Patient navigation for mammography screening: The need for system changes.

Abstract

e12051 Background: While national breast cancer mortality rates have decreased modestly among non-Hispanic White women, mortality has increased among Hispanic and Native American women, who present with later stage breast cancer, and use less screening mammography. The aims of the study were to identify barriers to mammography screening faced by Hispanic women age 40 to 64 and those faced by providers and elicit hypotheses about patient navigation interventions to increase utilization of mammography services. Methods: A socio-ecological model grounded the study. Social network, community, system design, and policy factors influence, and create barriers and facilitators to individual cancer screening behaviors among Hispanic females. The study included exploratory and confirmatory phases. The exploratory phase was informed by literature on screening barriers and facilitators. Interviews and focus groups were conducted, in five geographic regions in New Mexico, with the following groups 1) Primary care providers at federally qualified health centers; 2) Breast and Cervical Cancer Program staff; 3) Promotoras; 4) Hispanic women who self-identified as having had a mammogram or not having had a mammogram within the past two years; 5) Radiologists and radiology technologists. Qualitative investigation of the data began with content analysis of the transcripted data, using a team approach for open coding. The coding structure was imported into NVivo 8, and thematic themes were systematically identified, leading to the development of explicit hypotheses. Results: The exploratory phase generated novel recommendations to increase mammography utilization, focused on factors at the individual, social network, and community levels. Conclusions: The confirmatory phase resulted in hypotheses about navigation solutions, requiring system and policy changes: 1) revise protocols so that women who are seen for chronic/acute visits can receive a screening mammography referral; 2) provide opportunities for registered nurses to be trained to conduct CBE and refer patients for mammography; 3) revise policy so that referral to screening mammogram does not solely rely on the availability of primary care providers for preventive well women visits. No significant financial relationships to disclose.