Patient Perspectives of Clinical Care and Patient Navigation in Follow-up of Abnormal Mammography
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Racial and ethnic disparities in cancer care and survival are well documented. Patient navigation has been shown to improve timely follow-up of abnormal breast screenings for underserved patients. Few studies showed the impact of navigation on patient experiences of care.
We compared the experiences of patients enrolled in a patient navigator program and non-navigated patients referred to a hospital breast center for follow-up of abnormal mammogram in an underserved community health center population.
Group comparison study using data from a mail and telephone survey to measure the experience of navigated and non-navigated patients.
English- and Spanish-speaking patients with abnormal mammography attending the Avon Breast Center between April 1, 2005 and April 30, 2007. Seventy-two navigated patients and 181 non-navigated patients completed surveys; the survey response rate was 53.6%.
Timeliness of care, preparation for the visit to the breast center, ease of access, quality of care, provider communication, unmet need and patient satisfaction.
Most measures of the patient experience did not differ between navigated and non-navigated patients. Overall quality of care was rated as excellent (55% vs 62%, p = 0.294). Navigated patients were significantly more likely than non-navigated to ‘definitely’ understand what to expect at their visit (79% vs 60%, p = 0.003), to receive a reminder letter or telephone call (89% vs 77%, p = 0.029), and to feel welcome (89% vs 75%, p = 0.012). Navigated patients were less likely than non-navigated to rate the concern shown for their cultural/religious beliefs as excellent (45% vs 54%, p = 0.014).
Assessing patient perspectives is essential to evaluate the success of quality improvement interventions. In our center, we measured few significant disparities in the perceptions of care of these two very different populations of patients, although, there are still areas in which our program needs improvement. Further research is needed to understand the effectiveness of patient navigation programs in reducing racial and ethnic disparities.
- Ries LAG, Melbert D, Krapcho M et al (eds). SEER Cancer Statistics Review, 1975–2004, National Cancer Institute. Available from URL: http://seer.cancer.gov/csr/1975_2004/ [accessed June 8, 2010].
- Smedley BD, Stith AY, Nelson AR (eds). Unequal treatment: Confronting racial and ethnic disparities in health care. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press 2003.
- US Department of Health and Human Services. Making cancer health disparities history. Trans-HHS Cancer Health Disparities Progress Review Group. March 2004. Available from URL: http://www.hhs.gov/chdprg/pdf/chdprg.pdf [accessed June 8, 2010].
- Bradley CJ, Given CW, Roberts C. Disparities in cancer diagnosis and survival. Cancer. 2001;91(1):178–88. CrossRef
- Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. JAMA. 2000;284(16):2061–9. CrossRef
- Blendon RJ, Donelan K, Lukas CV, et al. The uninsured and the debate over the repeal of the Massachusetts universal health care law. JAMA. 1992;267(8):1113–7. CrossRef
- Donelan K, Blendon RJ, Hill CA, et al. What ever happened to the health insurance crisis in the United States? Voices from a national survey. JAMA. 1996;276(16):1346–50. CrossRef
- Blendon RJ, Scheck AC, Donelan K, et al. How white and African Americans view their health and social problems. Different experiences, different expectations. JAMA. 1995;273(4):341–6. CrossRef
- Epstein AM, Ayanian JZ. Racial disparities in medical care. N Engl J Med. 2001;344(19):1471–3. CrossRef
- Lurie N, Dubowitz T. Health disparities and access to health. JAMA. 2007;297(10):1118–21. CrossRef
- Lurie N. Health disparities–less talk, more action. N Engl J Med. 2005;353(7):727–9. CrossRef
- Jacobs EA, Lauderdale DS, Meltzer D, Shorey JM, Levinson W, Thisted RA. Impact of interpreter services on delivery of health care to limited-English-proficient patients. J Gen Intern Med. 2001;16(7):468–74. CrossRef
- Flores G. Language barriers to health care in the United States. N Engl J Med. 2006;355(3):229–31. CrossRef
- Cheng EM, Chen A, Cunningham W. Primary language and receipt of recommended health care among Hispanics in the United States. J Gen Intern Med. 2007;22(Suppl 2):283–8. CrossRef
- Koutoujian Rep. PJ, Wilkerson Sen. D. Massachusetts State Commission to End Racial and Ethnic Disparities. August 2007. Available from URL: http://www.mahealthcouncil.org/2007_Disparities_Report.pdf [accessed June 8, 2010].
- Mulligan D, Auerbach J. The health of Boston 2006. The Boston Public Health Commission. Mar 2006. Available from URL: http://www.bphc.org/about/Documents/Health%20of%20Boston%202006.pdf [accessed June 8, 2010].
- Patrick DL, Murray TP, Bigby J, Auerbach J, O’Keefe J, Cohen B. Racial and ethnic disparities by EOHHS regions in Massachusetts. Massachusetts Department of Public Health. Nov 2007. Available from URL: http://www.mass.gov/Eeohhs2/docs/dph/research_epi/disparity_report.pdf [accessed June 8, 2010].
- Liu MJ, Hawk H, Gershman ST, et al. The effects of a national breast and cervical cancer early detection program on social disparities in breast cancer diagnosis and treatment in Massachusetts. Cancer Causes Control. 2005;16(1):27–33. CrossRef
- Bigby J, Ko LK, Johnson N, David MM, Ferrer B. REACH Boston 2010 Breast and Cervical Cancer Coalition. A community approach to addressing excess breast and cervical cancer mortality among women of African descent in Boston. Public Health Rep. 2003;118(4):338–47.
- Massachusetts Department of Public Health. Cancer in Massachusetts by race and ethnicity, 2000–2004. The Massachusetts Cancer Registry. Available from URL: http://www.mass.gov/Eeohhs2/docs/dph/cancer/race_ethnicity.pdf [accessed June 8, 2010].
- US Department of Health and Human Services. Addressing racial and ethnic disparities in health care (fact sheet). Agency for Healthcare Research and Quality. Available from URL: http://www.ahrq.gov/research/disparit.htm [accessed June 8, 2010].
- Freeman HP, Muth BJ, Kerner JF. Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract. 1995;3(1):19–30.
- Freeman HP. A Model Patient navigation program. Oncol Issues. Sep–Oct 2004:44–46.
- Freeman HP. Patient navigation: A community centered approach to reducing cancer mortality. J Cancer Educ. 2006;21(1 Suppl):S11–4. CrossRef
- Battaglia TA, Roloff K, Posner MA, Freund KM. Improving follow-up to abnormal breast cancer screening in an urban population. A patient navigation intervention. Cancer. 2007;109(2 Suppl):359–67. CrossRef
- Ell K, Vourlekis B, Lee PJ, Xie B. Patient navigation and case management following an abnormal mammogram: A randomized clinical trial. Prev Med. 2007;44(1):26–33. CrossRef
- Hiatt RA, Pasick RJ, Stewart S, et al. Community-based cancer screening for underserved women: Design and baseline findings from the breast and cervical cancer intervention study. Prev Med. 2001;33(3):190–203. CrossRef
- Ferrante JM, Chen PH, Kim S. The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: a randomized controlled trial. J Urban Health. 2008;85(1):114–24. Epub 2007 Sep 29. CrossRef
- Palmieri FM, DePeri ER, Mincey BA, et al. Comprehensive diagnostic program for medically underserved women with abnormal breast screening evaluations in an urban population. Mayo Clin Proc. 2009;84(4):317–22. CrossRef
- Psooy BJ, Schreuer D, Borgaonkar J, Caines JS. Patient navigation: Improving timeliness in the diagnosis of breast abnormalities. Can Assoc Radiol J. 2004;55(3):145–50.
- Freund KM, Battaglia TA, Calhoun E, et al. National Cancer Institute Patient Navigation Research Program: methods, protocol, and measures. Cancer. 2008;113(12):3391–3399. CrossRef
- Centers for Disease Control and Prevention. National breast and cervical cancer early detection program. Available from URL: http://www.cdc.gov/cancer/NBCCEDP/ [accessed June 8, 2010].
- Dohan D, Schrag D. Using navigators to improve care of underserved patients: current practices and approaches. Cancer. 2005;104(4):848–855. CrossRef
- Tang TS, Patterson SK, Roubidoux MA, Duan L. Women’s mammography experience and its impact on screening adherence. Psychooncology. 2009;18(7):727–734. CrossRef
- Davies E, Shaller D, Edgman-Levitan S, et al. Evaluating the use of a modified CAHPS survey to support improvements in patient-centered care: lessons from a quality improvement collaborative. Health Expect. 2008;11(2):160–176. CrossRef
- Campbell C, Craig J, Eggert J, Bailey-Dorton C. Implementing and measuring the impact of patient navigation at a comprehensive community cancer center. Oncol Nurs Forum. 2010;37(1):61–68. CrossRef
- American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. Available from URL: http://www.aapor.org/AM/Template.cfm?Section=Standard_Definitions1&Template=/CM/ContentDisplay.cfm&ContentID=1814 [accessed June 8, 2010].
- Institute of Medicine. Crossing the quality chasm: a new health system for the twenty-first century. Washington: National Academy Press; 2001.
- See for example: Massachusetts General Hospital Disparities Solution Center. Available from URL: http://www2.massgeneral.org/disparitiessolutions/mgh.html [accessed June 8, 2010].
- Percac-Lima S, Grant RW, Green AR, et al. A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial. J Gen Intern Med. 2009;24(2):211–217. CrossRef
- Patient Perspectives of Clinical Care and Patient Navigation in Follow-up of Abnormal Mammography
Journal of General Internal Medicine
Volume 26, Issue 2 , pp 116-122
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- patient satisfaction
- community-based interventions
- breast cancer
- Industry Sectors
- Author Affiliations
- 1. Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA, 02114, USA
- 2. International Communications Research, Media, PA, USA
- 3. Partners Healthcare Community Benefits, Boston, MA, USA
- 4. MGH Chelsea HealthCare Center, Chelsea, MA, USA
- 5. formerly MGH Patient Care Services, Boston, MA, USA
- 6. MGH Cancer Center, Boston, MA, USA