black (n=1), Hispanic (n=4), Native American (n=4), Pacific Islander (n=1), white (n=11), and mixed (n=1). Three major themes with associated subthemes were identified. The first theme, "Prior experiences with ACP," revealed that these discussions rarely occur, yet most patients desire them. A potential role for the primary care physician was broached. The second theme, "Factors that may affect perspectives on ACP," included a desire for more of a connection with the nephrologist, positive and negative experiences with the dialysis team, disenfranchisement, life experiences, personality traits, patient-family/friend relationships, and power differentials. The third theme, "Recommendations for discussing ACP," included thoughts on who should lead discussions, where and when discussions should take place, what should be discussed and how.Conclusions Many participants desired better communication with their nephrologist and/or their dialysis team. A number expressed feelings of disenfranchisement that could negatively impact ACP discussions through diminished trust. Life experiences, personality traits, and relationships with family and friends may affect patient perspectives regarding ACP. This study's findings may inform clinical practice and will be useful in designing prospective intervention studies to improve patient and family experiences at the end of life.

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“…Access to, and continuity of, primary care, the use of medical oncology and chemotherapy [18][19][20]22 , and being a nursing home resident 19,23,30 are also relevant. Socioeconomic and distance indicators of inequity should be investigated by linking the postal code of residence at death to census data 17,19,22,23,45 because a meta-analysis showed that the benefit from navigation is greatest for the most vulnerable individuals 46 .…”

Section: Strengths Limitations and Recommendationsmentioning

confidence: 99%