Monitoring and Developing a Volunteer Patient Navigation Intervention to Improve Mammography Compliance in a Safety Net Hospital

Abstract

PURPOSE: Although mammography screening is crucial for cancer detection, screening rates have been declining, particularly in patients of low socioeconomic status and minorities. We sought to evaluate and improve the compliance rates at our safety net hospital through a prospective randomized controlled trial of a volunteer-run patient navigation intervention. METHODS: Baseline 90-day institutional mammography compliance rates were evaluated for patients who received a physician order for screening mammograms over a 1-month period. This analysis aided in the creation of a prospective randomized controlled trial of a volunteer-run patient navigation intervention to improve compliance, with 49 total participants. The primary outcome was 14-day mammography compliance rates. Secondary analysis examined the efficacy of the intervention with respect to patient demographics, prior mammography compliance, family history of cancer, beliefs on mammography, and past medical history. RESULTS: Analysis of baseline institutional compliance revealed a 47.87% compliance rate, with the majority of compliance occurring within 14 days of order placement. The patient navigation intervention significantly improved compliance by 34% (42% in the control group, 76% in the intervention group). Additional findings included significantly improved compliance in patients who believed they had a low susceptibility to cancer, those who understood the benefits of mammography and early diagnosis, those who had a prior mammogram, those who were employed, and those with a family history of cancer. CONCLUSION: A system to monitor compliance and intervene using patient navigation significantly improved mammography compliance of patients in a safety net hospital. The relatively straightforward design of this volunteer-based intervention makes it affordable, easily replicable, and perhaps beneficial at other institutions.

Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review

“…Studies on ‘patient navigation’ rarely defined this term. Most studies were randomized controlled trials and assessed colorectal cancer screening participation (Appendix ) 15–64 . Participant numbers ranged from 49 49 to 28,929 24,25 .…”

“…Most studies were randomized controlled trials and assessed colorectal cancer screening participation (Appendix ) 15–64 . Participant numbers ranged from 49 49 to 28,929 24,25 . The most common measure of socioeconomic position was ethnicity/race, 16,17,22,26–28,32,38,40,41,44,47,48,50–52,58,59,62,64 followed by income, 15,20,31,39,48,49,51,52,59,63 and geographic area.…”

“…Participant numbers ranged from 49 49 to 28,929 24,25 . The most common measure of socioeconomic position was ethnicity/race, 16,17,22,26–28,32,38,40,41,44,47,48,50–52,58,59,62,64 followed by income, 15,20,31,39,48,49,51,52,59,63 and geographic area. 8,18,19,24,25,31,32,45,46,59 Other measures used were health insurance, 15,30,41,48,52,59,64 primary language, 21,29,30,39,40,59,64 language preference, 61 education, 52 health literacy, 15,18,19,26,45,46,50 employment, 49 material deprivation 24,25 or socioeconomic status 32…”

“…The screening methods evaluated were mammography 44–53 and clinical breast examination 47 for breast cancer, cytology 8,54,56–58 and HPV self‐sampling 56,57 for cervical cancer, and fecal occult blood test (FOBT), 15–19,21–26,29,30,32,34–40,42,43 fecal immunochemical test (FIT), 31,41 colonoscopy, 17,20–23,26–32,34–40,42,43 sigmoidoscopy, 21–23,26,29,30,32–37,39,40,43 barium enema 21,29,30,32,34–40 and virtual colonoscopy 32 for colorectal cancer screening. Studies were carried out mainly in the USA, although studies from other geographic areas (Australia, 54 Canada, 58 France, 24,25 UK 56,57 and Zambia 55 ) were also identified.…”

“…Patient navigators were located mainly at a primary care or community level, 8,15–19,21–23,26,27,30–48,50,51,55–58,60,61,63,64 and communicated with participants through phone calls 8,15–25,27–34,36–39,41–48,50–56,58,59,61–64 . In some cases they met in person, 8,18,20,24,25,28,39,42,44–47,49–51,55,58,62 and/or sent lette rs, 22,24,25,50–52,56,61,62 e‐mails 20,23,56,59 or text messages 56,59 . Regarding the services they provided, 27 studies (61.4%) described them addressing health system barriers, as scheduling appointments, 18,20,23,30,32–34,39,40,42,44,47,50,53,56,58,61,62 sending reminders, 15,16,18–21,27,32,34,35,37–40,42,45,46,56,61–64 completing paperwork, 62 or communicating or supporting communication with providers …”