TY - JOUR
T1 - Barriers to health care contribute to delays in follow-up among women with abnormal cancer screening
T2 - Data from the Patient Navigation Research Program
AU - Ramachandran, Ambili
AU - Snyder, Frederick R.
AU - Katz, Mira L.
AU - Darnell, Julie S.
AU - Dudley, Donald J.
AU - Patierno, Steven R.
AU - Sanders, Mechelle R.
AU - Valverde, Patricia A.
AU - Simon, Melissa A.
AU - Warren-Mears, Victoria
AU - Battaglia, Tracy A.
N1 - Publisher Copyright:
© 2015 American Cancer Society.
PY - 2015/11/15
Y1 - 2015/11/15
N2 - 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. Cancer 2015;121:4016-4024.
AB - 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. Cancer 2015;121:4016-4024.
KW - barriers to care
KW - disparities
KW - early detection of cancer
KW - health services research
KW - patient navigation
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U2 - 10.1002/cncr.29607
DO - 10.1002/cncr.29607
M3 - Article
C2 - 26385420
AN - SCOPUS:84946490559
SN - 0008-543X
VL - 121
SP - 4016
EP - 4024
JO - cancer
JF - cancer
IS - 22
ER -
