title: Barriers to health care contribute to delays in follow-up among women with abnormal cancer screening: Data from the Patient Navigation Research Program.
abstract: BACKGROUND
  There is limited understanding of the association between barriers to care and clinical outcomes within patient navigation programs.
  
  
  METHODS
  Secondary analyses of data from the intervention arms of the Patient Navigation Research Program were performed, which included navigated participants with abnormal breast and cervical cancer screening tests from 2007 to 2010. Independent variables were: 1) the number of unique barriers to care (0, 1, 2, or ≥3) documented during patient navigation encounters; and 2) the presence of socio-legal barriers originating from social policy (yes/no). The median time to diagnostic resolution of index screening abnormalities was estimated using Kaplan-Meier cumulative incidence curves. Multivariable Cox proportional hazards regression examined the impact of barriers on time to resolution, controlling for sociodemographics and stratifying by study center.
  
  
  RESULTS
  Among 2600 breast screening participants, approximately 75% had barriers to care documented (25% had 1 barrier, 16% had 2 barriers, and 34% had ≥3 barriers). Among 1387 cervical screening participants, greater than one-half had barriers documented (31% had 1 barrier, 11% had 2 barriers, and 13% had ≥3 barriers). Among breast screening participants, the presence of barriers was associated with less timely resolution for any number of barriers compared with no barriers. Among cervical screening participants, only the presence of ≥2 barriers was found to be associated with less timely resolution. Both types of barriers, socio-legal and other barriers, were found to be associated with delay among breast and cervical screening participants.
  
  
  CONCLUSIONS
  Navigated women with barriers resolved cancer screening abnormalities at a slower rate compared with navigated women with no barriers. Further innovations in navigation care are necessary to maximize the impact of patient navigation programs nationwide.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Ambili
authors.initials: A
authors.lastname: Ramachandran
authors.affiliation: Nova Research Company, Bethesda, Maryland.
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Snyder
authors.affiliation: College of Public Health, The Ohio State University, Columbus, Ohio.
authors.forename: Mira L
authors.initials: ML
authors.lastname: Katz
authors.affiliation: School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Julie S
authors.initials: JS
authors.lastname: Darnell
authors.affiliation: Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Dudley
authors.affiliation: Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Patierno
authors.affiliation: Department of Family Medicine, University of Rochester, Rochester, New York.
authors.forename: Mechelle R
authors.initials: MR
authors.lastname: Sanders
authors.affiliation: Colorado School of Public Health, University of Colorado at Denver, Denver, Colorado.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Valverde
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Simon
authors.affiliation: Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, Oregon.
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
authors.affiliation: Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D062526:Patient Navigation; D016016:Proportional Hazards Models; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
keywords: barriers to care; disparities; early detection of cancer; health services research; patient navigation