Patient navigator reported patient barriers and delivered activities in two large federally-funded cancer screening programs

• Type of Material: Article
• Authors: Wendy E. Barrington, University of Washington; Amy DeGroff, Centers for Disease Control and Prevention; Stephanie Melillo, Centers for Disease Control and Prevention; Vu Thuy, University of Washington; Allison Cole, University of Washington; Ngoc-Cam Escoffery, Emory University; Natoshia Askelson, University of Iowa; Laura Seegmiller, University of Iowa; Sarah Koopman Gonzalez, Case Western Reserve University; Peggy Hannon, University of Washington
• Language: English
• Date: 2019-12-01
• Publisher: ACADEMIC PRESS INC ELSEVIER SCIENCE
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ypmed.2019.105858
• Title of Journal or Parent Work: PREVENTIVE MEDICINE
• Volume: 129
• Start Page: 105858
• End Page: 105858
• Grant/Funding Information: This paper is a product of the Alliance for Reducing Cancer, Northwest at the University of Washington Health Promotion Research Center (HPRC, cooperative agreement # U48DP005013) in collaboration with the University of Iowa (cooperative agreement # U48 DP005021) and Case Western Reserve University (cooperative agreement # U48 DP005030) as part of the Cancer Prevention and Control Research Network (CPCRN). CPCRN is a thematic network of the Prevention Research Centers (PRCs) Program that is co-funded by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI).; Publication of this supplement was supported by the Cancer Prevention and Control Network (CPCRN), University of North Carolina at Chapel Hill and the following co-funders: Case Western Reserve University, Oregon Health & Science University, University of South Carolina, University of Iowa, University of Kentucky, University of Pennsylvania and University of Washington.
• Keywords: Colorectal; Screening; General & Internal Medicine; Public, Environmental & Occupational Health; HEALTH-CARE; Navigation; Medicine, General & Internal; Science & Technology; Life Sciences & Biomedicine; Cancer; RANDOMIZED CONTROLLED-TRIAL; NATIONAL BREAST; UNITED-STATES; COMMUNITY; Breast; EVIDENCE-BASED INTERVENTIONS; Cervical

Abstract

Few data are available on patient navigators (PNs) across diverse roles and organizational settings that could inform optimization of patient navigation models for cancer prevention. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Colorectal Cancer and Control Program (CRCCP) are two federally-funded screening programs that support clinical- and community-based PNs who serve low-income and un- or underinsured populations across the United States. An online survey assessing PN characteristics, delivered activities, and patient barriers to screening was completed by 437 of 1002 identified PNs (44%). Responding PNs were racially and ethnically diverse, had varied professional backgrounds and practice-settings, worked with diverse populations, and were located within rural and urban/suburban locations across the U.S. More PNs reported working to promote screening for breast/cervical cancers (BCC, 94%) compared to colorectal cancer (CRC, 39%). BCC and CRC PNs reported similar frequencies of individual- (e.g., knowledge, motivation, fear) and community-level patient barriers (e.g., beliefs about healthcare and screening). Despite reporting significant patient structural barriers (e.g., transportation, work and clinic hours), most BCC and CRC PNs delivered individual-level navigation activities (e.g., education, appointment reminders). PN training to identify and champion timely and patient-centered adjustments to organizational policies, practices, and norms of the NBCCEDP, CRCCP, and partner organizations may be beneficial. More research is needed to determine whether multilevel interventions that support this approach could reduce structural barriers and increase screening and diagnostic follow-up among the marginalized communities served by these two important cancer-screening programs.