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Effect of patient navigation on satisfaction with cancer-related care

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Abstract

Purpose

Despite growing popularity of patient navigation (PN) as a means to improve cancer care quality and reduce cancer-related disparities, there are few well-designed controlled trials assessing the impact of PN on patient outcomes like satisfaction with care. The present controlled study examined effect of PN on satisfaction with cancer-related care.

Methods

Patients who presented with a symptom or abnormal screening test (n = 1788) or definitive diagnosis (n = 445) of breast, cervical, colorectal, or prostate cancer from eight Patient Navigator Research Program sites were included in one of two groups: intervention (PN) or comparison (usual care or usual care plus cancer educational materials). Trained patient navigators met with intervention group participants to help them assess and identify resources to address barriers to cancer diagnostic or treatment care. Using a validated instrument, we assessed participants’ satisfaction with their cancer diagnostic or treatment care up to 3 months after diagnostic resolution of a cancer-related abnormality or within 3 months of initiation of cancer treatment.

Results

Overall, patients reported high satisfaction with diagnostic care and cancer treatment. There were no statistically significant differences between PN and control groups in satisfaction with cancer-related care (p > 0.05). Hispanic and African American participants were less likely to report high satisfaction with cancer care when compared to White patients. Middle-aged participants with higher education, higher household income, private insurance, owning their own home, working full-time, and those whose primary language is English had higher satisfaction with cancer-related diagnostic care.

Conclusions

PN had no statistically significant effect on patients’ satisfaction with cancer-related care. Further research is needed to define the patient populations who might benefit from PN, content of PN that is most useful, and services that might enhance PN.

Trial registrations

clinicaltrials.gov identifiers: NCT00613275, NCT00496678, NCT00375024, NCT01569672

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Acknowledgments

Study data resulted from the collaborative efforts of the following sites, the National Cancer Institute’s (NCI’s) Center to Reduce Cancer Health Disparities (CRCHD), and the NCI Program Evaluation Contractor (NOVA Research Company). The Patient Navigation Research Program Investigators include NCI, CRCHD: Martha Hare, Mollie Howerton, Ken Chu, Emmanuel Taylor, Mary Ann Van Duyn; NOVA Research: Paul Young, Frederick Snyder, Kathy Parillo; Boston Medical Center and Boston University: PI-Karen Freund, Co-PI-Tracy Battaglia, Sharon Bak, Bonnie Sherman, Sarah Karon, Richard Kalish, Nisha Thrakar, James Taylor, Stephen Tringale, Patrick Egan, Barbara Lottero, Walter Phinney; Denver Health and Hospital Authority: PI-Peter Raich, Co-PI-Elizabeth Whitley, Patricia Valverde, Diane Fairclough, William Thorland, Lina Escobar, Kristin Kilbourn, Besty Risendahl, Rachel Everhart, Evelinn Borrayo, Tim Byers, Hermenia Arambula, Inna Pines, Carol Spitz, Jesus Tovar; George Washington University Cancer Institute: PI-Steven Patierno, Lisa Alexander, Paul Levine, Heather Young, Heather Hoffman, Nancy LaVerda, Larisa Caicedo, William Funderburk, Elmer Huerta, Jeanne Mandelblatt, Jennifer Eng-Wong, Sandra Swain, Wayne Frederick, Felicia Buadoo-Adade; H. Lee Moffitt Cancer Center and Research Institute: PI-Richard Roetzheim, Cathy Meade, Kristen Wells, Ercilia Calcano, Ji-Hyun Lee, William Fulp, Marlene Rivera; Northwest Portland Area Indian Health Board: PI-Victoria Warren-Mears, Matthew Town, Jenine Dankovchik, Meagan Cahn; Northwestern University Robert H. Lurie Comprehensive Cancer Center: PI-Steven Rosen, Melissa Simon, Narissa Nonzee, June McKoy; Ohio State University Comprehensive Cancer Center: PI-Electra Paskett, Douglas Post, Mira Katz, David Murray, Cathy Tatum, Cecilia DeGraffinreid, Gregory Young, Melissa Gorsline; University of Illinois at Chicago and Access Community Health Center: PI-Elizabeth Calhoun, Julie Darnell, Julia Shklovskaya, Mickey Eder, Young Cho, Talar Markossian; University of Rochester: PI-Kevin Fiscella, Samantha Hendren, Jennifer Carroll, Ronald Epstein, Jennifer Griggs, Sharon Humiston, Pascal Jean-Pierre, Starlene Loader, Vi Luong, Sally Rousseau, Charcy Salamone, Michele Sanders, Bonnie Schwartzbauer, Amanat Yosha; University of Texas Health Science Center at San Antonio Cancer Therapy and Research Center: PI-Donald Dudley, Joan Drake, Kevin Hall, Alan Holden, Anand Karnard, Amelie Ramirez, Jennie Quinlan, Pam Saegert. This project was supported by grants 5U01CA116875, 5U01CA116885, 5U01CA116924, 5U01CA116892, 5U01CA116937, 5U01CA116903, 5U01CA117281, 5U01CA116925 from the Center to Reduce Cancer Health Disparities, National Cancer Institute, National Institutes of Health; and # SIRSG-05-253-01 and #CRP-12-219-01-CPPB from the American Cancer Society and the Avon Foundation. Dr. Wells’ contribution was also funded by a grant from NCI (R25CA090314; Paul Jacobsen, Ph.D., Principal Investigator). The content of the paper is solely the responsibility of the authors and does not necessarily represent the official views of the American Cancer Society or the CRCHD at the NCI.

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Authors and Affiliations

  1. Department of Psychology, San Diego State University and University of California, San Diego Moores Cancer Center, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-1863, USA

    Kristen J. Wells

  2. Family Medicine Research Programs, University of Rochester Medical Center, 1381 South Avenue, Rochester, NY, 14620, USA

    Paul C. Winters & Kevin Fiscella

  3. Department of Psychology, University of Notre Dame, 109 Haggar Hall, Notre Dame, IN, 46556, USA

    Pascal Jean-Pierre

  4. Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA

    Victoria Warren-Mears

  5. Ohio State University, 1590 North High Street, Suite 525, Columbus, OH, 43201, USA

    Douglas Post

  6. National Institutes of Health, National Cancer Institute, 9609 Medical Center Drive, Room 6W118, Bethesda, MD, 20892, USA

    Mary Ann S. Van Duyn

  7. Division of Health Policy & Administration, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, Room 758, Chicago, IL, 60612, USA

    Julie Darnell

  8. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street #63, Boston, MA, 02111, USA

    Karen M. Freund

Authors
  1. Kristen J. Wells
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  2. Paul C. Winters
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  3. Pascal Jean-Pierre
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  4. Victoria Warren-Mears
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  5. Douglas Post
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  6. Mary Ann S. Van Duyn
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  7. Kevin Fiscella
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  8. Julie Darnell
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  9. Karen M. Freund
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Consortia

Patient Navigation Research Program Investigators

Corresponding author

Correspondence to Kristen J. Wells.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

Table 4 Site A high satisfaction with care (median cut-off) by demographics
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Table 5 Site B high satisfaction with care (median cut-off) by demographics
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Table 6 Site C high satisfaction with care (median cut-off) by demographics
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Table 7 Site D high satisfaction with care (median cut-off) by demographics
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Table 8 Site E high satisfaction with care (median cut-off) by demographics
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Table 9 Site F high satisfaction with care (median cut-off) by demographics
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Table 10 Site G high satisfaction with care (median cut-off) by demographics
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Table 11 Site H high satisfaction with care (median cut-off) by demographics
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Table 12 Site A clinical variables by time of measurement
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Table 13 Site B clinical variables by time of measurement
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Table 14 Site C clinical variables by time of measurement
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Table 15 Site D clinical variables by time of measurement
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Table 16 Site E clinical variables by time of measurement
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Table 17 Site F clinical variables by time of measurement
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Table 18 Site G clinical variables by time of measurement
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Table 19 Site H clinical variables by time of measurement
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Wells, K.J., Winters, P.C., Jean-Pierre, P. et al. Effect of patient navigation on satisfaction with cancer-related care. Support Care Cancer 24, 1729–1753 (2016). https://doi.org/10.1007/s00520-015-2946-8

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