Patient navigation (PN) is a widely used intervention approach in initiatives to reduce cancer health disparities and facilitate access to care, particularly in African American (AA) populations. However, the results of PN vary and little is known about the elements that make PN effective. Furthermore, resources for navigator training are limited and unstandardized. Such knowledge is critically important as PN is a widely accepted and used clinical tool and the patient navigator workforce is expected to undergo tremendous growth as a result of the Patient Navigator Outreach and Chronic Disease Prevention Act, recently passed legislation. One compelling area for investigation is the quality of communication within navigation encounters. Effective communication is essential to a navigator's efforts to identify the full range of barriers to healthcare a patient faces and to develop feasible strategies to overcome these barriers. Guided by Communication Accommodation Theory, the proposed research will focus on patient-centered and empathic communication with the goal of identifying concrete verbal behaviors associated with effective PN. The goal of the proposed research will be achieved through collaboration with a funded R01 parent study that is investigating the impact of PN on adherence to colonoscopy referral among AA primary care patients (R01- CA120658). The parent study includes a randomized clinical trial comparing two telephone-based navigation arms: 1) patient navigation conducted by a peer-lay navigator who is matched to the patient's age and has had a recent screening colonoscopy and 2) navigation conducted by a degreed health professional. The proposed R21 study will randomly select 220 audiotapes of these navigation encounters stratified on two variables: patients'actual adherence to colonoscopy referral (yes vs. no) and type of navigator (peer vs. professional). The audiotapes will then be analyzed using two complementary coding schemes: the Roter Interaction Analysis System and the Empathic Communication Coding System.
The specific aims of this proposed research are 1) to examine the effect of patient-centered and empathic communication within patient navigation encounters on adherence to colonoscopy referral among AA primary care patients, and 2) to investigate differences between peer and professional navigators in terms of their patient-centered and empathic communication exchanges with AA primary care patients referred for colonoscopy. Results will yield data on key communication strategies that can be translated into disseminable and evidence-based training modules to enhance existing navigator training curricula. Such training can increase the effectiveness of new navigators who may have limited experience interacting with AA patients in the context of a cancer screening intervention, as well as those who are continuing in the relatively new and rapidly growing and evolving area of PN. Although the focus of the proposed research is PN, results are likely to be generalizable beyond PN and should provide insight for health education and promotion in general.
The proposed research titled """"""""Communication Patterns in Cancer Screening Navigation with African Americans"""""""" is relevant to public health because it focuses on key communication behaviors in the context of a widely applied intervention approach: patient navigation. The proposed research will identify specific communication behaviors associated with adherence to colonoscopy referral among African American primary care patients and will support future efforts to both increase colonoscopy and reduce colorectal cancer burden in this population. These data can then be translated into training curricula for patient navigators that directly supports 1) the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005 which mandates and funds the recruitment and training of patient navigators in order to reduce cancer health disparities, and 2) the strategic objectives stated within the National Cancer Institute Strategic Plan related to the development of a cadre of healthcare workers, including researchers and clinicians, prepared to effectively address cancer health disparities.
