title: Effect of Patient Navigation on Breast Cancer Screening Among African American Medicare Beneficiaries: A Randomized Controlled Trial.
abstract: BACKGROUND
  There is growing evidence that patient navigation improves breast cancer screening rates; however, there are limited efficacy studies of its effect among African American older adult women.
  
  
  OBJECTIVE
  To evaluate the effect of patient navigation on screening mammography among African American female Medicare beneficiaries in Baltimore, MD.
  
  
  METHODS
  The Cancer Prevention and Treatment Demonstration (CPTD), a multi-site study, was a randomized controlled trial conducted from April 2006 through December 2010.
  
  
  METHODS
  Community-based and clinical setting.
  
  
  METHODS
  The CPTD Screening Trial enrolled 1905 community-dwelling African American female Medicare beneficiaries who were ≥65 years of age and resided in Baltimore, MD. Participants were recruited from health clinics, community centers, health fairs, mailings using Medicare rosters, and phone calls.
  
  
  METHODS
  Participants were randomized to either: printed educational materials on cancer screening (control group) or printed educational materials + patient navigation services designed to help participants overcome barriers to cancer screening (intervention group).
  
  
  METHODS
  Self-reported receipt of mammography screening within 2 years of the end of the study.
  
  
  RESULTS
  The median follow-up period for participants in this analysis was 17.8 months. In weighted multivariable logistic regression analyses, women in the intervention group had significantly higher odds of being up to date on mammography screening at the end of the follow-up period compared to women in the control group (odds ratio [OR] 2.26, 95 % confidence interval [CI]1.59-3.22). The effect of the intervention was stronger among women who were not up to date with mammography screening at enrollment (OR 3.63, 95 % CI 2.09-6.38).
  
  
  CONCLUSIONS
  Patient navigation among urban African American Medicare beneficiaries increased self-reported mammography utilization. The results suggest that patient navigation for mammography screening should focus on women who are not up to date on their screening.
authors.affiliation: Division of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Jessie Kimbrough
authors.initials: JK
authors.lastname: Marshall
authors.affiliation: Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Olive M
authors.initials: OM
authors.lastname: Mbah
authors.affiliation: Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA. jgf9001@nyp.org.
authors.forename: Jean G
authors.initials: JG
authors.lastname: Ford
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Darcy
authors.initials: D
authors.lastname: Phelan-Emrick
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Bone
authors.affiliation: Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wenzel
authors.affiliation: Health Partners Cancer Program and Institute for Education and Research, Minneapolis, MN, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Shapiro
authors.affiliation: Centers for Medicare and Medicaid Services, Baltimore, MD, USA.
authors.forename: Mollie
authors.initials: M
authors.lastname: Howerton
authors.affiliation: Park West Health Systems, Baltimore, MD, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Johnson
authors.affiliation: TVCOFA Corporation, Baltimore, MD, USA.
authors.forename: Qiana
authors.initials: Q
authors.lastname: Brown
authors.affiliation: Formerly of the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Altovise
authors.initials: A
authors.lastname: Ewing
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Craig Evan
authors.initials: CE
authors.lastname: Pollack
mesh_terms: D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000208:ethnology* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography / Q000191:economics; D006278:Medicare / Q000191:economics*; D010353:Patient Education as Topic / Q000379:methods*; D062526:Patient Navigation / Q000191:economics*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: African American; mammography; patient navigation