Abstract 862: Network patient navigation: An integrative, longitudinal model to reduce breast cancer disparities

Abstract

Abstract Introduction: Minority breast cancer mortality rates in Washington, DC are among the nation's highest. To address disparities we instituted the DC Citywide Patient Navigation Research Program (DC-PNRP) - an inter-institutional collaboration that is one of 9 National PNRP sites funded by NCI/ACS to evaluate the effectiveness of patient navigation in reducing barriers to obtaining health care while also addressing psychosocial factors. Study Procedures: More than 1000 minority women have been enrolled from 7 recruitment sites at the point of suspicious finding to investigate whether patient navigation decreases time from suspicious breast finding to diagnostic resolution and time from diagnosis to treatment initiation. Utilizing a non-randomized design, concurrent, medical records-based controls have been identified. Data collection will extend through March 2010. A unique framework of “network navigation” emerged whereby services were integrated across a city-wide network of unaffiliated healthcare sites. Navigators from a broad partnership of clinical and community sites were trained to work collaboratively within a city-wide network to enroll patients in the study and assure each patient receives timely, quality care. This “integrative navigation” model is collecting data addressing not only structural barriers to access to care (i.e., inadequate insurance, lack of transportation, etc.), but also psychosocial barriers (i.e., fear, medical mistrust, acculturation, etc.). Frequent trainings, efforts that promote increased communication between navigators, and sharing of information about community resources were implemented to enhance care coordination and to assure appropriate referral strategies between community outreach, screening, and treatment sites. Results and Conclusion: Implementation of DC-PNRP led us to broaden the original treatment-oriented navigation model to create a “Longitudinal Navigation” paradigm that follows the patient from outreach through survivorship. Data will be shown describing how this model addresses barriers to access and the underlying fragmentation of services that exist in DC for low-income uninsured or under-insured women. Data on the types and distribution of barriers will also be presented. This city-wide program serves as model for inter-institutional cooperation to improve health care access, particularly for the underserved. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 862.