1
|
Siddiqi A, Monton O, Woods A, Masroor T, Fuller S, Owczarzak J, Yenokyan G, Cooper LA, Freund KM, Smith TJ, Kutner JS, Colborn KL, Joyner R, Elk R, Johnston FM. Dissemination and Implementation of a Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC): a study protocol for a hybrid type 1 randomized controlled trial. BMC Palliat Care 2023; 22:139. [PMID: 37718442 PMCID: PMC10506196 DOI: 10.1186/s12904-023-01250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND There are persistent racial and ethnic health disparities in end-of-life health outcomes in the United States. African American patients are less likely than White patients to access palliative care, enroll in hospice care, have documented goals of care discussions with their healthcare providers, receive adequate symptom control, or die at home. We developed Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC) to address these disparities. DeCIDE PC is an integrated community health worker (CHW) palliative care intervention that uses community health workers (CHWs) as care team members to enhance the receipt of palliative care for African Americans with advanced cancer. The overall objectives of this study are to (1) assess the effectiveness of the DeCIDE PC intervention in improving palliative care outcomes amongst African American patients with advanced solid organ malignancy and their informal caregivers, and (2) develop generalizable knowledge on how contextual factors influence implementation to facilitate dissemination, uptake, and sustainability of the intervention. METHODS We will conduct a multicenter, randomized, assessor-blind, parallel-group, pragmatic, hybrid type 1 effectiveness-implementation trial at three cancer centers across the United States. The DeCIDE PC intervention will be delivered over 6 months with CHW support tailored to the individual needs of the patient and caregiver. The primary outcome will be advance care planning. The treatment effect will be modeled using logistic regression. The secondary outcomes are quality of life, quality of communication, hospice care utilization, and patient symptoms. DISCUSSION We expect the DeCIDE PC intervention to improve integration of palliative care, reduce multilevel barriers to care, enhance clinic and patient linkage to resources, and ultimately improve palliative care outcomes for African American patients with advanced cancer. If found to be effective, the DeCIDE PC intervention may be a transformative model with the potential to guide large-scale adoption of promising strategies to improve palliative care use and decrease disparities in end-of-life care for African American patients with advanced cancer in the United States. TRIAL REGISTRATION Registered on ClinicalTrials.gov (NCT05407844). First posted on June 7, 2022.
Collapse
Affiliation(s)
- Amn Siddiqi
- Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Olivia Monton
- Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Alison Woods
- Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Taleaa Masroor
- Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Shannon Fuller
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Jill Owczarzak
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Lisa A Cooper
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
- Johns Hopkins University School of Nursing, 525 N Wolfe Street, Baltimore, MD, 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-515, Baltimore, MD, 21287, USA
| | - Karen M Freund
- Department of Medicine, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Thomas J Smith
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Jean S Kutner
- Department of Medicine, University of Colorado School of Medicine, 12401 E 17th Ave, Aurora, CO, 80045, USA
| | - Kathryn L Colborn
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
| | - Robert Joyner
- Richard A. Henson Research Institute, TidalHealth Peninsula Regional, 100 East Carroll Street, Salisbury, MD, 21801, USA
| | - Ronit Elk
- Department of Medicine, University of Alabama at Birmingham, 933 19th Street S, Birmingham, AL, 35205, USA
| | - Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA.
| |
Collapse
|
2
|
Shah SK, Nakagawa M, Lieblong BJ. Examining aspects of successful community-based programs promoting cancer screening uptake to reduce cancer health disparity: A systematic review. Prev Med 2020; 141:106242. [PMID: 32882299 PMCID: PMC7704699 DOI: 10.1016/j.ypmed.2020.106242] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 01/27/2023]
Abstract
Certain minorities in the US are disproportionately burdened with higher cancer incidence and mortality rates. Programs encouraging timely uptake of cancer screening measures serve to reduce cancer health disparities. A systematic literature review was conducted to assess the effectiveness and the qualities of these programs, and to elucidate characteristics of success programs to aid in designing of future ones. We focused on community-based programs rather than clinic-based programs as the former are more likely to reach disadvantaged populations, and on prevention programs for breast, cervical, and/or colon cancers as longstanding screening recommendations for these cancers exist. PubMed, CINAHL and EBSCO databases were searched for articles that utilized community organizations and community health workers. Fourteen programs described in 34 manuscripts were identified. While 10 of 14 programs reported statistically significant increases in cancer prevention knowledge and/or increase in screening rates, only 7 of them enrolled large numbers of participants (defined as ≥1000). Only 7 programs had control groups, only 4 programs independently verified screening uptake, and 2 programs had long-term follow-up (defined as more than one screening cycle). Only one program demonstrated elimination of cancer health disparity at a population level. While most community-based cancer prevention programs have demonstrated efficacy in terms of increased knowledge and/or screening uptake, scalability and demonstration in reduction at a population level remain a challenge.
Collapse
Affiliation(s)
- Sumit K Shah
- University of Arkansas for Medical Sciences, College of Medicine, Department of Pathology, 4301 W. Markham St. Slot 845, Little Rock, AR 72205, United States of America
| | - Mayumi Nakagawa
- University of Arkansas for Medical Sciences, College of Medicine, Department of Pathology, 4301 W. Markham St. Slot 845, Little Rock, AR 72205, United States of America
| | - Benjamin J Lieblong
- University of Arkansas for Medical Sciences, College of Medicine, Department of Pathology, 4301 W. Markham St. Slot 845, Little Rock, AR 72205, United States of America.
| |
Collapse
|
3
|
Simon MA, O'Brian CA, Kanoon JM, Venegas A, Ignoffo S, Picard C, Allgood KL, Tom L, Margellos-Anast H. Leveraging an Implementation Science Framework to Adapt and Scale a Patient Navigator Intervention to Improve Mammography Screening Outreach in a New Community. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:530-537. [PMID: 30834504 PMCID: PMC6934925 DOI: 10.1007/s13187-019-01492-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Helping Her Live (HHL) is a community health worker-led outreach model that navigates women from vulnerable communities to mammography screening and diagnostic follow-up. The objective of this study was to evaluate HHL implementation on the southwest side of Chicago. HHL has been implemented on the west side of Chicago since 2008, where it has increased mammogram completion and diagnostic follow-up rates among Black and Hispanic women from resource poor communities. In 2014, HHL was translated to the southwest side of Chicago; implementation success was evaluated by comparing outreach, navigation request, and mammogram completion metrics with the west side. During January 2014-December 2015, outreach was less extensive in the southwest setting (SW) compared to the benchmark west setting (W); however, the proportion of women who completed mammograms in SW was 50%, which compared favorably to the proportion observed in the benchmark setting W (42%). The distribution of insurance status and the racial and ethnic makeup of individuals met on outreach in the W and SW were significantly different (p < 0.0005). This successful expansion of HHL in terms of both geographic and demographic reach justifies further studies leveraging these results and tailoring HHL to additional underserved communities.
Collapse
Affiliation(s)
- Melissa A Simon
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair, Suite 1800, Chicago, IL, 60611, USA.
| | - Catherine A O'Brian
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair, Suite 1800, Chicago, IL, 60611, USA
| | - Jacqueline M Kanoon
- Office of Community Engaged Research and Implementation Science (OCERIS), University of Illinois Cancer Center, Chicago, IL, 60612, USA
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, 60608, USA
| | - Alnierys Venegas
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, 60608, USA
| | - Stacy Ignoffo
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, 60608, USA
| | - Charlotte Picard
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, 60608, USA
| | - Kristi L Allgood
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, 60608, USA
| | - Laura Tom
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair, Suite 1800, Chicago, IL, 60611, USA
| | | |
Collapse
|
4
|
Allgood KL, Hunt B, Kanoon JM, Simon MA. Evaluation of Mammogram Parties as an Effective Community Navigation Method. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1061-1068. [PMID: 28290092 PMCID: PMC5840031 DOI: 10.1007/s13187-017-1206-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Women of color do not have the same level of access to mammography services as their White counterparts, and this inequity may be one of the contributing factors to the documented racial disparity in breast cancer mortality in the US. The present study sought to assess the effectiveness of the mammogram party, a promising, but under-studied approach to increasing mammography uptake, particularly among under-served populations. The program targeted mammogram-eligible women in community settings on the west and southwest sides of Chicago, gathering basic demographic information, mammography history, and interest in assistance obtaining a mammogram. Women were navigated either through traditional one-on-one navigation or to a mammogram party. Seven outcome metrics were calculated for each type of navigation. We compared navigation outcomes for those who attended to those who did not attend a mammogram party using two-tailed t tests and chi-square tests. We found that the mammography completion rate for mammogram parties was comparable to that for standard one-on-one navigation (65.8 vs. 63.7%), which is more labor-intensive as evidenced by the number of contacts needed to successfully navigate a woman to mammography (10.9 vs. 15.0). Mammogram parties offer a unique opportunity for fellowship and support for clients who are particularly fearful of mammograms or identifying breast cancer. Programmatically, mammogram parties are an efficient way to complete several mammograms in 1 day. Having the option to both navigate women to mammogram parties or one-on-one navigation allows for more flexibility for scheduling and may ensure a completed a mammogram.
Collapse
Affiliation(s)
- Kristi L Allgood
- Sinai Health System, Sinai Urban Health Institute, 1500 S. Fairfield Avenue, K435, Chicago, IL, 60608, USA.
| | - Bijou Hunt
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jacqueline M Kanoon
- Sinai Health System, Sinai Urban Health Institute, 1500 S. Fairfield Avenue, K435, Chicago, IL, 60608, USA
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
- Office of Community Engaged Research and Implementation Science (OCERIS), University of Illinois Cancer Center, Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
5
|
Breast Cancer Disparities Among Women in Underserved Communities in the USA. CURRENT BREAST CANCER REPORTS 2018; 10:131-141. [PMID: 31501690 DOI: 10.1007/s12609-018-0277-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of Review Breast cancer disparities that exist between high-income countries (HIC) and low- and middle-income countries (LMICs) are also reflected within population subgroups throughout the United States (US). Here we examine three case studies of US populations "left behind" in breast cancer outcomes/equity. Recent Findings African Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State all experience a myriad of factors that contribute to lower rates of breast cancer detection and appropriate treatment as well as poorer survival. These factors, related to the social determinants of health, including geographic isolation, lack of availability of care, and personal constraints, can be addressed with interventions at multiple levels. Summary Although HICs have reduced mortality of breast cancer compared to LMICs, there remain inequities in the US healthcare system. Concerted efforts are needed to ensure that all women have access to equitable screening, detection, treatment, and survivorship resources.
Collapse
|
6
|
Mello-Carpes PB, Carpes FP. Improving physiology learning and understanding by adding outreach activities to the teaching: report of the IUPS and ADInstruments Teaching Workshop 2017. ADVANCES IN PHYSIOLOGY EDUCATION 2018; 42:159-161. [PMID: 29446314 DOI: 10.1152/advan.00148.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Pâmela B Mello-Carpes
- Physiology Research Group, Federal University of Pampa, Uruguaiana, Rio Grande do Sul, Brazil
| | - Felipe Pivetta Carpes
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, Rio Grande do Sul, Brazil
| |
Collapse
|
7
|
Hunt BR, Allgood KL, Kanoon JM, Benjamins MR. Keys to the Successful Implementation of Community-Based Outreach and Navigation: Lessons from a Breast Health Navigation Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:175-182. [PMID: 26341220 DOI: 10.1007/s13187-015-0904-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The well-documented racial disparities in breast cancer mortality have prompted an aggressive response from the public health community, including the development and implementation of breast health education and breast cancer navigation programs. Many programs are successfully reaching women and providing education and motivation to get screened, and separately, many programs are successfully navigating women who have received abnormal results from a screening mammogram and need follow-up. However, a crucial gap in services remains, where women in the community are not receiving systematic navigation to their initial screening mammogram. This paper describes a community-based, community health worker-led breast health education and screening navigation program, details the metrics used to measure navigation outcomes, and discusses unique features of this project which could be adapted within other settings to initiate similar programming.
Collapse
Affiliation(s)
- Bijou R Hunt
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave Room K443, Chicago, IL, 60608, USA.
| | - Kristi L Allgood
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave Room K443, Chicago, IL, 60608, USA
| | - Jacqueline M Kanoon
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave Room K443, Chicago, IL, 60608, USA
| | - Maureen R Benjamins
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave Room K443, Chicago, IL, 60608, USA
| |
Collapse
|
8
|
de la Riva EE, Hajjar N, Tom LS, Phillips S, Dong X, Simon MA. Providers' Views on a Community-Wide Patient Navigation Program: Implications for Dissemination and Future Implementation. Health Promot Pract 2016; 17:382-90. [PMID: 27009130 PMCID: PMC5600160 DOI: 10.1177/1524839916628865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The DuPage Patient Navigation Collaborative (DPNC) adapted and scaled the Patient Navigation Research Program's intervention model to navigate uninsured suburban DuPage County women with an abnormal breast or cervical cancer screening result. Recent findings reveal the effectiveness of the DPNC in addressing patient risk factors for delayed follow-up, but gaps remain as patient measures may not adequately capture navigator impact. Using semistructured interviews with 19 DPNC providers (representing the county health department, clinics, advocacy organizations, and academic partners), this study explores the critical roles of the DPNC in strengthening community partnerships and enhancing clinical services. Findings from these provider interviews revealed that a wide range of resources existed within DuPage but were often underused. Providers indicated that the DPNC was instrumental in fostering community partnerships and that navigators enhanced the referral processes, communications, and service delivery among clinical teams. Providers also recommended expanding navigation to mental health, women's health, and for a variety of chronic conditions. Considering that many in the United States have recently gained access to the health care system, clinical teams might benefit by incorporating navigators who serve a dual working purpose embedded in the community and clinics to enhance the service delivery for vulnerable populations.
Collapse
Affiliation(s)
| | | | - Laura S Tom
- Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Sara Phillips
- Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - XinQi Dong
- Rush University Medical Center, Chicago, IL, USA
| | - Melissa A Simon
- Northwestern University-Feinberg School of Medicine, Chicago, IL, USA Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| |
Collapse
|
9
|
Simon MA, Tom LS, Nonzee NJ, Murphy KR, Endress R, Dong X, Feinglass J. Evaluating a bilingual patient navigation program for uninsured women with abnormal screening tests for breast and cervical cancer: implications for future navigator research. Am J Public Health 2015; 105:e87-94. [PMID: 25713942 DOI: 10.2105/ajph.2014.302341] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The DuPage Patient Navigation Collaborative evaluated the Patient Navigation Research Program (PNRP) model for uninsured women receiving free breast or cervical cancer screening through the Illinois Breast and Cervical Cancer Program in DuPage County, Illinois. METHODS We used medical records review and patient surveys of 477 women to compare median follow-up times with external Illinois Breast and Cervical Cancer Program and Chicago PNRP benchmarks of performance. We examined the extent to which we mitigated community-defined timeliness risk factors for delayed follow-up, with a focus on Spanish-speaking participants. RESULTS Median follow-up time (29.0 days for breast and 56.5 days for cervical screening abnormalities) compared favorably to external benchmarks. Spanish-speaking patients had lower health literacy, lower patient activation, and more health care system distrust than did English-speaking patients, but despite the prevalence of timeliness risk factors, we observed no differences in likelihood of delayed (> 60 days) follow-up by language. CONCLUSIONS Our successful replication and scaling of the PNRP navigation model to DuPage County illustrates a promising approach for future navigator research.
Collapse
Affiliation(s)
- Melissa A Simon
- Melissa A. Simon is with the Departments of Obstetrics and Gynecology and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, and the Robert H. Lurie Comprehensive Cancer Center, Chicago. Laura S. Tom and Narissa J. Nonzee are with the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University. Kara R. Murphy and Richard Endress are with Access DuPage, Wheaton, IL. XinQi Dong is with the Institute for Healthy Aging, Rush University Medical Center, Chicago. Joe Feinglass is with the Departments of General Internal Medicine and Geriatrics and Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | | | | | | | | | | | | |
Collapse
|
10
|
Allgood KL, Rauscher GH, Whitman S, Vasquez-Jones G, Shah AM. Validating self-reported mammography use in vulnerable communities: findings and recommendations. Cancer Epidemiol Biomarkers Prev 2014; 23:1649-58. [PMID: 24859870 PMCID: PMC4135480 DOI: 10.1158/1055-9965.epi-13-1253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Most health surveys ask women whether they have had a recent mammogram, all of which report mammography use (past 2 years) at about 70% to 80% regardless of race or residence. We examined the potential extent of overreporting of mammography use in low income African-American and Latina women, and whether self-report inaccuracies might bias estimated associations between patient characteristics and mammography use. METHODS Using venue-based sampling in two poor communities on the west side of Chicago, we asked eligible women living in two west side communities of Chicago to complete a survey about breast health (n = 2,200) and to provide consent to view their medical record. Of the 1,909 women who screened eligible for medical record review, 1,566 consented (82%). We obtained medical records of all women who provided both permission and a valid local mammography facility (n = 1,221). We compared the self-reported responses from the survey with the imaging reports found in the medical record (documented). To account for missing data, we conducted multiple imputations for key demographic variables and report standard measures of accuracy. RESULTS Although 73% of women self-reported a mammogram in the last 2 years, only 44% of self-reports were documented. Overreporting of mammography use was observed for all three ethnic groups. CONCLUSIONS These results suggest considerable overestimation of prevalence of use in these vulnerable populations. IMPACT Relying on known faulty self-reported mammography data as a measure of mammography use provides an overly optimistic picture of utilization, a problem that may be exacerbated in vulnerable minority communities.
Collapse
Affiliation(s)
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois; and
| | | | | | - Ami M Shah
- UCLA Center for Health Policy Research, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
11
|
Phillips SS, Tom LS, Bularzik C, Simon MA. Time and Motion Study of a Community Patient Navigator. AIMS Public Health 2014; 1:51-59. [PMID: 29546075 PMCID: PMC5689794 DOI: 10.3934/publichealth.2014.2.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/31/2014] [Indexed: 11/22/2022] Open
Abstract
Research on patient navigation has focused on validating the utility of navigators by defining their roles and analyzing their effects on patient outcomes, patient satisfaction, and cost effectiveness. Patient navigators are increasingly used outside the research context, and their roles without research responsibilities may look very different. This pilot study captured the activities of a community patient navigator for uninsured women with a positive screening test for breast cancer, using a time and motion approach over a period of three days. We followed the actions of this navigator minute by minute to assess the relative ratios of actions performed and to identify areas for time efficiency improvement to increase direct time with patients. This novel approach depicts the duties of a community patient navigator no longer fettered by navigation logs, research team meetings, surveys, and the consent process. We found that the community patient navigator was able to spend more time with patients in the clinical context relative to performing paperwork or logging communication with patients as a result of her lack of research responsibilities. By illuminating how community patient navigation functions as separate from the research setting, our results will inform future hiring and training of community patient navigators, system design and operations for improving the efficiency and efficacy of navigators, and our understanding of what community patient navigators do in the absence of research responsibilities.
Collapse
Affiliation(s)
- Sara S Phillips
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.,Rush Medical College, Chicago, IL, 60612, USA
| | - Laura S Tom
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Melissa A Simon
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| |
Collapse
|