Use of Community Health Workers and Patient Navigators to Improve Cancer Outcomes Among Patients Served by Federally Qualified Health Centers: A Systematic Literature Review

Abstract

Introduction: In the United States, disparities in cancer screening, morbidity, and mortality are well documented, and often are related to race/ethnicity and socioeconomic indicators including income, education, and healthcare access. Public health approaches that address social determinants of health have the greatest potential public health benefit, and can positively impact health disparities. As public health interventions, community health workers (CHWs), and patient navigators (PNs) work to address disparities and improve cancer outcomes through education, connecting patients to and navigating them through the healthcare system, supporting patient adherence to screening and diagnostic services, and providing social support and linkages to financial and community resources. Clinical settings, such as federally qualified health centers (FQHCs) are mandated to provide care to medically underserved communities, and thus are also valuable in the effort to address health disparities. We conducted a systematic literature review to identify studies of cancer-related CHW/PN interventions in FQHCs, and to describe the components and characteristics of those interventions in order to guide future intervention development and evaluation.Method: We searched five databases for peer-reviewed CHW/PN intervention studies conducted in partnership with FQHCs with a focus on cancer, carried out in the United States, and published in English between January 1990 and December 2013.Results: We identified 24 articles, all reporting positive outcomes of CHW/PNs interventions in FQHCs. CHW/PN interventions most commonly promoted breast, cervical, or colorectal cancer screening and/or referral for diagnostic resolution. Studies were supported largely through federal funding. Partnerships with academic institutions and community-based organizations provided support and helped develop capacity among FQHC clinic leadership and community members.Discussion: Both the FQHC system and CHW/PNs were borne from the need to address persistent, complex health disparities among medically underserved communities. Our findings support the effectiveness of CHW/PN programs to improve completion and timeliness of breast, cervical, and colorectal cancer screening in FQHCs, and highlight intervention components useful to design and sustainability.

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

“…PN was shown to have early success in helping with the accrual of minorities to clinical trials by increasing awareness and access and reducing barriers to participation . Most reviews have focused on the efficacy of PN in various settings across the breast cancer continuum, on female cancers across the cancer continuum, or on improving screening rates and the time to diagnosis . Other reviews have shown that PN improves patient‐reported outcomes such as patient satisfaction …”

“…16 Most reviews have focused on the efficacy of PN in various settings across the breast cancer continuum, 17,18 on female cancers across the cancer continuum, 19 or on improving screening rates and the time to diagnosis. 20,21 Other reviews have shown that PN improves patient-reported outcomes such as patient satisfaction. [22][23][24] Few systematic reviews have evaluated the efficacy of PN across the cancer continuum, including all cancer types and populations.…”

Surgical treatment of young women with breast cancer: Public vs private hospitals

“…The presence of patient navigators (PN) at the public hospital is an important resource in overcoming disparities and likely had a major contribution toward the high compliance rates for RT and systemic therapy. The PNs help guide patients through the healthcare system, and also provide education, help patients adhere to treatment plans, and connect patients to resources within the community as well …”

“…The PNs help guide patients through the healthcare system, and also provide education, help patients adhere to treatment plans, and connect patients to resources within the community as well. 30 The safety-net hospital had a greater proportion of its patients with higher tumor stage, and patients were more likely to present with a palpable mass. This was expected, as patients at the public hospital were more likely to be racial minorities, non-English speakers, and have a lower education level, and studies have shown that women from lower SES backgrounds and younger women are more likely to present with aggressive breast cancer.…”

Mobile Mammography Unit Utilization: Perceptions and Interests Among African American Women

“…According to data available for 2014, the number of US women diagnosed with breast cancer was 236,968 and 41,211 died from the disease [3]. Moreover, for racial/ethnic minorities and those of low socioeconomic status (SES), these groups experience a poorer quality of life and diminished survival [4][5][6] compared to Caucasian women and those of a higher socioeconomic status. This is due, in part, to underutilization of mammography screening and a lack of adherence to subsequent follow-up guidelines [7][8].…”