title: The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis.
abstract: Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screening test among a national sample. A prospective meta-analysis estimated the adjusted odds of achieving timely diagnostic resolution at 60, 180, and 365 days. Exploratory analyses were conducted on the pooled sample to identify which groups had the most benefit from navigation. Clinics from six medical centers serving vulnerable populations participated in the Patient Navigation Research Program. Women with an abnormal breast cancer screening test between 2007 and 2009 were included and received the patient navigation intervention or usual care. Patient navigators worked with patients and their care providers to address patient-specific barriers to care to prevent delays in diagnosis. A total of 4675 participants included predominantly racial/ethnic minorities (74 %) with public insurance (40 %) or no insurance (31 %). At 60 days and 180 days, there was no statistically significant effect of navigation on achieving timely diagnostic care, but a benefit of navigation was seen at 365 days (aOR 2.12, CI 1.36-3.29). We found an equal benefit of navigation across all groups, regardless of race/ethnicity, language, insurance status, and type of screening abnormality. Patient navigation resulted in more timely diagnostic resolution at 365 days among a diverse group of minority, low-income women with breast cancer screening abnormalities. Trial registrations clinicaltrials.gov Identifiers: NCT00613275, NCT00496678, NCT00375024, NCT01569672.
authors.affiliation: Women's Health Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Building 1st Floor, Boston, MA, 02118, USA. tracy.battaglia@bmc.org.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
authors.affiliation: Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Avenue, Bldg 115, Room 556, Maywood, IL, 60153, USA.
authors.forename: Julie S
authors.initials: JS
authors.lastname: Darnell
authors.affiliation: Section of Hematology Oncology, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA, 02118, USA.
authors.forename: Naomi
authors.initials: N
authors.lastname: Ko
authors.affiliation: NOVA Research Company, 801 Roeder Road, Suite 700, Silver Spring, MD, 20910, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Snyder
authors.affiliation: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, The Ohio State University, 1590 North High Street, Columbus, OH, 43201, USA.
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.affiliation: Department of Psychology, San Diego State University, 6363 Alvarado Ct., Ste. 103, San Diego, CA, 92120-4913, USA.
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Wells
authors.affiliation: Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO, 80246, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Whitley
authors.affiliation: University of Michigan School of Public Health, 2800 Plymouth Road, Building 16, 116 W, Ann Arbor, MI, 48109, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
authors.affiliation: Division of Hematology-Oncology, Cancer Therapy & Research Center (CTRC), UT Health Science Center, 7979 Wurzbach Rd., San Antonio, TX, 78229, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Karnad
authors.affiliation: George Washington University Cancer Institute, 950 New Hampshire Ave. NW 5th Floor, Washington, DC, 20052, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Young
authors.affiliation: Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, OR, 97201, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
authors.affiliation: Northwestern University Feinberg School of Medicine, 633 N. St Clair, Suite 1800, Chicago, IL, 60611, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Simon
authors.affiliation: University of Arizona Health Sciences, 550 East Van Buren, Phoenix, AZ, 85004-2230, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Calhoun
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups; D016017:Odds Ratio; D062526:Patient Navigation / Q000379:methods*; D011446:Prospective Studies; D061665:Time-to-Treatment
keywords: Breast cancer; Care delivery; Disparities; Patient navigation