Abstract A24: Does patient navigation improve time to diagnostic resolution of abnormal mammograms among depressed urban women?

Abstract

Abstract Background: Depression is more common in women, lower socio-economic groups, certain racial/ethnic minorities, and is associated with higher breast cancer mortality. Patient navigation has been shown to improve access to timely cancer care in a patient-centered manner, by identifying and helping to overcome barriers to healthcare. Our objective is to determine if patient navigation improves time to diagnostic resolution after abnormal mammograms for vulnerable women who are depressed. Methods: The Boston University Patient Navigator Research Program provided navigation for all patients who had an abnormal screening mammogram in 3 affiliated community health center (CHC) 2007–2008, with 3 CHCs serving as control sites and receiving usual care. A woman was categorized as “depressed” if depression was recorded in her medical record during the 12 months preceding the screening test abnormality. All women were followed for 12 months to determine if they completed diatnostic evaluation. Demographic characteristics of depressed and non-depressed women were compared through chi-square tests. Differences in the percent of women who did not complete diagnostic evaluation within 12 months for depressed vs. non-depressed women, and for navigated vs. control women, were tested through chi-square and described through odds ratios and 95% confidence intervals. Results: Among 1299 women with abnormal mammograms, 17% were depressed, 12% had anxiety. Most of the women were non-White: 28% Hispanic, 35% Black, and 11% Vietnamese; English was the primary language in 58%, and less than one third had private health care insurance. Depression was positively associated with white race and Hispanic ethnicity (P < 0.01), English and Spanish language (P <0.001), older age (P =0.03), anxiety (P < 0.001), and public health insurance status (P < 0.001); and negatively associated with no insurance status (P < 0.001). Among controls, there was a suggestion that non-depressed women were more likely to complete diagnostic resolution compated to depressed women (14% vs. 8%, OR 1.95 (0.94, 4.03), p=0.072). Among depressed women, those who were navigated were significantly more likely to complete diagnostic resolution (14% vs. 5%, OR 3.24 (1.03, 12.26), p=0.046). Depression is common in women needing diagnostic testing for abnormal cancer screening, and depressed women may particularly benefit from patient navigation. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A24.