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Patient Perspectives of Clinical Care and Patient Navigation in Follow-up of Abnormal Mammography

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ABSTRACT

Background

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.

Objective

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.

Design

Group comparison study using data from a mail and telephone survey to measure the experience of navigated and non-navigated patients.

Participants

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%.

Main Measures

Timeliness of care, preparation for the visit to the breast center, ease of access, quality of care, provider communication, unmet need and patient satisfaction.

Key Results

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).

Conclusions

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.

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ACKNOWLEDGEMENTS

The authors acknowledge the significant contributions to this project of patient navigators Atala Esquilin and Deborah Crowley, RN, BSN, clinical team members Connie Roche, NP, and Kevin Hughes, MD, of the Avon Breast Center, and Nessa Rodgers of the MGH Center for Community Health Improvement (formerly of Partners Healthcare Community Benefits).

Funding

This work was funded in part by the MGH Cancer Center and in part by the Avon Foundation.

Conflict of interest

One of our authors (David Dutwin) is employed by the survey research firm that conducted our survey, International Communications Research. No other author has a conflict of interest, financial or otherwise.

Author information

Authors and Affiliations

  1. Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA, 02114, USA

    Karen Donelan EdM, ScD & Johanna R. Mailhot MSc

  2. International Communications Research, Media, PA, USA

    David Dutwin PhD

  3. Partners Healthcare Community Benefits, Boston, MA, USA

    Kristen Barnicle MA

  4. MGH Chelsea HealthCare Center, Chelsea, MA, USA

    Sarah Abernethy Oo MSW & Sanja Percac-Lima MD, PhD

  5. formerly MGH Patient Care Services, Boston, MA, USA

    Karin Hobrecker AB

  6. MGH Cancer Center, Boston, MA, USA

    Bruce A. Chabner MD

Authors
  1. Karen Donelan EdM, ScD
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  2. Johanna R. Mailhot MSc
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  3. David Dutwin PhD
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  4. Kristen Barnicle MA
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  5. Sarah Abernethy Oo MSW
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  6. Karin Hobrecker AB
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  7. Sanja Percac-Lima MD, PhD
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  8. Bruce A. Chabner MD
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Corresponding author

Correspondence to Karen Donelan EdM, ScD.

APPENDIX

APPENDIX

Table 4 Alternative View

Table 4 Patient Experience with Clinical Care, Navigated and Non-navigated Patients, 2005–2007 [% Rating Positively (Excellent or Very Good)]
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Donelan, K., Mailhot, J.R., Dutwin, D. et al. Patient Perspectives of Clinical Care and Patient Navigation in Follow-up of Abnormal Mammography. J GEN INTERN MED 26, 116–122 (2011). https://doi.org/10.1007/s11606-010-1436-4

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  • DOI: https://doi.org/10.1007/s11606-010-1436-4

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