Barriers reported among patients with breast and cervical abnormalities in the patient navigation research program: impact on timely care.
BACKGROUND
Patient navigation (PN) is a system-level strategy to decrease cancer mortality rates by reducing barriers to cancer care. Barriers to resolution among participants in the PN intervention arm with a breast or cervical abnormality in the Patient Navigation Research Program and navigators' actions to address those barriers were examined.


METHODS
Data from seven institutions (2005-2010) included 1,995 breast and 1,194 cervical patients. A stratified Cox proportional hazards regression model was used to examine the effects of barriers on time to resolution of an abnormal screening test or clinical finding.


RESULTS
The range of unique barriers was 0 to 12 and 0 to 7 among participants with breast and cervical abnormalities, respectively. About two thirds of breast and one half of cervical participants had at least one barrier resulting in longer time to diagnostic resolution among breast (adjusted hazard ratio [HR], 0.744; p < .001) and cervical (adjusted HR, 0.792; p < .001) participants. Patient- and system-level barriers were most common. Frequent navigator actions were making arrangements, scheduling appointments, referrals, and education.


CONCLUSIONS
Having a barrier resulted in a delay in diagnostic resolution of an abnormal screening test or clinical finding. Health care systems can use these findings to improve existing PN programs or when developing new programs.
The Ohio State University, Columbus, Ohio. Electronic address: mira.katz@osumc.edu.
Mira L
ML
Katz
The Ohio State University, Columbus, Ohio.
Gregory S
GS
Young
The Ohio State University, Columbus, Ohio.
Paul L
PL
Reiter
Boston University School of Medicine, Boston, Massachusetts.
Tracy A
TA
Battaglia
San Diego State University, San Diego, California.
Kristen J
KJ
Wells
University of Rochester, Rochester, New York.
Mechelle
M
Sanders
Northwestern University, Chicago, Illinois.
Melissa
M
Simon
University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Donald J
DJ
Dudley
The George Washington University, Washington, DC.
Steven R
SR
Patierno
The Ohio State University, Columbus, Ohio.
Electra D
ED
Paskett
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D062526:Patient Navigation; D016016:Proportional Hazards Models; D012944:Social Support; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult