Skip to main content

Advertisement

SpringerLink
Log in

Helping Men Find Their Way: Improving Prostate Cancer Clinic Attendance via Patient Navigation

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Navigation programs aim to help patients overcome barriers to cancer diagnosis and treatment. Missed clinic appointments have undesirable effects on the patient, health system, and society, and treatment delays have been shown to result in inferior surgical cure rates for men with prostate cancer (CaP). We sought to measure the impact of patient navigation on CaP clinic adherence. Patient navigators contacted patients prior to their first encounter for known or suspected CaP between 7/1/2016 and 6/30/2017. Encounters from 7/1/2014 to 6/30/2015 were used as a historical control. Patient-variables were analyzed including age, health insurance status, home address, zip code, race, ethnicity, and referring primary care clinic. Encounter-level variables included diagnosis (categorized as known or suspected CaP), date of appointment, type of appointment [new vs. return], and provider. The associations between several factors including navigation contact and these variables with missed appointment were analyzed using generalized linear mixed effects multivariate logistic regression. A total of 2854 scheduled clinic encounters from 986 unique patients were analyzed. Patient navigation resulted in a lower missed appointment rate (8.8% vs. 13.9%, OR = 0.64, IQR 0.44–0.93, p = 0.02 on multivariable analysis). Lack of health insurance (OR = 13.18 [5.13–33.83]), suspected but not confirmed CaP diagnosis (OR = 7.44 [4.85–11.42]), and Black (1.97 [1.06–3.65]) or Hispanic (OR = 3.61 [1.42–9.16]) race, were associated with missed appointment. Implementation of patient navigation reduced missed appointment rates for CaP related ambulatory encounters. Identifying risk factors for missed appointment may aid in targeting navigation services to those most likely to benefit from this intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Freeman, H. P., & Rodriguez, R. L. (2011). History and principles of patient navigation. Cancer,117(15 Suppl), 3539–3542.

    PubMed  PubMed Central  Google Scholar 

  2. Wells, K. J., Battaglia, T. A., Dudley, D. J., Garcia, R., Greene, A., Calhoun, E., et al. (2008). Patient navigation: State of the art or is it science? Cancer,113(8), 1999–2010.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ramachandran, A., Freund, K. M., Bak, S. M., Heeren, T. C., Chen, C. A., & Battaglia, T. A. (2015). Multiple barriers delay care among women with abnormal cancer screening despite patient navigation. Journal of Womens Health (Larchmont),24(1), 30–36.

    Article  Google Scholar 

  4. Rodday, A. M., Parsons, S. K., Snyder, F., Simon, M. A., Llanos, A. A., Warren‐Mears, V., et al. (2015). Impact of patient navigation in eliminating economic disparities in cancer care. Cancer,121(22), 4025–4034.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Charlot, M., Santana, M. C., Chen, C. A., Bak, S., Heeren, T. C., Battaglia, T. A., et al. (2015). Impact of patient and navigator race and language concordance on care after cancer screening abnormalities. Cancer,121(9), 1477–1483.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ko, N. Y., Snyder, F. R., Raich, P. C., Paskett, E. D., Dudley, D. J., Lee, J. H., et al. (2016). Racial and ethnic differences in patient navigation: Results from the Patient Navigation Research Program. Cancer,122(17), 2715–2722.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Molfenter, T. (2013). Reducing appointment no-shows: Going from theory to practice. Substance Use and Misuse,48(9), 743–749.

    Article  PubMed  Google Scholar 

  8. Jandorf, L., Gutierrez, Y., Lopez, J., Christie, J., & Itzkowitz, S. H. (2005). Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. Journal of Urban Health,82(2), 216–224.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Christie, J., Itzkowitz, S., Lihau-Nkanza, I., Castillo, A., Redd, W., & Jandorf, L. (2008). A randomized controlled trial using patient navigation to increase colonoscopy screening among low-income minorities. Journal of the National Medical Association,100(3), 278–284.

    Article  PubMed  Google Scholar 

  10. Sullivan, C., Leon, J. B., Sayre, S. S., Marbury, M., Ivers, M., Pencak, J. A., et al. (2012). Impact of navigators on completion of steps in the kidney transplant process: A randomized, controlled trial. Clinical Journal of the American Society of Nephrology,7(10), 1639–1645.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ferrante, J. M., Chen, P. H., & Kim, S. (2008). The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: A randomized controlled trial. Journal of Urban Health,85(1), 114–124.

    Article  PubMed  Google Scholar 

  12. Percac-Lima, S., Ashburner, J. M., Zai, A. H., Chang, Y., Oo, S. A., Guimaraes, E., et al. (2016). Patient navigation for comprehensive cancer screening in high-risk patients using a population-based health information technology system: A randomized clinical trial. JAMA Internal Medicine,176(7), 930–937.

    Article  PubMed  Google Scholar 

  13. Tingen, M. S., Weinrich, S. P., Heydt, D. D., Boyd, M. D., & Weinrich, M. C. (1998). Perceived benefits: A predictor of participation in prostate cancer screening. Cancer Nursing,21(5), 349–357.

    Article  CAS  PubMed  Google Scholar 

  14. Capik, C., & Gozum, S. (2012). The effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening. European Journal of Oncology Nursing,16(1), 71–77.

    Article  PubMed  Google Scholar 

  15. Johnson, T. V., Goodman, M., & Master, V. A. (2007). The efficacy of written screening tools in an inner city hospital: Literacy based limitations on patient access to appropriate care. The Journal of Urology,178(2), 623–629. (discussion 629).

    Article  PubMed  Google Scholar 

  16. Dobbs, R. W., Malhotra, N. R., Caldwell, B. M., Rojas, R., Moreira, D. M., & Abern, M. R. (2018). Determinants of clinic absenteeism: A novel method of examining distance from clinic and transportation. Journal of Community Health,43(1), 19–26.

    Article  PubMed  Google Scholar 

  17. Reuland, D. S., Brenner, A. T., Hoffman, R., McWilliams, A., Rhyne, R. L., Getrich, C., et al. (2017). Effect of combined patient decision aid and patient navigation vs usual care for colorectal cancer screening in a vulnerable patient population: A randomized clinical trial. JAMA Internal Medicine,177(7), 967–974.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Genoff, M. C., Zaballa, A., Gany, F., Gonzalez, J., Ramirez, J., Jewell, S. T., et al. (2016). Navigating language barriers: A systematic review of patient navigators’ impact on cancer screening for limited english proficient patients. Journal of General Internal Medicine,31(4), 426–434.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Siegel, R. L., Miller, K. D., & Jemal, A. (2019). Cancer statistics, 2019. CA: A Cancer Journal for Clinicians,69(1), 7–34.

    Google Scholar 

  20. Dobbs, R. W., Greenwald, D. T., Wadhwa, H., Freeman, V. L., & Abern, M. R. (2017). Is prostate cancer stage migration continuing for black men in the PSA era? Prostate Cancer and Prostatic Diseases,20(2), 210–215.

    Article  CAS  PubMed  Google Scholar 

  21. Halbert, C. H., Weathers, B., Delmoor, E., Mahler, B., Coyne, J., Thompson, H. S., et al. (2009). Racial differences in medical mistrust among men diagnosed with prostate cancer. Cancer,115(11), 2553–2561.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Abern, M. R., Aronson, W. J., Terris, M. K., Kane, C. J., Presti, J. C., Jr., Amling, C. L., et al. (2013). Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: Possible implications for active surveillance from the SEARCH database. Prostate,73(4), 409–417.

    Article  PubMed  Google Scholar 

  23. Dobbs, R. W., Malhotra, N. R., Abern, M. R., & Moreira, D. M. (2019). Prostate cancer disparities in Hispanics by country of origin: A nationwide population-based analysis. Prostate Cancer and Prostatic Diseases,22(1), 159–167.

    Article  CAS  PubMed  Google Scholar 

  24. DuBard, C. A., & Gizlice, Z. (2008). Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. American Journal of Public Health,98(11), 2021–2028.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Moyer, V. A., & US Preventive Services Task Force, (2012). Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine,157(2), 120–134.

    Article  PubMed  Google Scholar 

  26. US Preventive Services Task Force, Grossman, D. C., Curry, S. J., Owens, D. K., Bibbins-Domingo, K., Caughey, A. B., et al. (2018). Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA,319(18), 1901–1913.

    Article  Google Scholar 

  27. Weinrich, S. P., Boyd, M. D., Weinrich, M., Greene, F., Reynolds, W. A., Jr., & Metlin, C. (1998). Increasing prostate cancer screening in African American men with peer-educator and client-navigator interventions. Journal of Cancer Education,13(4), 213–219.

    CAS  PubMed  Google Scholar 

  28. Simon, M. A., Nonzee, N. J., McKoy, J. M., Liu, D., Luu, T. H., Byer, P., et al. (2013). Navigating veterans with an abnormal prostate cancer screening test: A quasi-experimental study. BMC Health Serv Research,13, 314.

    Article  Google Scholar 

  29. Serrell, E. C., Hansen, M., Mills, G., Perry, A., Robbins, T., Feinberg, M., et al. (2019). Prostate cancer navigation: Initial experience and association with time to care. World journal of Urology,37(6), 1095–1101.

    Article  PubMed  Google Scholar 

  30. Freund, K. M. (2017). Implementation of evidence-based patient navigation programs. Acta Oncologica,56(2), 123–127.

    Article  PubMed  Google Scholar 

  31. Clark, C. R., Baril, N., Kunicki, M., Johnson, N., Soukup, J., Ferguson, K., et al. (2009). Addressing social determinants of health to improve access to early breast cancer detection: Results of the Boston REACH 2010 breast and cervical cancer coalition women’s health demonstration project. Journal of Womens Health (Larchmont),18(5), 677–690.

    Article  Google Scholar 

  32. Davis, C., Darby, K., Likes, W., & Bell, J. (2009). Social workers as patient navigators for breast cancer survivors: What do African-American medically underserved women think of this idea? Social Work in Health Care,48(6), 561–578.

    Article  PubMed  Google Scholar 

  33. Crockett-Maillet, G. (2008). The breast cancer navigator. A new role for nurse practitioners. Advance for Nurse Practitioners,16(1), 53–54, 56.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, College of Medicine, University of Illinois at Chicago, 820 S. Wood St, M/C 955, Chicago, 606012, USA

    Ryan W. Dobbs, Brandon M. Caldwell, Daniel F. Garvey, Daniel M. Moreira & Michael R. Abern

  2. Department of Urology, Cook County Hospital & Health System, Chicago, USA

    James Stinson

  3. Department of Internal Medicine, College of Medicine, Baylor University, Houston, USA

    Shaleen R. Vasavada

  4. School of Public Health, University of Illinois at Chicago, Chicago, USA

    Vincent L. Freeman

  5. Jane Addams School of Social Work, University of Illinois at Chicago, Chicago, USA

    Jack Lu

Authors
  1. Ryan W. Dobbs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James Stinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shaleen R. Vasavada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brandon M. Caldwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincent L. Freeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel F. Garvey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jack Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel M. Moreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael R. Abern
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael R. Abern.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dobbs, R.W., Stinson, J., Vasavada, S.R. et al. Helping Men Find Their Way: Improving Prostate Cancer Clinic Attendance via Patient Navigation. J Community Health 45, 561–568 (2020). https://doi.org/10.1007/s10900-019-00776-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-019-00776-w

Keywords

Search

Navigation