The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis

Battaglia, Tracy A.; Darnell, Julie S.; Ko, Naomi; Snyder, Frederick; Paskett, Electra D.; Wells, Kristen J.; Whitley, Elizabeth M.; Griggs, Jennifer J.; Karnad, Anand B.; Young, Heather A.; Warren‐Mears, Victoria; Simon, Melissa A.; Calhoun, Elizabeth A.

doi:10.1007/s10549-016-3887-8

Cited by 37 publications

(26 citation statements)

References 44 publications

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“…While there have been some successful interventions to decrease delays, these have largely focused on patient navigation in an attempt to address individual barriers to follow‐up . While navigation programs have been successful, this personalized intervention guiding individual women through the complexities of breast cancer diagnosis does not seem to have its impact for at least 3 months after the abnormal mammogram . Navigation's focus on the individual appears to be most successful for the patients at highest risk of nonfollow‐up, yet those patients are also the most challenging to achieve follow‐up for even in the context of a navigation program .…”

Section: Discussionmentioning

confidence: 99%

“…46,47 While navigation programs have been successful, this personalized intervention guiding individual women through the complexities of breast cancer diagnosis does not seem to have its impact for at least 3 months after the abnormal mammogram. 48,49 Navigation's focus on the individual appears to be most successful for the patients at highest risk of nonfollow-up, yet those patients are also the most challenging to achieve follow-up for even in the context of a navigation program. 50,51 Thus, the focus of resource-intensive navigation programs addressing individual barriers to follow-up may need to be on the most at-risk patients.…”

Section: Discussionmentioning

confidence: 99%

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Mammography facilities serving vulnerable women have longer follow‐up times

Karliner

Kaplan

Livaudais‐Toman

et al. 2018

Health Services Research

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Objective To investigate mammography facilities’ follow‐up times, population vulnerability, system‐based processes, and association with cancer stage at diagnosis. Data Sources Prospectively collected from San Francisco Mammography Registry (SFMR) 2005‐2011, California Cancer Registry 2005‐2012, SFMR facility survey 2012. Study Design We examined time to biopsy for 17 750 abnormal mammogram results (BI‐RADS 4/5), categorizing eight facilities as short or long follow‐up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced‐stage (≥IIb) cancer diagnosis by facility follow‐up group. Data Extraction Methods Merged SFMR, Cancer Registry and facility survey data. Principal Findings Facilities (N = 4) with short follow‐up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow‐up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow‐up facilities. The long follow‐up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow‐up facility was associated with higher adjusted odds of advanced‐stage cancer (OR 1.45; 95% CI 1.10‐1.91). Conclusions Providing mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow‐up and cancer diagnosis stage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mammography facilities serving vulnerable women have longer follow‐up times

Karliner

Kaplan

Livaudais‐Toman

et al. 2018

Health Services Research

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“…1,6,18,25 This program hired one full-time patient navigator who was already experienced navigating low-income women through women's health cancer screening and treatment. The navigator had master's level education and was experienced both in patient navigation and research assistance but was not a health care professional.…”

Section: Methodsmentioning

confidence: 99%

Using a Patient Navigator to Improve Postpartum Care in an Urban Women's Health Clinic

Yee¹,

Martinez²,

Nguyen³

et al. 2017

Obstetrics &Amp; Gynecology

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102

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Objective To estimate whether postpartum visit attendance was improved in women exposed to a postpartum patient navigation program compared with those who received care immediately prior to the program's initiation, and to assess whether other postpartum health behaviors improved during the intervention period. Methods This is a prospective observational study of women enrolled in a patient navigation program compared to women receiving care prior to the program. Navigating New Motherhood was a postpartum patient navigation program for adult, English-speaking women receiving prenatal care at a Medicaid-based university clinic. In 2015, Navigating New Motherhood introduced a clinic-level change in which a navigator was hired and assumed supportive and logistical responsibilities for enrolled patients between delivery and postpartum visit completion. We compared medical record data from women who enrolled in Navigating New Motherhood to those of women receiving care in the same clinic for one year immediately prior to Navigating New Motherhood. The primary outcome was postpartum visit attendance. Secondary outcomes included WHO Tier 1 or 2 contraception uptake and other health services measures. We conducted bivariable and multivariable analyses. Results Of the 225 women approached for Navigating New Motherhood participation after program initiation, 96.9% (N=218) enrolled; these women were compared to 256 women in the historical cohort. Most women on both groups were racial or ethnic minorities and all had Medicaid insurance. There were no important differences in demographic, clinical, or health services characteristics between groups, though women in Navigating New Motherhood were more likely to transfer into the clinic for prenatal care and to deliver babies admitted to the NICU. The primary outcome, return for postpartum care, was more common among women in Navigating New Motherhood (88.1% vs. 70.3%, p<0.001), a difference that persisted after adjustment for potential confounding factors (aOR 3.57, 95% CI 2.11-6.04). Women in Navigating New Motherhood also were more likely to receive a WHO Tier 1 or 2 contraceptive method (aOR 1.56, 95% 1.02-2.38), postpartum depression screening (aOR 2.82, 95% CI 1.79-4.43), and influenza (aOR 2.10, 95% CI 1.38-3.19) and HPV vaccination (aOR 2.33, 95% CI 1.25-4.33). Conclusions Implementation of a postpartum navigation program was associated with improved retention in routine postpartum care and frequency of contraception uptake, depression screening, and vaccination.

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“…Navigators improve timeliness of diagnostic breast cancer care in vulnerable populations. (54) The Patient Care Connect Program, which provides lay navigation in rural and under-resourced community cancer centers in the network of the University of Alabama at Birmingham (UAB), shows promise as a cost-effective intervention in minority and low patients of lower socioeconomic status to enhance access and possibly increase enrollment to clinical trials, but requires intensive training and program support to be successful. (55–58) Navigation has been associated with high patient satisfaction, particularly among minority and elderly patients,(59) but more work on how to implement navigation in vulnerable populations and low resource settings is needed.…”

Section: Disparities In the Usmentioning

confidence: 99%

Breast Cancer Disparities at Home and Abroad: A Review of the Challenges and Opportunities for System-Level Change

Reeder‐Hayes

Anderson

2017

Clinical Cancer Research

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Sizeable disparities exist in breast cancer outcomes, both between Black and White patients in the United States, and between patients in the US and other high-income countries compared to low- and middle-income countries (LMICs). In both settings, health system factors are key drivers of disparities. In the US, Black women are more likely to die of breast cancer than Whites, and have poorer outcomes even among patients with similar stage and tumor subtype. Over-representation of higher-risk “triple negative” breast cancers contributes to breast cancer mortality in Black women; however, the greatest survival disparities occur within the good-prognosis hormone-receptor positive (HR+) subtypes. Disparities in access to treatment within the complex US health system may be responsible for a substantial portion of these differences in survival. In LMICs, breast cancer mortality rates are substantially higher than in the US, while incidence continues to rise. This mortality burden is largely attributable to health system factors, including late-stage presentation at diagnosis and lack of availability of systemic therapy. This article will review the existing evidence for how health-system factors in the United States contribute to breast cancer disparities, discuss methods for studying the relationship of health system factors to racial disparities, and provide examples of health system interventions that show promise for mitigating breast cancer disparities. We will then review evidence of global breast cancer disparities in low and middle income countries, the treatment factors that contribute to these disparities, and actions being taken to combat breast cancer disparities around the world.

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The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis

Cited by 37 publications

References 44 publications

Mammography facilities serving vulnerable women have longer follow‐up times

Mammography facilities serving vulnerable women have longer follow‐up times

Using a Patient Navigator to Improve Postpartum Care in an Urban Women's Health Clinic

Breast Cancer Disparities at Home and Abroad: A Review of the Challenges and Opportunities for System-Level Change

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