Disparities in cancer treatment and outcomes have been extensively documented by the race, ethnicity, and socioeconomic status (SES) of the patient. Patient navigation represents a potentially powerful intervention for addressing these disparities, but has not been rigorously evaluated. The primary aim of this project is to assess the impact of a primary care-based, patient navigation-activation program on cancer-related quality of care using a randomized controlled study design. A key aim assesses whether members of underserved populations derive greater benefit from navigation than do patients who face fewer access barriers. Six, large inner-city practices serving predominately minority and low-income populations will be recruited. Implementation of the intervention will be preceded by evaluation of the practices'needs, assessment of patient barriers, and development of a navigator curriculum and training manuals. Patients from these practices will be recruited using patient registries established in each practice for breast and colorectal cancer screening. Consenting patients with abnormal breast or colorectal screening results will be randomized to usual care or patient navigation. Well-trained community health workers, will assess patient barriers, assist patients in overcoming these barriers, and coach patients in communicating with their physicians. The primary patient outcomes will be time to a definitive diagnostic test and time to completion of cancer treatment, adherence to recommendations, receipt of guideline concordant care, satisfaction, and quality of life. Secondary outcomes include differential effects by race/ethnicity, income, or health literacy, mediating effects of patient activation, and costs of navigation and care. Findings from this project have implications for national policy related to the design and implementation of patient navigation programs for cancer and interventions designed to eliminate disparities in cancer treatment

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project--Cooperative Agreements (U01)
Project #
3U01CA116924-05S3
Application #
8144513
Study Section
Special Emphasis Panel (ZCA1-SRRB-D (M1))
Program Officer
Vanduyn, Maryann
Project Start
2005-09-30
Project End
2012-08-31
Budget Start
2009-09-01
Budget End
2012-08-31
Support Year
5
Fiscal Year
2010
Total Cost
$60,000
Indirect Cost
Name
University of Rochester
Department
Family Medicine
Type
Schools of Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Wells, Kristen J; Campbell, Kevin; Kumar, Ambuj et al. (2018) Effects of patient navigation on satisfaction with cancer care: a systematic review and meta-analysis. Support Care Cancer 26:1369-1382
Whitley, Elizabeth M; Raich, Peter C; Dudley, Donald J et al. (2017) Relation of comorbidities and patient navigation with the time to diagnostic resolution after abnormal cancer screening. Cancer 123:312-318
Jean-Pierre, Pascal; Cheng, Ying; Wells, Kristen J et al. (2016) Satisfaction with cancer care among underserved racial-ethnic minorities and lower-income patients receiving patient navigation. Cancer 122:1060-7
Paskett, Electra D; Dudley, Donald; Young, Gregory S et al. (2016) Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening. J Womens Health (Larchmt) 25:15-21
Battaglia, Tracy A; Darnell, Julie S; Ko, Naomi et al. (2016) The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis. Breast Cancer Res Treat 158:523-34
Wells, Kristen J; Winters, Paul C; Jean-Pierre, Pascal et al. (2016) Effect of patient navigation on satisfaction with cancer-related care. Support Care Cancer 24:1729-53
Ko, Naomi Y; Snyder, Frederick R; Raich, Peter C et al. (2016) Racial and ethnic differences in patient navigation: Results from the Patient Navigation Research Program. Cancer 122:2715-22
Sanders, Mechelle; Winters, Paul; Fiscella, Kevin (2015) Preliminary validation of a scale to measure patient perceived similarity to their navigator. BMC Res Notes 8:388
Rodday, Angie Mae; Parsons, Susan K; Snyder, Frederick et al. (2015) Impact of patient navigation in eliminating economic disparities in cancer care. Cancer 121:4025-34
Ramachandran, Ambili; Snyder, Frederick R; Katz, Mira L et al. (2015) Barriers to health care contribute to delays in follow-up among women with abnormal cancer screening: Data from the Patient Navigation Research Program. Cancer 121:4016-24

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