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Gordon H, Ramirez G, Harwell EL, Bloss JE, Gámez R, LePrevost CE. Exploring the learning preferences of farmworker-serving community health workers. Health Info Libr J 2024; 41:195-200. [PMID: 38616382 DOI: 10.1111/hir.12528] [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: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
Community health workers are responsible for finding, processing, and transferring health information to communities with limited access to health-related resources, including farmworkers. This paper is the culmination of an undergraduate student research project to explore the learning processes and preferences of farmworker-serving community health workers in the USA. The project was designed for students from farmworker or agricultural backgrounds at two North Carolina universities and was supported by a North Carolina Department of Health and Human Services workforce development grant. Semi-structured interviews were conducted, in person and virtually, with a convenience sample of 17 current and former community health workers. The interview data were analysed thematically and identified a preference for a combination of learning styles, with visual and hands-on learning being the most preferred. Community health workers also identified the importance of learning preferences in relation to their responsibilities as health educators. This study provides librarians, along with public health and medical professionals, with useful information about learning preferences to inform the creation of new and varied learning materials for community health workers.
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Affiliation(s)
- Hannah Gordon
- Department of Applied Ecology, College of Agriculture and Life Sciences, NC State University, Raleigh, North Carolina, USA
| | - Genesis Ramirez
- Department of Applied Ecology, College of Agriculture and Life Sciences, NC State University, Raleigh, North Carolina, USA
| | - Emery L Harwell
- Department of Applied Ecology, College of Agriculture and Life Sciences, NC State University, Raleigh, North Carolina, USA
| | - Jamie E Bloss
- Laupus Health Sciences Library, East Carolina University, Greenville, North Carolina, USA
| | - Raúl Gámez
- Center for the Study of Higher & Postsecondary Education, Marsal Family School of Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Catherine E LePrevost
- Department of Applied Ecology, College of Agriculture and Life Sciences, NC State University, Raleigh, North Carolina, USA
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Toal-Sullivan D, Dahrouge S, Tesfaselassie J, Olejnik L. Access to primary health care: perspectives of primary care physicians and community stakeholders. BMC PRIMARY CARE 2024; 25:152. [PMID: 38711025 PMCID: PMC11071188 DOI: 10.1186/s12875-024-02312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/15/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Action on the social determinants of health is important to strengthen primary health care and promote access among underserved populations. We report on findings from stakeholder consultations undertaken at one of the Canadian sites of the Innovative Models Promoting Access-to-Care Transformation (IMPACT) program, as part of the development of a best practice intervention to improve access to primary health care. The overarching objective of this qualitative study was to understand the processes, barriers, and facilitators to connect patients to health enabling community resources (HERs) to inform a patient navigation model situated in primary care. METHODS Focus groups and interviews were conducted with primary care physicians, and community health and social service providers to understand their experiences in supporting patients in reaching HERs. Current gaps in access to primary health care and the potential of patient navigation were also explored. We applied Levesque et al., (2013) access framework to code the data and four themes emerged: (1) Approachability and Ability to Perceive, (2) Acceptability and Ability to Seek, (3) Availability and Accommodation, and Ability to Reach, and (4) Appropriateness. RESULTS Determinants of access included patient and provider awareness of HERs, the nature of the patient-provider relationship, funding of HERs, integration of primary and community care services, and continuity of information. Participants' perspectives about the potential scope and role of a patient navigator provided valuable insight for the development of the Access to Resources in the Community (ARC) navigation model and how it could be embedded in a primary care setting. CONCLUSION Additional consultation with key stakeholders in the health region is needed to gain a broader understanding of the challenges in caring for primary care patients with social barriers and how to support them in accessing community-based primary health care to inform the design of the ARC intervention.
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Affiliation(s)
- Darene Toal-Sullivan
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Canada
| | | | | | - Laura Olejnik
- Hamilton Health Sciences, McMaster University, Hamilton, Canada
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Ver Hoeve ES, Calhoun E, Hernandez M, High E, Armin JS, Ali-Akbarian L, Frithsen M, Andrews W, Hamann HA. Evaluating implementation of a community-focused patient navigation intervention at an NCI-designated cancer center using RE-AIM. BMC Health Serv Res 2024; 24:550. [PMID: 38685006 PMCID: PMC11059763 DOI: 10.1186/s12913-024-10919-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patient navigation is an evidence-based intervention that reduces cancer health disparities by directly addressing the barriers to care for underserved patients with cancer. Variability in design and integration of patient navigation programs within cancer care settings has limited this intervention's utility. The implementation science evaluation framework, RE-AIM, allows quantitative and qualitative examination of effective implementation of patient navigation programs into cancer care settings. METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation of a community-focused patient navigation intervention at an NCI-designated cancer center between June 2018 and October 2021. Using a 3-month longitudinal, non-comparative measurement period, univariate and bivariate analyses were conducted to examine associations between participant-level demographics and primary (i.e., barrier reduction) and secondary (i.e., patient-reported outcomes) effectiveness outcomes. Mixed methods analyses were used to examine adoption and delivery of the intervention into the cancer center setting. Process-level analyses were used to evaluate maintenance of the intervention. RESULTS Participants (n = 311) represented a largely underserved population, as defined by the National Cancer Institute, with the majority identifying as Hispanic/Latino, having a household income of $35,000 or less, and being enrolled in Medicaid. Participants were diagnosed with a variety of cancer types and most had advanced staged cancers. Pre-post-intervention analyses indicated significant reduction from pre-intervention assessments in the average number of reported barriers, F(1, 207) = 117.62, p < .001, as well as significant increases in patient-reported physical health, t(205) = - 6.004, p < .001, mental health, t(205) = - 3.810, p < .001, self-efficacy, t(205) = - 5.321, p < .001, and satisfaction with medical team communication, t(206) = - 2.03, p = .029. Referral patterns and qualitative data supported increased adoption and integration of the intervention into the target setting, and consistent intervention delivery metrics suggested high fidelity to intervention delivery over time. Process-level data outlined a successful transition from a grant-funded community-focused patient navigation intervention to an institution-funded program. CONCLUSIONS This study utilized the implementation science evaluation framework, RE-AIM, to evaluate implementation of a community-focused patient navigation program. Our analyses indicate successful implementation within a cancer care setting and provide a potential guide for other oncology settings who may be interested in implementing community-focused patient navigation programs.
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Affiliation(s)
| | | | | | | | | | | | - Michael Frithsen
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Wendy Andrews
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
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Fischer SM, Min SJ, Kline DM, Lester K, Gozansky W, Schifeling C, Himberger J, Lopez J, Fink RM. Patient Navigator Intervention to Improve Palliative Care Outcomes for Hispanic Patients With Serious Noncancer Illness: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:384-393. [PMID: 38345793 PMCID: PMC10862271 DOI: 10.1001/jamainternmed.2023.8145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/08/2023] [Indexed: 02/15/2024]
Abstract
Importance Disparities persist across the trajectory of serious illness, including at the end of life. Patient navigation has been shown to reduce disparities and improve outcomes for underserved populations. Objective To determine the effectiveness of a lay patient navigator intervention, Apoyo con Cariño, in improving palliative care outcomes among Hispanic patients. Design, Setting, and Participants This was a multicenter randomized clinical trial that took place across academic, nonprofit, safety-net, and community health care systems in urban, rural, and mountain/frontier regions of Colorado from January 2017 to January 2021. Self-identifying Hispanic adults with serious noncancer medical illness and limited prognosis were recruited. Data were collected and analyzed from July 2022 to July 2023. Interventions Participants randomized to the intervention group received 5 home visits from a bilingual, bicultural lay patient navigator; participants randomized to control received care as usual. Both groups received culturally tailored educational materials. Investigators/outcome accessors remained blinded to participant assignment. Main Outcomes and Measures Change in score from baseline to 3 months on the Functional Assessment of Chronic Illness Therapy (FACIT) General quality of life (QOL) scale (primary outcome), Advance Care Planning (ACP) Engagement Survey, Brief Pain Inventory, Edmonton Symptom Assessment Scale, and FACIT Spiritual Well-Being subscale; at 6 months, advance directive (AD) documentation; and at 46 months or death, hospice utilization and length of stay, as well as aggressiveness of care at end of life. Results Of 209 patients enrolled (mean [SD] age, 63.6 [14.3] years; 108 [51.7%] male), 105 patients were randomized to control and 104 patients to the intervention. There were no statistically significant differences in the change in mean (SD) QOL score between the intervention and control groups (5.0 [16.5] vs 4.3 [15.5]; P = .75). Participants in the intervention group, compared with the control group, had statistically significant greater increases in mean (SD) ACP engagement (0.8 [1.3] vs 0.1 [1.4]; P < .001) and were more likely to have a documented AD (62 of 104 [59.6%] vs 28 of 105 [26.9%]; P < .001). There were no statistically significant differences in mean (SD) change in pain intensity score (0-10) between patients in the intervention group compared with control (-0.4 [2.6] vs -0.5 [2.8]; P = .79), nor pain interference (-0.2 [3.7] vs -0.4 [3.7]; P = .71). Patients receiving the intervention were more likely to be referred to hospice compared with patients receiving control (19 of 43 patients [44.2%] vs 7 of 33 patients [21.2%]; P = .04) and less likely to receive aggressive care at end of life (27 of 42 patients [64.3%] vs 28 of 33 patients [84.8%]; P = .046). Conclusion and Relevance In this randomized clinical trial, a culturally tailored patient navigator intervention did not improve QOL for patients. However, the intervention did increase ACP engagement, AD documentation, and hospice utilization in Hispanic persons with serious medical illness. Trial Registration ClinicalTrials.gov Identifier: NCT03181750.
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Affiliation(s)
- Stacy M. Fischer
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora
| | | | | | | | | | | | | | - Joseph Lopez
- University of Colorado Health North, Fort Collins
| | - Regina M. Fink
- University of Colorado School of Medicine, Aurora
- University of Colorado College of Nursing, Aurora
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Rost M, De Clercq E, Arnold L, Rakic M. Interventions to enhance cross-cultural competence in oncology: A meta-analysis of effectiveness studies and a qualitative review. Eur J Oncol Nurs 2023; 64:102277. [PMID: 36944274 DOI: 10.1016/j.ejon.2023.102277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Cross-cultural competence of healthcare providers is crucial to create a culturally safe environment. Cancer poses special challenges to cross-culturally competent communication and decision-making. Yet, no research synthesis on cross-cultural competence interventions has focused specifically on oncology. METHODS We conducted a meta-analysis and qualitative review of literature on the effectiveness of cross-cultural competence interventions in oncology. No limitations were placed on publication date, language, oncology setting, or geographic region. Of 1.565 citations identified, 15 articles met the inclusion criteria. Information on study design, samples, measured outcomes, and effectiveness statistics were coded. Average weighted effects were calculated applying meta-analysis methodology. RESULTS Studies were published between 2000 and 2020; more than half in the last seven years; two thirds in the USA. Overall study quality was at a low to moderate level, notably only one study provided a control-group-design. In sum, nurses constituted the largest occupational group among participants. Results of the meta-analysis indicate that cross-cultural competence interventions have differential effects. While the overall effect of cross-cultural competence interventions was not statistically significant, results showed that the cross-cultural competence dimensions of knowledge and behavior did improve. Effects beyond that remain unclear. CONCLUSIONS We provide valuable information on research gaps. The lack of studies and insufficient methodological rigor of available studies show that more research is needed to support the claim that interventions actually improve the various dimensions of cross-cultural competence in oncology. To build a stronger evidence base, it is necessary to include patient-reported outcomes and to center their experiences in future research.
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, 4056, Switzerland.
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, 4056, Switzerland
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller-University of Jena, 07743, Germany
| | - Milenko Rakic
- Institute for Biomedical Ethics, University of Basel, 4056, Switzerland
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Hawley NL, Rivara AC, Naseri J, Faumuina K, Potoa’e-Solaita N, Iopu F, Faiai M, Naveno E, Tasele S, Lefale T, Lantini R, Carlson JC, Rabin TL, Semaia P, Mugadza P, Rosen RK. Protocol: Implementation and evaluation of an adolescent-mediated intervention to improve glycemic control and diabetes self-management among Samoan adults. PLoS One 2023; 18:e0279084. [PMID: 36795707 PMCID: PMC9934313 DOI: 10.1371/journal.pone.0279084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Diagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need for prevention and treatment in this group, and building on the family-centered culture, we will pilot test an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired adult family member with diagnosed diabetes. METHODS We will conduct a randomized controlled trial in American Samoa among n = 160 dyads (adolescent without diabetes, adult with diabetes). Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum. Aside from research assessments we will have no contact with the adults in the dyad who will proceed with their usual care. To test our hypothesis that adolescents will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe exposure to the intervention may encourage positive behavior change in the adolescent themselves, we will measure the same outcomes in adolescents. Outcomes will be measured at baseline, after active intervention (six months post-randomization) and at 12-months post-randomization to examine maintenance effects. To determine potential for sustainability and scale up, we will examine intervention acceptability, feasibility, fidelity, reach, and cost. DISCUSSION This study will explore Samoan adolescents' ability to act as agents of familial health behavior change. Intervention success would produce a scalable program with potential for replication in other family-centered ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.
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Affiliation(s)
- Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
- * E-mail:
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Joshua Naseri
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Kitiona Faumuina
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | | | - Francine Iopu
- Department of Public Health, Portland State University, Portland, OR, United States of America
| | - Mata’uitafa Faiai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | | | - Susie Tasele
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Temukisa Lefale
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Ryan Lantini
- Center for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, United States of America
| | - Jenna C. Carlson
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tracy L. Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Penny Semaia
- Athletic Department, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Phyllis Mugadza
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Rochelle K. Rosen
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
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Hernandez ND, Durant R, Lisovicz N, Nweke C, Belizaire C, Cooper D, Soiro F, Rivers D, Sodeke S, Rivers BM. African American Cancer Survivors' Perspectives on Cancer Clinical Trial Participation in a Safety-Net Hospital: Considering the Role of the Social Determinants of Health. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1589-1597. [PMID: 33728872 PMCID: PMC8443686 DOI: 10.1007/s13187-021-01994-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 05/21/2023]
Abstract
Although there has been an increase focus on recruitment of minority populations at safety-net hospitals into cancer clinical trials, there is still a paucity of research exploring minority participation in cancer clinical trials at safety-net settings. The study utilized a multi-level, qualitative approach to assess the clinical and non-clinical facilitators and barriers to African American participation in cancer clinical trials at a safety-net hospital. From June 2018 to July 2019, cancer survivors (n = 25) were recruited from a cancer center at a safety-net hospital in the southeastern USA and participated in a 60-min focus group. Data was coded and analyzed to identify the most prominent themes. Most participants were female (78%), with a mean age of 56 years. The majority were diagnosed with breast cancer (68%) and disabled or unemployed (55%). Major themes identified were (1) lack of understanding of cancer clinical trials, (2) perceptions and fears of cancer clinical trials, and (3) preferred role and characteristics of patient navigator. The barriers and facilitators to enrollment in cancer clinical trials were more pronounced in the safety-net setting, given the overdue burden of social determinants of health. Study findings yield important insights and essential practices for recruiting and engaging underrepresented Black cancer patients into cancer clinical trials, specifically for safety-net settings. Including patient navigators may help traverse potential barriers to cancer clinical trial participation and will allow for the attention to social determinants of health, and ultimately increase the number of African Americans participating in cancer clinical trials.
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Affiliation(s)
- N D Hernandez
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.
| | - R Durant
- Division of Preventive Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Lisovicz
- Division of Preventive Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - C Nweke
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | | | - D Cooper
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - F Soiro
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - D Rivers
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - S Sodeke
- Tuskegee University, Tuskegee, AL, USA
| | - B M Rivers
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
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Battaglia TA, Gunn CM, Bak SM, Flacks J, Nelson KP, Wang N, Ko NY, Morton SJ. Patient navigation to address sociolegal barriers for patients with cancer: A comparative-effectiveness study. Cancer 2022; 128 Suppl 13:2623-2635. [PMID: 35699610 PMCID: PMC10152516 DOI: 10.1002/cncr.33965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sociolegal barriers to cancer care are defined as health-related social needs like affordable healthy housing, stable utility service, and food security that may be remedied by public policy, law, regulation, or programming. Legal support has not been studied in cancer care. METHODS The authors conducted a randomized controlled trial of patients who had newly diagnosed cancer at a safety-net medical center in Boston from 2014 through 2017, comparing standard patient navigation versus enhanced navigation partnered with legal advocates to identify and address sociolegal barriers. English-speaking, Spanish-speaking, or Haitian Creole-speaking patients with breast and lung cancer were eligible within 30 days of diagnosis. The primary outcome was timely treatment within 90 days of diagnosis. Secondary outcomes included patient-reported outcomes (distress, cancer-related needs, and satisfaction with navigation) at baseline and at 6 months. RESULTS In total, 201 patients with breast cancer and 19 with lung cancer enrolled (response rate, 78%). The mean patient age was 55 years, 51% of patients were Black and 22% were Hispanic, 20% spoke Spanish and 8% spoke Haitian Creole, 73% had public health insurance, 77% reported 1 or more perceived sociolegal barrier, and the most common were barriers to housing and employment. Ninety-six percent of participants with breast cancer and 73% of those with lung cancer initiated treatment within 90 days. No significant effect of enhanced navigation was observed on the receipt of timely treatment among participants with breast cancer (odds ratio, 0.88; 95% CI, 0.17-4.52) or among those with lung cancer (odds ratio, 4.00; 95% CI, 0.35-45.4). No differences in patient-reported outcomes were observed between treatment groups. CONCLUSIONS Navigation enhanced by access to legal consultation and support had no impact on timely treatment, patient distress, or patient needs. Although most patients reported sociolegal barriers, few required intensive legal services that could not be addressed by navigators. LAY SUMMARY In patients with cancer, the experience of sociolegal barriers to care, such as unstable housing, utility services, or food insecurity, is discussed. Addressing these barriers through legal information and assistance may improve care. This study compares standard patient navigation versus enhanced navigation partnered with legal advocates for patients with breast and lung cancers. Almost all patients in both navigation groups received timely care and also reported the same levels of distress, needs, and satisfaction with navigation. Although 75% of patients in the study had at least 1 sociolegal barrier identified, few required legal advocacy beyond what a navigator who received legal information and coaching could provide.
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Affiliation(s)
- Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Christine M Gunn
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Sharon M Bak
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - JoHanna Flacks
- Medical-Legal Partnership, Boston (MLPB), Boston, Massachusetts
| | - Kerrie P Nelson
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Naomi Y Ko
- Department of Medicine, Hematology, and Medical Oncology, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
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Bush M, Hatfield M, Schuh M, Balasuriya B, Mahairas A, Jacobs J, Studts C, Westgate P, Schoenberg N, Shinn J, Creel L. Communities Helping the Hearing of Infants by Reaching Parents (CHHIRP) through patient navigation: a hybrid implementation effectiveness stepped wedge trial protocol. BMJ Open 2022; 12:e054548. [PMID: 35440449 PMCID: PMC9020299 DOI: 10.1136/bmjopen-2021-054548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION As the most common neonatal sensory disorder in the USA, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain timely intervention include significant communication impairment and negative socioeconomic effects. Early Hearing Detection and Intervention (EHDI) national standards dictate that all infants should be screened and diagnosed by 3 months of age and there is a need for interventions that promote adherence to timely diagnosis. Patient navigation (PN) has been shown to be efficacious to decrease non-adherence with infant hearing diagnostic care; however, PN has yet to be tested in diverse communities or implemented into real-world settings. METHODS AND ANALYSIS The proposed research is a community-engaged, type 1 hybrid effectiveness-implementation trial of a PN intervention aimed at decreasing infant hearing diagnosis non-adherence after failed newborn hearing screening, delivered in state-funded EHDI clinics. Guided by our community advisory board and partners, we aim to (1) test the effectiveness of PN to decrease non-adherence to receipt of infant hearing diagnosis within 3 months after birth using a stepped-wedge trial design, (2) investigate implementation outcomes and factors influencing implementation and (3) determine the cost-effectiveness of PN from the perspective of third-party payers. The study will be conducted from April 2019 until March 2024. ETHICS AND DISSEMINATION This protocol was approved by the University of Kentucky Institutional Review Board. Although all research involving human subjects contains some risk, there are no known serious risks anticipated from participating in this study. We will seek to disseminate our results in a systematic fashion to patients, key stakeholder, policymakers and the scientific community. Our results will impact the field by partnering with communities to inform the scale-up of this innovative patient supportive intervention to create efficient and effective EHDI programmes and maximise public health impact. TRIAL REGISTRATION NUMBER Clinicaltrials.gov (Pre-results phase): NCT03875339.
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Affiliation(s)
- Matthew Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Miranda Hatfield
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Marissa Schuh
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Beverly Balasuriya
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Anthony Mahairas
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Julie Jacobs
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Christina Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Philip Westgate
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Jennifer Shinn
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Liza Creel
- Department of Health Management & Systems Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, USA
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Community Health Worker Impact on Knowledge, Antenatal Care, And Birth Outcomes: A Systematic Review. Matern Child Health J 2022; 26:79-101. [PMID: 34981332 DOI: 10.1007/s10995-021-03299-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Community health worker (CHW) interventions have been shown to be effective in areas of maternal and child health (MCH), mostly in relation to infant and neonatal mortality. The specific aims of this review were to expand outcomes to include improving knowledge related to pregnancy and infant health and the receipt of antenatal care (ANC), along with birth outcomes. We also summarized the role, characteristics and activities of CHWs in interventions conducted in settings with demonstrated improvements in key MCH outcomes. METHODS Articles were retrieved from: PubMed, CINAHL, Global Health, Scopus, Web of Science, and the Cochrane Library from January 2008 through 2018. We included evaluation studies that utilized CHWs as all or part of an intervention to improve outcomes, were printed in English, and published in peer-reviewed journals. RESULTS Initial electronic database search identified 816 studies and 123 studies met inclusion criteria for full text review. The quality assessment resulted in 0 strong-, 19 moderate-, and 25 weak-rated studies. In most interventions, CHWs were a component of a larger intervention. The majority of the studies (n = 10) found that a CHW intervention can have a positive impact on outcomes. CHW interventions showed improvements in knowledge and ANC. When combined with clinical services, the interventions positively impacted birth outcomes. Most conducted home visits and utilized CHW that were members of the community. CONCLUSIONS FOR PRACTICE CHWs serve an important role as health educators conducting home visits as a member of the community they serve. They should also continue to collaborate with clinical providers to address MCH outcomes.
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11
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Graboyes EM, Sterba KR, Li H, Warren GW, Alberg AJ, Calhoun EA, Nussenbaum B, McCay J, Marsh CH, Osazuwa-Peters N, Neskey DM, Kaczmar JM, Sharma AK, Harper J, Day TA, Hughes-Halbert C. Development and Evaluation of a Navigation-Based, Multilevel Intervention to Improve the Delivery of Timely, Guideline-Adherent Adjuvant Therapy for Patients With Head and Neck Cancer. JCO Oncol Pract 2021; 17:e1512-e1523. [PMID: 33689399 PMCID: PMC8791819 DOI: 10.1200/op.20.00943] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE More than half of patients with head and neck squamous cell carcinoma (HNSCC) experience a delay initiating guideline-adherent postoperative radiation therapy (PORT), contributing to excess mortality and racial disparities in survival. However, interventions to improve the delivery of timely, equitable PORT among patients with HNSCC are lacking. This study (1) describes the development of NDURE (Navigation for Disparities and Untimely Radiation thErapy), a navigation-based multilevel intervention (MLI) to improve guideline-adherent PORT and (2) evaluates its feasibility, acceptability, and preliminary efficacy. METHODS NDURE was developed using the six steps of intervention mapping (IM). Subsequently, NDURE was evaluated by enrolling consecutive patients with locally advanced HNSCC undergoing surgery and PORT (n = 15) into a single-arm clinical trial with a mixed-methods approach to process evaluation. RESULTS NDURE is a navigation-based MLI targeting barriers to timely, guideline-adherent PORT at the patient, healthcare team, and organizational levels. NDURE is delivered via three in-person navigation sessions anchored to case identification and surgical care transitions. Intervention components include the following: (1) patient education, (2) travel support, (3) a standardized process for initiating the discussion of expectations for PORT, (4) PORT care plans, (5) referral tracking and follow-up, and (6) organizational restructuring. NDURE was feasible, as judged by accrual (88% of eligible patients [100% Blacks] enrolled) and dropout (n = 0). One hundred percent of patients reported moderate or strong agreement that NDURE helped solve challenges starting PORT; 86% were highly likely to recommend NDURE. The rate of timely, guideline-adherent PORT was 86% overall and 100% for Black patients. CONCLUSION NDURE is a navigation-based MLI that is feasible, is acceptable, and has the potential to improve the timely, equitable, guideline-adherent PORT.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC,Evan M. Graboyes, MD, MPH, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425; e-mail:
| | - Katherine R. Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Graham W. Warren
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC,Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - Brian Nussenbaum
- American Board of Otolaryngology - Head and Neck Surgery, Houston, TX
| | - Jessica McCay
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Courtney H. Marsh
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, NC,Department of Population Health Sciences, Duke University, Durham, NC
| | - David M. Neskey
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - John M. Kaczmar
- Department of Medicine, Division of Medical Oncology, Medical University of South Carolina, Charleston, SC
| | - Anand K. Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - Jennifer Harper
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - Terry A. Day
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Chanita Hughes-Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC,Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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12
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Blashill AJ, Gordon JR, Rojas SA, Ramers CB, Lin CD, Carrizosa CM, Nogg KA, Lamb KM, Lucido NC, Jones IJ, Rivera D, Cobian Aguilar RA, Brady JP, Fuentes M, Wells KJ. Pilot randomised controlled trial of a patient navigation intervention to enhance engagement in the PrEP continuum among young Latino MSM: a protocol paper. BMJ Open 2021; 11:e040955. [PMID: 34039570 PMCID: PMC8160175 DOI: 10.1136/bmjopen-2020-040955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) are one of the most at-risk group for contracting HIV in the USA. However, the HIV epidemic impacts some groups of MSM disproportionately. Latino MSM comprise 25.1% of new HIV infections among MSM between the ages of 13 and 29 years. The daily medication tenofovir/emtricitabine was approved by the Food and Drug Administration for pre-exposure prophylaxis (PrEP) in 2012 and has demonstrated strong efficacy in reducing HIV acquisition. METHODS AND ANALYSIS Through extensive formative research, this study uses a pilot randomised controlled trial design and will examine the feasibility and acceptability of a patient navigation intervention designed to address multiple barriers to improve engagement in the PrEP continuum among 60 Latino MSM between the ages of 18 and 29 years. The patient navigation intervention will be compared with usual care plus written information to evaluate the feasibility and acceptability of the intervention and study methods and the intervention's potential in improving PrEP continuum behaviours. The results will be reviewed for preparation for a future full-scale efficacy trial. ETHICS AND DISSEMINATION This study was approved by the institutional review board at San Diego State University and is registered at ClinicalTrials.gov. The intervention development process, plan and the results of this study will be shared through peer-reviewed journal publications, conference presentations and healthcare system and community presentations. REGISTRATION DETAILS Registered under the National Institutes of Health's ClinicalTrials.gov (NCT04048382) on 7 August 2019 and approved by the San Diego State University (HS-2017-0187) institutional review board. This study began on 5 August 2019 and is estimated to continue through 31 March 2021. The clinical trial is in the pre-results stage.
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Affiliation(s)
- Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Janna R Gordon
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Sarah A Rojas
- Family Health Centers of San Diego, San Diego, California, USA
| | | | - Chii-Dean Lin
- Department of Psychology, San Diego State University, San Diego, California, USA
| | | | - Kelsey A Nogg
- San Diego State University Research Foundation, San Diego, California, USA
| | - Kalina M Lamb
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Nicholas C Lucido
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Isaiah J Jones
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - David Rivera
- Department of Psychology, San Diego State University, San Diego, California, USA
| | | | - John P Brady
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Martin Fuentes
- Family Health Centers of San Diego, San Diego, California, USA
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
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13
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Magasi S, Papadimitriou C. Peer Support Interventions in Physical Medicine and Rehabilitation: A Framework to Advance the Field. Arch Phys Med Rehabil 2021; 103:S222-S229. [PMID: 33440133 DOI: 10.1016/j.apmr.2020.09.400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/03/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022]
Abstract
Peer support is a central tenet of the Disability Rights Movement and is based on the recognition that experiential knowledge and shared experiences provide opportunities for informational, emotional, and appraisal support among people with physical disabilities. "Peer support interventions" is an umbrella term used to describe a range of ancillary services provided by people with disabilities to people with disabilities, including peer mentoring, peer health education, and peer health navigation. A growing body of research documents the development, implementation, and outcomes of peer support interventions for people with physical disabilities in physical medicine and rehabilitation. The organization, structure, and objectives of peer support interventions vary tremendously, making it difficult to synthesize findings across studies and establish best practices to support their systematic implementation across the continuum of care. This article is a call to action for greater conceptual clarity in how peer support interventions are developed, implemented, and evaluated. We propose a 9-part evidence-informed framework delineating both theory-driven and contextual considerations to help strengthen the evidence base of peer support interventions for people with disabilities in physical medicine and rehabilitation.
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Affiliation(s)
- Susan Magasi
- Department of Occupational Therapy, University of Illinois, Chicago, Chicago, Illinois.
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14
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Nyhof BB, Wright FC, Look Hong NJ, Groot G, Helyer L, Meiers P, Quan ML, Baxter NN, Urquhart R, Warburton R, Gagliardi AR. Identifying opportunities to support patient-centred care for ductal carcinoma in situ: qualitative interviews with clinicians. BMC Cancer 2020; 20:364. [PMID: 32354355 PMCID: PMC7191683 DOI: 10.1186/s12885-020-06821-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background Women with ductal carcinoma in situ (DCIS) report poor patient-clinician communication, and long-lasting confusion and anxiety about their treatment and prognosis. Research shows that patient-centred care (PCC) improves patient experience and outcomes. Little is known about the clinician experience of delivering PCC for DCIS. This study characterized communication challenges faced by clinicians, and interventions they need to improve PCC for DCIS. Methods Purposive and snowball sampling were used to recruit Canadian clinicians by specialty, gender, years of experience, setting, and geographic location. Qualitative interviews were conducted by telephone. Data were analyzed using constant comparison. Findings were mapped to a cancer-specific, comprehensive PCC framework to identify opportunities for improvement. Results Clinicians described approaches they used to address the PCC domains of fostering a healing relationship, exchanging information, and addressing emotions, but do not appear to be addressing the domains of managing uncertainty, involving women in making decisions, or enabling self-management. However, many clinicians described challenges or variable practices for all PCC domains but fostering a healing relationship. Clinicians vary in describing DCIS as cancer based on personal beliefs. When exchanging information, most find it difficult to justify treatment while assuring women of a good prognosis, and feel frustrated when women remain confused despite their efforts to explain it. While they recognize confusion and anxiety among women, clinicians said that patient navigators, social workers, support groups and high-quality information specific to DCIS are lacking. Despite these challenges, clinicians said they did not need or want communication interventions. Conclusions Findings represent currently unmet opportunities by which to help clinicians enhance PCC for DCIS, and underscore the need for supplemental information and supportive care specific to DCIS. Future research is needed to develop and test communication interventions that improve PCC for DCIS. If effective and widely implemented, this may contribute to improved care experiences and outcomes for women diagnosed with and treated for DCIS.
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Affiliation(s)
- Bryanna B Nyhof
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.
| | | | | | - Gary Groot
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Pamela Meiers
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Nancy N Baxter
- St Michael's Hospital Department of Surgery and Li Ka Shing Knowledge Institute, Department of Surgery and the Institute for Health Policy Management and Evaluation, Toronto, Canada.,University of Toronto, Toronto, Canada
| | | | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada
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15
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Chang PF, Zhang F, Schaaf AJ. Deaf in one ear: Communication and social challenges of patients with single-sided deafness post-diagnosis. PATIENT EDUCATION AND COUNSELING 2020; 103:530-536. [PMID: 31704032 DOI: 10.1016/j.pec.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 10/12/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To understand the communication and social challenges that individuals with SSD face post diagnosis. METHODS Fifty-two single-sided deaf patients from all over the world participated in semi-structured interviews. Interviews were digitally recorded, transcribed verbatim, and coded using a thematic analysis approach. RESULTS Patients with single sided deafness identified challenges including: increased reliance on family members, decreased sense of autonomy, communication quality changes with family members, information discrepancy across family members and various emotional responses, conflicting information from interactions with multiple medical professionals, and lack of knowledge regarding what to anticipate post diagnosis. CONCLUSION This study provides insights into patients' perspectives around single-sided deafness and its challenges, and the various health care approaches (e.g., patient- and family-centered care, third party disability, patient navigation) that could be implemented post diagnosis to decrease negative experiences and outcomes associated with SSD. PRACTICAL IMPLICATIONS This study has practical implications for improving our understanding of what single-sided deaf patients need and for health professionals to offer better care to current and future populations impacted by single-sided deafness.
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Affiliation(s)
- Pamara F Chang
- Department of Communication, University of Cincinnati, Cincinnati, OH, USA.
| | - Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Andrea J Schaaf
- Department of Communication, Michigan State University, East Lansing, MI, USA
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16
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Britt HR, JaKa MM, Fernstrom KM, Bingham PE, Betzner AE, Taghon JR, Shippee ND, Shippee TP, Schellinger SE, Anderson EW. Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience. Am J Hosp Palliat Care 2019; 36:408-416. [PMID: 30541333 PMCID: PMC6442020 DOI: 10.1177/1049909118817740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Whole-person care is a new paradigm for serious illness, but few programs have been robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered program for patients living with serious illness, on health-care utilization, care experience, and quality of life, employing a quasi-experimental design with a Usual Care (UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest not-for-profit health-care system with outcomes measured every 3 months until the end of life. Enrolled patients (N = 903) were estimated to be within 3 years of end of life and diagnosed with 1+ serious illness. Exclusion criteria included hospice enrollment at time of screening or active dying. Community health workers (CHWs) delivered standardized monthly 1-hour home visits based on palliative care guidelines and motivational interviewing to promote patients' physical, psychosocial, and financial well-being. Primary outcomes included health-care utilization and patient- and caregiver-experience and quality of life. Patients were elderly (LC 74, UC 78 years) and primarily non-Hispanic, white, living at home with cardiovascular disease as the primary diagnosis (LC 69%, UC 57%). A higher proportion of LC patients completed advance directives (N = 173, 38%) than UC patients (N = 66, 15%; P < .001). LifeCourse patients who died spent more days in hospice (88 ± 191 days) compared to UC patients (44 ± 71 days; P = .018). LifeCourse patients reported greater improvements than UC in communication as part of the care experience ( P = .016). Implementation of person-centered programs delivered by CHWs is feasible; inexpensive upstream expansion of palliative care models can yield benefits for patients and caregivers. Trial Registration: Trial NCT01746446 was registered on November 27, 2012 at ClinicalTrials.gov .
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Affiliation(s)
| | | | | | | | | | | | - Nathan D. Shippee
- Division of Health Policy-Management, University of Minnesota, Minneapolis,
MN, USA
| | - Tetyana P. Shippee
- Division of Health Policy-Management, University of Minnesota, Minneapolis,
MN, USA
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17
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Magasi S, Papadimitriou C, Panko Reis J, The K, Thomas J, VanPuymbrouck L, Wilson T. Our Peers-Empowerment and Navigational Support (OP-ENS): Development of a Peer Health Navigator Intervention to Support Medicaid Beneficiaries With Physical Disabilities. Rehabil Process Outcome 2019; 8:1179572719844759. [PMID: 34497460 PMCID: PMC8282170 DOI: 10.1177/1179572719844759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/19/2019] [Indexed: 11/17/2022] Open
Abstract
People with disabilities (PWD) are a health disparities population who experience well-documented physical, structural, attitudinal, and financial barriers to health care. The disability rights community is deeply engaged in advocacy to promote health care justice for all PWD. As the community continues to work toward systems change, there is a critical need for community-directed interventions that ensure individuals with disabilities are able to access the health care services they need and are entitled to. Peer health navigator (PHN) programs have been shown to help people from diverse underserved communities break down barriers to health care. The PHN model has not been systematically adapted to meet the needs of PWD. In this article, we describe the collaborative process of developing Our Peers—Empowerment and Navigational Supports (OP-ENS), an evidence-informed PHN intervention for Medicaid beneficiaries with physical disabilities in Chicago, IL, USA. Our Peers—Empowerment and Navigational Supports is a 12-month community-based PHN intervention that pairs Medicaid beneficiaries with physical disabilities (peers) with disability PHNs who use a structured recursive process of barrier identification and asset mapping, goal setting, and action planning to help peers meet their health care needs. Our Peers—Empowerment and Navigational Supports was developed by a collaborative team that included disability rights leaders, representatives from a Medicaid managed care organization, and academic disability health care justice researchers. We highlight both the conceptual and empirical evidence that informed OP-ENS as well as the lessons learned that can assist future developers.
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Affiliation(s)
- Susan Magasi
- Departments of Occupational Therapy and Disability Studies, The University of Illinois at Chicago, Chicago, IL, USA
| | - Christina Papadimitriou
- Departments of Interdisciplinary Health Sciences and Sociology, Oakland University, Rochester, MI, USA
| | | | - Kimberly The
- Departments of Occupational Therapy and Disability Studies, The University of Illinois at Chicago, Chicago, IL, USA
| | - Jennifer Thomas
- Formerly of Community Care Alliance of Illinois, Chicago IL, USA
| | | | - Tom Wilson
- Formerly of Access Living, Chicago, IL, USA
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18
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Stacey CL, Pai M, Novisky MA, Radwany SM. Revisiting ‘awareness contexts’ in the 21st century hospital: How fragmented and specialized care shape patients' Awareness of Dying. Soc Sci Med 2019; 220:212-218. [DOI: 10.1016/j.socscimed.2018.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/28/2022]
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Valverde PA, Calhoun E, Esparza A, Wells KJ, Risendal BC. The early dissemination of patient navigation interventions: results of a respondent-driven sample survey. Transl Behav Med 2018; 8:456-467. [PMID: 29800405 DOI: 10.1093/tbm/ibx080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Patient navigators (PNs) coordinate medical services and connect patients with resources to improve outcomes, satisfaction, and reduce costs. Little national information is available to inform workforce development. We analyzed 819 responses from an online PN survey conducted in 2009-2010. Study variables were mapped to the five Consolidated Framework for Implementation Research (CFIR) constructs to explore program variations by type of PN. Five logistic regression models compared each PN type to all others while adjusting for covariates. Thirty-five percent of respondents were nurse navigators, 28% lay navigators, 20% social work (SW)/counselor navigators, 7% allied health navigators, and 10% were "other" types of PNs. Most were non-Hispanic White (71%), female (94%), and at least college educated (70%). The primary differences were observed among: the core intervention tasks; position structure; work setting; health conditions navigated; navigator race/ethnicity; personal cancer experiences; navigation training; and patient populations served. Lay PNs had fewer odds of identifying as Hispanic, work in rural settings and assist underserved populations compared to others. Nurse navigators showed greater odds of clinical responsibilities, work in hospital or government settings and fewer odds of navigating minority populations compared to others. SW/counselor navigators also had additional duties, provided greater assistance to Medicare patient populations, and less odds of navigating underserved populations than others. In summary, our survey indicates that the type of PN utilized is an indicator of other substantial differences in program implementation. CFIR provides a robust method to compare differences and should incorporate care coordination outcomes in future PN research.
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Affiliation(s)
- Patricia A Valverde
- Department of Community and Behavioral Health, School of Public Health, Aurora, CO
| | - Elizabeth Calhoun
- University of Arizona, Office of the Senior Vice President for Health Sciences, Vice President for Population Health Sciences, Executive Director, Center for Population Science and Discovery, Roy P. Drachman Hall, Tucson, AZ
| | - Angelina Esparza
- Executive Staff Analyst/Chief Program Officer, Houston Department for Health and Human Services, Houston, TX
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO
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20
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Wells KJ, Valverde P, Ustjanauskas AE, Calhoun EA, Risendal BC. What are patient navigators doing, for whom, and where? A national survey evaluating the types of services provided by patient navigators. PATIENT EDUCATION AND COUNSELING 2018; 101:285-294. [PMID: 28935442 PMCID: PMC5808907 DOI: 10.1016/j.pec.2017.08.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/01/2017] [Accepted: 08/28/2017] [Indexed: 05/12/2023]
Abstract
OBJECTIVE A nationwide cross-sectional study was conducted to assess patient navigator, patient population, and work setting characteristics associated with performance of various patient navigation (PN) tasks. METHODS Using respondent-driven sampling, 819 navigators completed a survey assessing frequency of providing 83 PN services, along with information about themselves, populations they serve, and setting in which they worked. Analyses of variance and Pearson correlations were conducted to determine differences and associations in frequency of PN services provided by various patient, navigator, and work setting characteristics. RESULTS Nurse navigators and navigators with lower education provide basic navigation; social workers typically made arrangements and referrals; and individuals with higher education, social workers, and nurses provide treatment support and clinical trials/peer support. Treatment support and clinical trials/peer support are provided to individuals with private insurance. Basic navigation, arrangements and referrals, and care coordination are provided to individuals with Medicaid or no insurance. CONCLUSION Providing basic navigation is a core competency for patient navigators. There may be two different specialties of PN, one which seeks to reduce health disparities and a second which focuses on treatment and emotional support. PRACTICE IMPLICATIONS The selection and training of patient navigators should reflect the specialization required for a position.
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Affiliation(s)
- Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, USA; University of California, San Diego Moores Cancer Center, La Jolla, USA.
| | - Patricia Valverde
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, USA
| | - Amy E Ustjanauskas
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Elizabeth A Calhoun
- Department of Public Health Policy and Management, University of Arizona Health Sciences, Tucson, USA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, USA
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21
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Bush ML, Taylor ZR, Noblitt B, Shackleford T, Gal TJ, Shinn JB, Creel LM, Lester C, Westgate PM, Jacobs JA, Studts CR. Promotion of early pediatric hearing detection through patient navigation: A randomized controlled clinical trial. Laryngoscope 2017; 127 Suppl 7:S1-S13. [PMID: 28940335 DOI: 10.1002/lary.26822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/26/2017] [Accepted: 06/30/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the efficacy of a patient navigator intervention to decrease nonadherence to obtain audiological testing following failed screening, compared to those receiving the standard of care. METHODS Using a randomized controlled design, guardian-infant dyads, in which the infants had abnormal newborn hearing screening, were recruited within the first week after birth. All participants were referred for definitive audiological diagnostic testing. Dyads were randomized into a patient navigator study arm or standard of care arm. The primary outcome was the percentage of patients with follow-up nonadherence to obtain diagnostic testing. Secondary outcomes were parental knowledge of infant hearing testing recommendations and barriers in obtaining follow-up testing. RESULTS Sixty-one dyads were enrolled in the study (patient navigator arm = 27, standard of care arm = 34). The percentage of participants nonadherent to diagnostic follow-up during the first 6 months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4% vs. 38.2%) (P = .005). The timing of initial follow-up was significantly lower in the navigator arm compared with the standard of care arm (67.9 days after birth vs. 105.9 days, P = .010). Patient navigation increased baseline knowledge regarding infant hearing loss diagnosis recommendations compared with the standard of care (P = .004). CONCLUSIONS Patient navigation decreases nonadherence rates following abnormal infant hearing screening and improves knowledge of follow-up recommendations. This intervention has the potential to improve the timeliness of delivery of infant hearing healthcare; future research is needed to assess the cost and feasibility of larger scale implementation. LEVEL OF EVIDENCE 1b. Laryngoscope, 127:S1-S13, 2017.
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Affiliation(s)
- Matthew L Bush
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - Zachary R Taylor
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - Bryce Noblitt
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | | | - Thomas J Gal
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - Jennifer B Shinn
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky
| | - Liza M Creel
- Department of Health Management and Systems Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky
| | - Cathy Lester
- Cabinet for Health and Family Services, Commission for Children with Special Health Care Needs, Louisville, Kentucky
| | - Philip M Westgate
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Julie A Jacobs
- Department of Health, Behavior and Society, University of Kentucky College of Public Health, Lexington, Kentucky, U.S.A
| | - Christina R Studts
- Department of Health, Behavior and Society, University of Kentucky College of Public Health, Lexington, Kentucky, U.S.A
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22
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Molina Y, Kim SJ, Berrios N, Glassgow AE, San Miguel Y, Darnell JS, Pauls H, Vijayasiri G, Warnecke RB, Calhoun EA. Patient Navigation Improves Subsequent Breast Cancer Screening After a Noncancerous Result: Evidence from the Patient Navigation in Medically Underserved Areas Study. J Womens Health (Larchmt) 2017; 27:317-323. [PMID: 28933653 DOI: 10.1089/jwh.2016.6120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Past efforts to assess patient navigation on cancer screening utilization have focused on one-time uptake, which may not be sufficient in the long term. This is partially due to limited resources for in-person, longitudinal patient navigation. We examine the effectiveness of a low-intensity phone- and mail-based navigation on multiple screening episodes with a focus on screening uptake after receiving noncancerous results during a previous screening episode. METHODS The is a secondary analysis of patients who participated in a randomized controlled patient navigation trial in Chicago. Participants include women referred for a screening mammogram, aged 50-74 years, and with a history of benign/normal screening results. Navigation services focused on identification of barriers and intervention via shared decision-making processes. A multivariable logistic regression intent-to-treat model was used to examine differences in odds of obtaining a screening mammogram within 2 years of the initial mammogram (yes/no) between navigated and non-navigated women. Sensitivity analyses were conducted to explore patterns across subsets of participants (e.g., navigated women successfully contacted before the initial appointment; women receiving care at Hospital C). RESULTS The final sample included 2,536 women (741 navigated, 1,795 non-navigated). Navigated women exhibited greater odds of obtaining subsequent screenings relative to women in the standard care group in adjusted models and analyses including women who received navigation before the initial appointment. CONCLUSIONS Our findings suggest that low-intensity navigation services can improve follow-up screening among women who receive a noncancerous result. Further investigation is needed to confirm navigation's impacts on longitudinal screening.
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Affiliation(s)
- Yamile Molina
- 1 School of Public Health, Cancer Center, Center for Research on Women and Gender, University of Illinois at Chicago , Chicago, Illinois
| | - Sage J Kim
- 2 School of Public Health, University of Illinois at Chicago , Chicago, Illinois
| | - Nerida Berrios
- 2 School of Public Health, University of Illinois at Chicago , Chicago, Illinois
| | | | - Yazmin San Miguel
- 4 Department of Epidemiology, University of California San Diego, San Diego State University , San Diego, California
| | - Julie S Darnell
- 5 Health Sciences Division, Loyola University , Chicago, Illinois
| | - Heather Pauls
- 6 College of Nursing, University of Illinois at Chicago , Chicago, Illinois
| | - Ganga Vijayasiri
- 7 Institute for Health Research and Policy, University of Illinois at Chicago , Chicago, Illinois
| | - Richard B Warnecke
- 7 Institute for Health Research and Policy, University of Illinois at Chicago , Chicago, Illinois
| | - Elizabeth A Calhoun
- 2 School of Public Health, University of Illinois at Chicago , Chicago, Illinois
- 8 University of Arizona , Tucson, Arizona
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23
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Apter AJ, Morales KH, Han X, Perez L, Huang J, Ndicu G, Localio A, Nardi A, Klusaritz H, Rogers M, Phillips A, Cidav Z, Schwartz JS. A patient advocate to facilitate access and improve communication, care, and outcomes in adults with moderate or severe asthma: Rationale, design, and methods of a randomized controlled trial. Contemp Clin Trials 2017; 56:34-45. [PMID: 28315481 PMCID: PMC5503302 DOI: 10.1016/j.cct.2017.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 11/24/2022]
Abstract
Few interventions to improve asthma outcomes have targeted low-income minority adults. Even fewer have focused on the real-world practice where care is delivered. We adapted a patient navigator, here called a Patient Advocate (PA), a term preferred by patients, to facilitate and maintain access to chronic care for adults with moderate or severe asthma and prevalent co-morbidities recruited from clinics serving low-income urban neighborhoods. We describe the planning, design, methodology (informed by patient and provider focus groups), baseline results, and challenges of an ongoing randomized controlled trial of 312 adults of a PA intervention implemented in a variety of practices. The PA coaches, models, and assists participants with preparations for a visit with the asthma clinician; attends the visit with permission of participant and provider; and confirms participants' understanding of what transpired at the visit. The PA facilitates scheduling, obtaining insurance coverage, overcoming patients' unique social and administrative barriers to carrying out medical advice and transfer of information between providers and patients. PA activities are individualized, take account of comorbidities, and are generalizable to other chronic diseases. PAs are recent college graduates interested in health-related careers, research experience, working with patients, and generally have the same race/ethnicity distribution as potential participants. We test whether the PA intervention, compared to usual care, is associated with improved and sustained asthma control and other asthma outcomes (prednisone bursts, ED visits, hospitalizations, quality of life, FEV1) relative to baseline. Mediators and moderators of the PA-asthma outcome relationship are examined along with the intervention's cost-effectiveness.
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Affiliation(s)
- Andrea J Apter
- Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Medicine, 3400 Spruce St, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Knashawn H Morales
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Xiaoyan Han
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Luzmercy Perez
- Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jingru Huang
- Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Grace Ndicu
- Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Localio
- Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alyssa Nardi
- Temple Physicians, Inc., Temple University Health System, Philadelphia, PA 19129, USA
| | - Heather Klusaritz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marisa Rogers
- Department of Medicine, 3400 Spruce St, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexis Phillips
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Zuleyha Cidav
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - J Sanford Schwartz
- Department of Medicine, 3400 Spruce St, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA
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24
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Rocque GB, Taylor RA, Acemgil A, Li X, Pisu M, Kenzik K, Jackson BE, Halilova KI, Demark-Wahnefried W, Meneses K, Li Y, Martin MY, Chambless C, Lisovicz N, Fouad M, Partridge EE, Kvale EA. Guiding Lay Navigation in Geriatric Patients With Cancer Using a Distress Assessment Tool. J Natl Compr Canc Netw 2016; 14:407-14. [PMID: 27059189 DOI: 10.6004/jnccn.2016.0047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/27/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is growing interest in psychosocial care and evaluating distress in patients with cancer. As of 2015, the Commission on Cancer requires cancer centers to screen patients for distress, but the optimal approach to implementation remains unclear. METHODS We assessed the feasibility and impact of using distress assessments to frame lay navigator interactions with geriatric patients with cancer who were enrolled in navigation between January 1, 2014, and December 31, 2014. RESULTS Of the 5,121 patients enrolled in our lay patient navigation program, 4,520 (88%) completed at least one assessment using a standardized distress tool (DT). Navigators used the tool to structure both formal and informal distress assessments. Of all patients, 24% reported distress scores of 4 or greater and 5.5% reported distress scores of 8 or greater. The most common sources of distress at initial assessment were pain, balance/mobility difficulties, and fatigue. Minority patients reported similar sources of distress as the overall program population, with increased relative distress related to logistical issues, such as transportation and financial/insurance questions. Patients were more likely to ask for help with questions about insurance/financial needs (79%), transportation (76%), and knowledge deficits about diet/nutrition (76%) and diagnosis (66%) when these items contributed to distress. CONCLUSIONS Lay navigators were able to routinely screen for patient distress at a high degree of penetration using a structured distress assessment.
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Affiliation(s)
- Gabrielle B Rocque
- University of Alabama at Birmingham Comprehensive Cancer Center,Hematology and Oncology, University of Alabama at Birmingham School of Medicine
| | - Richard A Taylor
- University of Alabama at Birmingham Comprehensive Cancer Center,Preventive Medicine, University of Alabama at Birmingham School of Medicine
| | - Aras Acemgil
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | - Xuelin Li
- University of Alabama at Birmingham School of Nursing
| | - Maria Pisu
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | - Kelly Kenzik
- University of Alabama at Birmingham School of Nursing
| | - Bradford E Jackson
- Preventive Medicine, University of Alabama at Birmingham School of Medicine
| | | | | | - Karen Meneses
- University of Alabama at Birmingham Comprehensive Cancer Center,Preventive Medicine, University of Alabama at Birmingham School of Medicine
| | - Yufeng Li
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | | | - Carol Chambless
- University of Alabama at Birmingham Comprehensive Cancer Center
| | - Nedra Lisovicz
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | - Mona Fouad
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | | | - Elizabeth A Kvale
- University of Alabama at Birmingham Comprehensive Cancer Center,Birmingham VA Medical Center, Birmingham, Alabama
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25
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Baik SH, Gallo LC, Wells KJ. Patient Navigation in Breast Cancer Treatment and Survivorship: A Systematic Review. J Clin Oncol 2016; 34:3686-3696. [PMID: 27458298 DOI: 10.1200/jco.2016.67.5454] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Patient navigation is an intervention approach that improves cancer outcomes by reducing barriers and facilitating timely access to cancer care. Little is known about the benefits of patient navigation during breast cancer treatment and survivorship. This systematic review evaluates the efficacy of patient navigation in improving treatment and survivorship outcomes in women with breast cancer. METHODS The review included experimental and quasi-experimental studies of patient navigation programs that target breast cancer treatment and breast cancer survivorship. Articles were systematically obtained through electronic database searches of PubMed/MEDLINE, PsycINFO, Web of Science, CINAHL, and Cochrane Library. The Effective Public Health Practice Project Quality Assessment Tool was used to evaluate the methodologic quality of individual studies. RESULTS Thirteen studies met the inclusion criteria. Most were of moderate to high quality. Outcomes targeted included timeliness of treatment initiation, adherence to cancer treatment, and adherence to post-treatment surveillance mammography. Heterogeneity of outcome assessments precluded a meta-analysis. Overall, results demonstrated that patient navigation increases surveillance mammography rates, but only minimal evidence was found with regard to its effectiveness in improving breast cancer treatment outcomes. CONCLUSION This study is the most comprehensive systematic review of patient navigation research focused on improving breast cancer treatment and survivorship. Minimal research has indicated that patient navigation may be effective for post-treatment surveillance; however, more studies are needed to draw definitive conclusions about the efficacy of patient navigation during and after cancer treatment.
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Affiliation(s)
- Sharon H Baik
- All authors: San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology; Linda C. Gallo and Kristen J. Wells, San Diego State University; and Sharon H. Baik and Kristen J. Wells, University of California San Diego Moores Cancer Center, San Diego, CA
| | - Linda C Gallo
- All authors: San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology; Linda C. Gallo and Kristen J. Wells, San Diego State University; and Sharon H. Baik and Kristen J. Wells, University of California San Diego Moores Cancer Center, San Diego, CA
| | - Kristen J Wells
- All authors: San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology; Linda C. Gallo and Kristen J. Wells, San Diego State University; and Sharon H. Baik and Kristen J. Wells, University of California San Diego Moores Cancer Center, San Diego, CA
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26
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Whitley EM, Raich PC, Dudley DJ, Freund KM, Paskett ED, Patierno SR, Simon M, Warren-Mears V, Snyder FR. Relation of comorbidities and patient navigation with the time to diagnostic resolution after abnormal cancer screening. Cancer 2016; 123:312-318. [PMID: 27648520 DOI: 10.1002/cncr.30316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/20/2016] [Accepted: 08/08/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whether patient navigation improves outcomes for patients with comorbidities is unknown. The aims of this study were to determine the effect of comorbidities on the time to diagnostic resolution after an abnormal cancer screening test and to examine whether patient navigation improves the timeliness and likelihood of diagnostic resolution for patients with comorbidities in comparison with no navigation. METHODS A secondary analysis of comorbidity data collected by Patient Navigation Research Program sites using the Charlson Comorbidity Index (CCI) was conducted. The participants were 6,349 patients with abnormal breast, cervical, colon, or prostate cancer screening tests between 2007 and 2011. The intervention was patient navigation or usual care. The CCI data were highly skewed across projects and cancer sites, and the CCI scores were categorized as 0 (CCI score of 0 or no comorbidities identified; 76% of cases); 1 (CCI score of 1; 16% of cases), or 2 (CCI score ≥ 2; 8% of cases). Separate adjusted hazard ratios for each site and cancer type were obtained, and then they were pooled with a meta-analysis random effects methodology. RESULTS Patients with a CCI score ≥ 2 had delayed diagnostic resolution after an abnormal cancer screening test in comparison with those with no comorbidities. Patient navigation reduced delays in diagnostic resolution, with the greatest benefits seen for those with a CCI score ≥ 2. CONCLUSIONS Persons with a CCI score ≥ 2 experienced significant delays in timely diagnostic care in comparison with patients without comorbidities. Patient navigation was effective in reducing delays in diagnostic resolution among those with CCI scores > 1. Cancer 2017;123:312-318. © 2016 American Cancer Society.
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Affiliation(s)
- Elizabeth M Whitley
- Prevention Services Division, Colorado Department of Public Health and Environment, Denver, Colorado
| | - Peter C Raich
- Denver Health, Denver, Colorado.,University of Colorado Denver, Aurora, Colorado
| | - Donald J Dudley
- Cancer Therapy and Research Center, University of Texas Health Science Center, San Antonio, Texas.,University of Virginia, Charlottesville, Virginia
| | - Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, Ohio State University, Columbus, Ohio.,Division of Epidemiology, Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Steven R Patierno
- George Washington Cancer Institute, Washington, DC.,Duke Cancer Institute, Durham, North Carolina
| | - Melissa Simon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Victoria Warren-Mears
- Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, Oregon
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27
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Ko NY, Snyder FR, Raich PC, Paskett ED, Dudley D, Lee JH, Levine PH, Freund KM. Racial and ethnic differences in patient navigation: Results from the Patient Navigation Research Program. Cancer 2016; 122:2715-22. [PMID: 27227342 PMCID: PMC4992408 DOI: 10.1002/cncr.30109] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/14/2016] [Accepted: 04/04/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patient navigation was developed to address barriers to timely care and reduce cancer disparities. The current study explored navigation and racial and ethnic differences in time to the diagnostic resolution of a cancer screening abnormality. METHODS The authors conducted an analysis of the multisite Patient Navigation Research Program. Participants with an abnormal cancer screening test were allocated to either navigation or control. The unadjusted median time to resolution was calculated for each racial and ethnic group by navigation and control. Multivariable Cox proportional hazards models were fit, adjusting for sex, age, cancer abnormality type, and health insurance and stratifying by center of care. RESULTS Among a sample of 7514 participants, 29% were non-Hispanic white, 43% were Hispanic, and 28% were black. In the control group, black individuals were found to have a longer median time to diagnostic resolution (108 days) compared with non-Hispanic white individuals (65 days) or Hispanic individuals (68 days) (P<.0001). In the navigated groups, black individuals had a reduction in the median time to diagnostic resolution (97 days) (P<.0001). In the multivariable models, among controls, black race was found to be associated with an increased delay to diagnostic resolution (hazard ratio, 0.77; 95% confidence interval, 0.69-0.84) compared with non-Hispanic white individuals, which was reduced in the navigated arm (hazard ratio, 0.85; 95% confidence interval, 0.77-0.94). CONCLUSIONS Patient navigation appears to have the greatest impact among black patients, who had the greatest delays in care. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2715-2722. © 2016 American Cancer Society.
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Affiliation(s)
- Naomi Y Ko
- Section of Hematology Oncology, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA 02118, (617) 638-8036 phone, (617) 638-8096 fax
| | - Frederick R Snyder
- NOVA Research Company, 801 Roeder Road, Suite 700, Silver Spring, MD 20910
| | - Peter C Raich
- Denver Health, Denver, Colorado; and University of Colorado Denver, Aurora, Colorado, 94 High Meadow Dr., Dillon, CO 80435, (970)468-4763
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, 1590 North High Street, Columbus, OH 43201, (614) 293-3917 phone, (614) 293-5611 fax
| | - Donald Dudley
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA 22908, (434) 243-6790
| | - Ji-Hyun Lee
- University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, 1 University of New Mexico, Albuquerque, New Mexico 87131-0001, Phone: 505-272-3718
| | - Paul H. Levine
- The George Washington University School of Public Health; and Health Services; and The George Washington Cancer Institute, 950 New Hampshire Ave. NW 5th Floor, Washington, DC 20052, (202) 994-5330
| | - Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, 35 Kneeland Street, Boston, Massachusetts 02111
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28
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Battaglia TA, Darnell JS, Ko N, Snyder F, Paskett ED, Wells KJ, Whitley EM, Griggs JJ, Karnad A, Young H, Warren-Mears V, Simon MA, Calhoun E. The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis. Breast Cancer Res Treat 2016; 158:523-34. [PMID: 27432417 PMCID: PMC5216421 DOI: 10.1007/s10549-016-3887-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 11/26/2022]
Abstract
Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screening test among a national sample. A prospective meta-analysis estimated the adjusted odds of achieving timely diagnostic resolution at 60, 180, and 365 days. Exploratory analyses were conducted on the pooled sample to identify which groups had the most benefit from navigation. Clinics from six medical centers serving vulnerable populations participated in the Patient Navigation Research Program. Women with an abnormal breast cancer screening test between 2007 and 2009 were included and received the patient navigation intervention or usual care. Patient navigators worked with patients and their care providers to address patient-specific barriers to care to prevent delays in diagnosis. A total of 4675 participants included predominantly racial/ethnic minorities (74 %) with public insurance (40 %) or no insurance (31 %). At 60 days and 180 days, there was no statistically significant effect of navigation on achieving timely diagnostic care, but a benefit of navigation was seen at 365 days (aOR 2.12, CI 1.36-3.29). We found an equal benefit of navigation across all groups, regardless of race/ethnicity, language, insurance status, and type of screening abnormality. Patient navigation resulted in more timely diagnostic resolution at 365 days among a diverse group of minority, low-income women with breast cancer screening abnormalities. Trial registrations clinicaltrials.gov Identifiers: NCT00613275, NCT00496678, NCT00375024, NCT01569672.
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Affiliation(s)
- Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Building 1st Floor, Boston, MA, 02118, USA.
| | - Julie S Darnell
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Avenue, Bldg 115, Room 556, Maywood, IL, 60153, USA
| | - Naomi Ko
- Section of Hematology Oncology, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA, 02118, USA
| | - Fred Snyder
- NOVA Research Company, 801 Roeder Road, Suite 700, Silver Spring, MD, 20910, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, The Ohio State University, 1590 North High Street, Columbus, OH, 43201, USA
| | - Kristen J Wells
- Department of Psychology, San Diego State University, 6363 Alvarado Ct., Ste. 103, San Diego, CA, 92120-4913, USA
| | - Elizabeth M Whitley
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO, 80246, USA
| | - Jennifer J Griggs
- University of Michigan School of Public Health, 2800 Plymouth Road, Building 16, 116 W, Ann Arbor, MI, 48109, USA
| | - Anand Karnad
- Division of Hematology-Oncology, Cancer Therapy & Research Center (CTRC), UT Health Science Center, 7979 Wurzbach Rd., San Antonio, TX, 78229, USA
| | - Heather Young
- George Washington University Cancer Institute, 950 New Hampshire Ave. NW 5th Floor, Washington, DC, 20052, USA
| | - Victoria Warren-Mears
- Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, OR, 97201, USA
| | - Melissa A Simon
- Northwestern University Feinberg School of Medicine, 633 N. St Clair, Suite 1800, Chicago, IL, 60611, USA
| | - Elizabeth Calhoun
- University of Arizona Health Sciences, 550 East Van Buren, Phoenix, AZ, 85004-2230, USA
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29
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Giese-Davis J, Bliss-Isberg C, Wittenberg L, White J, Star P, Zhong L, Cordova MJ, Houston D, Spiegel D. Peer-counseling for women newly diagnosed with breast cancer: A randomized community/research collaboration trial. Cancer 2016; 122:2408-17. [DOI: 10.1002/cncr.30036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/01/2016] [Accepted: 03/22/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Janine Giese-Davis
- Psychosocial Oncology Division, Department of Oncology; University of Calgary; Calgary Alberta Canada
- Psychosocial Resources; Tom Baker Cancer Centre; Calgary Alberta Canada
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Stanford California
| | | | - Lynne Wittenberg
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Stanford California
| | - Jennifer White
- Psychosocial Oncology Division, Department of Oncology; University of Calgary; Calgary Alberta Canada
- Psychosocial Resources; Tom Baker Cancer Centre; Calgary Alberta Canada
| | | | - Lihong Zhong
- Psychosocial Oncology Division, Department of Oncology; University of Calgary; Calgary Alberta Canada
- Psychosocial Resources; Tom Baker Cancer Centre; Calgary Alberta Canada
| | - Matthew J. Cordova
- Martinez Outpatient Clinic and Community Living Center; VA Northern California Health Care System; Martinez California
| | | | - David Spiegel
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Stanford California
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30
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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: 10] [Impact Index Per Article: 1.3] [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.
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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
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Abstract
Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts - in rural aging, rural palliative care, and navigation - as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation.
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Jean-Pierre P, Cheng Y, Wells KJ, Freund KM, Snyder FR, Fiscella K, Holden AE, Paskett E, Dudley D, Simon MA, Valverde P. Satisfaction with cancer care among underserved racial-ethnic minorities and lower-income patients receiving patient navigation. Cancer 2016; 122:1060-7. [PMID: 26849163 PMCID: PMC4803516 DOI: 10.1002/cncr.29902] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient navigation is a barrier-focused program of care coordination designed to achieve timely and high-quality cancer-related care for medically underserved racial-ethnic minorities and the poor. However, to the authors' knowledge, few studies to date have examined the relationship between satisfaction with navigators and cancer-related care. METHODS The authors included data from 1345 patients with abnormal cancer screening tests or a definitive cancer diagnosis who participated in the Patient Navigation Research Program to test the efficacy of patient navigation. Participants completed demographic questionnaires and measures of patient satisfaction with cancer-related care (PSCC) and patient satisfaction with interpersonal relationship with navigator (PSN-I). The authors obtained descriptive statistics to characterize the sample and conducted regression analyses to assess the degree of association between PSN-I and PSCC, controlling for demographic and clinical factors. Analyses of variance were conducted to examine group differences controlling for statistically significant covariates. RESULTS Statistically significant relationships were found between the PSCC and PSN-I for patients with abnormal cancer screening tests (1040 patients; correlation coefficient (r), 0.4 [P<.001]) and those with a definitive cancer diagnosis (305 patients; correlation coefficient, 0.4 [P<.001]). The regression analysis indicated that having an abnormal colorectal cancer screening test in the abnormal screening test group and increased age and minority race-ethnicity status in the cancer diagnosis group were associated with a higher satisfaction with cancer care (P<.01). CONCLUSIONS Satisfaction with navigators appears to be significantly associated with satisfaction with cancer-related care. Information regarding the patient-navigator relationship should be integrated into patient navigation programs to maximize the likelihood of reducing caner disparities and mortality for medically underserved racial-ethnic minorities and the poor.
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Affiliation(s)
- Pascal Jean-Pierre
- University of Notre Dame, Notre Dame, IN
- Cancer Neurocognitive Translational Research Lab, Notre Dame, IN
| | - Ying Cheng
- University of Notre Dame, Notre Dame, IN
| | | | | | | | - Kevin Fiscella
- University of Rochester Medical Center, Department of Family Medicine and Public Health Sciences, Rochester, NY
| | - Alan E. Holden
- University of Texas Health Science Center, Institute for Health Promotion Research, San Antonio, TX
| | | | - Donald Dudley
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Patricia Valverde
- University of Colorado Denver, Colorado School of Public Health, Denver, Colorado
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Wells KJ, Winters PC, Jean-Pierre P, Warren-Mears V, Post D, Van Duyn MAS, Fiscella K, Darnell J, Freund KM. Effect of patient navigation on satisfaction with cancer-related care. Support Care Cancer 2016; 24:1729-53. [PMID: 26438146 PMCID: PMC4767607 DOI: 10.1007/s00520-015-2946-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Despite growing popularity of patient navigation (PN) as a means to improve cancer care quality and reduce cancer-related disparities, there are few well-designed controlled trials assessing the impact of PN on patient outcomes like satisfaction with care. The present controlled study examined effect of PN on satisfaction with cancer-related care. METHODS Patients who presented with a symptom or abnormal screening test (n = 1788) or definitive diagnosis (n = 445) of breast, cervical, colorectal, or prostate cancer from eight Patient Navigator Research Program sites were included in one of two groups: intervention (PN) or comparison (usual care or usual care plus cancer educational materials). Trained patient navigators met with intervention group participants to help them assess and identify resources to address barriers to cancer diagnostic or treatment care. Using a validated instrument, we assessed participants' satisfaction with their cancer diagnostic or treatment care up to 3 months after diagnostic resolution of a cancer-related abnormality or within 3 months of initiation of cancer treatment. RESULTS Overall, patients reported high satisfaction with diagnostic care and cancer treatment. There were no statistically significant differences between PN and control groups in satisfaction with cancer-related care (p > 0.05). Hispanic and African American participants were less likely to report high satisfaction with cancer care when compared to White patients. Middle-aged participants with higher education, higher household income, private insurance, owning their own home, working full-time, and those whose primary language is English had higher satisfaction with cancer-related diagnostic care. CONCLUSIONS PN had no statistically significant effect on patients' satisfaction with cancer-related care. Further research is needed to define the patient populations who might benefit from PN, content of PN that is most useful, and services that might enhance PN. TRIAL REGISTRATIONS clinicaltrials.gov identifiers: NCT00613275 , NCT00496678 , NCT00375024 , NCT01569672.
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Affiliation(s)
- Kristen J Wells
- Department of Psychology, San Diego State University and University of California, San Diego Moores Cancer Center, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-1863, USA.
| | - Paul C Winters
- Family Medicine Research Programs, University of Rochester Medical Center, 1381 South Avenue, Rochester, NY, 14620, USA
| | - Pascal Jean-Pierre
- Department of Psychology, University of Notre Dame, 109 Haggar Hall, Notre Dame, IN, 46556, USA
| | - Victoria Warren-Mears
- Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR, 97201, USA
| | - Douglas Post
- Ohio State University, 1590 North High Street, Suite 525, Columbus, OH, 43201, USA
| | - Mary Ann S Van Duyn
- National Institutes of Health, National Cancer Institute, 9609 Medical Center Drive, Room 6W118, Bethesda, MD, 20892, USA
| | - Kevin Fiscella
- Family Medicine Research Programs, University of Rochester Medical Center, 1381 South Avenue, Rochester, NY, 14620, USA
| | - Julie Darnell
- Division of Health Policy & Administration, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, Room 758, Chicago, IL, 60612, USA
| | - Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street #63, Boston, MA, 02111, USA
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Ustjanauskas AE, Bredice M, Nuhaily S, Kath L, Wells KJ. Training in Patient Navigation: A Review of the Research Literature. Health Promot Pract 2015; 17:373-81. [PMID: 26656600 DOI: 10.1177/1524839915616362] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite the proliferation of patient navigation programs designed to increase timely receipt of health care, little is known about the content and delivery of patient navigation training, or best practices in this arena. The current study begins to address these gaps in understanding, as it is the first study to comprehensively review descriptions of patient navigation training in the peer-reviewed research literature. Seventy-five patient navigation efficacy studies published since 1995, identified through PubMed and by the authors, were included in this narrative review. Fifty-nine of the included studies (79%) mentioned patient navigation training, and 55 of these studies additionally provided a description of training. Most studies did not thoroughly document patient navigation training practices. Additionally, several topics integral to the role of patient navigators, as well as components of training central to successful adult learning, were not commonly described in the research literature. Descriptions of training also varied widely across studies in terms of duration, location, format, learning strategies employed, occupation of trainer, and content. These findings demonstrate the need for established standards of navigator training as well as for future research on the optimal delivery and content of patient navigation training.
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Affiliation(s)
- Amy E Ustjanauskas
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | | | - Lisa Kath
- San Diego State University, San Diego, CA, USA
| | - Kristen J Wells
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA San Diego State University, San Diego, CA, USA
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The Family Value of Information, Community Support, and Experience Study: Rationale, Design, and Methods of a "Family-Centered" Research Study. J Nerv Ment Dis 2015; 203:896-900. [PMID: 26524515 DOI: 10.1097/nmd.0000000000000393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their child's recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on "family-centered" care in this study is strongly supported by the active role of consumers in study design and implementation.
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Enard KR, Nevarez L, Hernandez M, Hovick SR, Moguel MR, Hajek RA, Blinka CE, Jones LA, Torres-Vigil I. Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial. Cancer Causes Control 2015; 26:1351-9. [PMID: 26109462 PMCID: PMC5215648 DOI: 10.1007/s10552-015-0620-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 06/12/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Latino Medicare enrollees report suboptimal rates of colorectal cancer screening (CRCS) despite Medicare policies designed to improve CRCS access for older persons. Patient navigation (PN) may address many underlying barriers to CRCS, yet little is known about the effectiveness of PN to increase CRCS adherence among Latino Medicare enrollees. METHODS Using a randomized controlled trial study design, we evaluated tailored PN delivered outside of primary care settings as an intervention to increase CRCS adherence in this population. Intervention participants (n = 135) received tailored PN services which included education, counseling, and logistical support administered in their language of choice. Comparison participants (n = 168) received mailed cancer education materials. We compared CRCS rates between interventions and used multivariable logistic regression to assess the odds of CRCS adherence for PN versus comparison groups after adjusting for covariates of interest. RESULTS More navigated than non-navigated participants became CRCS adherent during the study period (43.7 vs. 32.1%, p = 0.04). The odds of CRCS adherence were significantly higher for PN relative to comparison participants before and after adjusting for covariates (unadjusted OR 1.64, p = 0.04; adjusted OR 1.82, p = 0.02). Higher CRCS adherence rates were observed primarily in the uptake of endoscopic screening methods. CONCLUSION This study demonstrates that PN delivered outside of the primary care environment is modestly effective in increasing CRCS adherence among Latino Medicare enrollees. This intervention strategy should be further evaluated as a complement to primary care-based PN and other care coordination strategies to increase adherence with CRCS and other evidence-based screenings among older Latinos.
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Affiliation(s)
- K R Enard
- Department of Health Management and Policy, Saint Louis University, 3545 Lafayette Ave, Room 380, Saint Louis, MO, 63104, USA,
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De La Cruz II, Freund KM, Battaglia TA, Chen CA, Bak S, Kalish R, Lottero B, Egan P, Heeren T, Kronman AC. Impact of depression on the intensity of patient navigation for women with abnormal cancer screenings. J Health Care Poor Underserved 2015; 25:383-95. [PMID: 24509033 DOI: 10.1353/hpu.2014.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patient navigation is increasingly being used to support vulnerable patients to receive timely and quality medical care. We sought to understand whether patients with depression utilize additional patient navigation services after abnormal cancer screening. We compared depressed and non-depressed women using three different measures of intensity of patient navigation: number of patient-navigator encounters, encounter time, and number of unique barriers to care. The study population consisted of 1,455 women who received navigation after abnormal screening for breast or cervical cancer at one of six community health centers in Boston. Navigators spent a median of 60-75 minutes over one or two encounters per participant, with 49% of participants having one or more documented barrier to care. Depressed women did not differ in total numbers of encounters, encounter time, or unique barriers compared with non-depressed women. Our findings suggest that pre-existing depression does not predict which women will utilize additional navigation services.
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Fischer SM, Cervantes L, Fink RM, Kutner JS. Apoyo con Cariño: a pilot randomized controlled trial of a patient navigator intervention to improve palliative care outcomes for Latinos with serious illness. J Pain Symptom Manage 2015; 49:657-65. [PMID: 25240788 PMCID: PMC4705861 DOI: 10.1016/j.jpainsymman.2014.08.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/07/2014] [Accepted: 08/14/2014] [Indexed: 02/06/2023]
Abstract
CONTEXT Latinos experience significant health disparities at the end of life compared with non-Latinos. OBJECTIVES To determine the feasibility of a patient navigator intervention to improve palliative care outcomes for Latino adults with serious illness. METHODS This was a pilot randomized controlled trial that included 64 Latino adults with life-limiting illness randomized to an intervention or a control group. All participants received a packet of linguistically matched materials on palliative care. In addition, intervention participants received up to five home visits from the bilingual, bicultural patient navigator. Visits focused on addressing barriers to palliative care through education, activation, and culturally tailored messaging. Outcomes included feasibility and advance care planning rates, documentation of pain management discussions in the medical record, and hospice utilization. RESULTS Of the 32 patients randomized to the intervention arm, 81% had at least one home visit (range 1-5) with the patient navigator. Overall, advance care planning was higher in the intervention group (47% [n = 15] vs. 25% [n = 8], P = 0.06), and 79% of intervention participants had a discussion about pain management documented in their medical record vs. 54% of control patients (P = 0.05). Hospice enrollment between the two groups (n = 18 decedents) was similar (n = 7 intervention vs. n = 6 control); length of stay in the intervention group was 36.4 ± 51.6 vs. 19.7 ± 33.6 days for control patients (P = 0.39). CONCLUSION A culturally tailored patient navigator intervention was feasible and suggests improved palliative care outcomes for Latinos facing advanced medical illness, justifying a fully powered randomized controlled trial.
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Affiliation(s)
- Stacy M Fischer
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | | | - Regina M Fink
- University of Colorado Hospital, Aurora, Colorado, USA; University of Colorado College of Nursing, Aurora, Colorado, USA
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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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.
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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
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Ramachandran A, Freund KM, Bak SM, Heeren TC, Chen CA, Battaglia TA. Multiple barriers delay care among women with abnormal cancer screening despite patient navigation. J Womens Health (Larchmt) 2014; 24:30-6. [PMID: 25513858 DOI: 10.1089/jwh.2014.4869] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While there is widespread dissemination of patient navigation programs in an effort to reduce delays in cancer care, little is known about the impact of barriers to care on timely outcomes. METHODS We conducted a secondary analysis of the Boston Patient Navigation Research Program (PNRP) to examine the effect that the presence of barriers had on time to diagnostic resolution of abnormal breast or cervical cancer screening tests. We used multivariable Cox proportional hazards regression with time to diagnostic resolution as the outcome to examine the effect of the number of barriers, controlling for demographic covariates and clustered by patients' primary navigator. RESULTS There were 1481 women who received navigation; mean age was 39 years; 32% were White, 27% Black, and 31% Hispanic; 28% had private health insurance; and 38% did not speak English. Overall, half (n=745, 50%) had documentation of one or more barriers to care. Women with barriers were more likely to be older, non-White, non-English language speakers, and on public or no health insurance compared with women without barriers. In multivariable analyses, we found less timely diagnostic resolution as the number of barriers increased (one barrier, adjusted hazard ratio [aHR] 0.81 [95% CI 0.56-1.17], p=0.26; two barriers, aHR 0.55 [95% CI 0.37-0.81], p=0.0025; three or more barriers, aHR 0.31 [95% CI 0.21-0.46], p<0.0001)]. CONCLUSION Within a patient navigation program proven to reduce delays in care, we found that navigated patients with documented barriers to care experience less timely resolution of abnormal cancer screening tests.
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Affiliation(s)
- Ambili Ramachandran
- 1 Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine , Boston, Massachusetts
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Rousseau SJ, Humiston SG, Yosha A, Winters PC, Loader S, Luong V, Schwartzbauer B, Fiscella K. Patient navigation moderates emotion and information demands of cancer treatment: a qualitative analysis. Support Care Cancer 2014; 22:3143-51. [PMID: 24890503 PMCID: PMC4221546 DOI: 10.1007/s00520-014-2295-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/19/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Patient navigation is increasingly employed to guide patients through cancer treatment. We assessed the elements of navigation that promoted patients' involvement in treatment among patients with breast and colorectal cancer that participated in a navigation study. METHODS We conducted qualitative analysis of 28 audiotaped and transcribed semi-structured interviews of navigated and unnavigated cancer patients. RESULTS Themes included feeling emotionally and cognitively overwhelmed and desire for a strong patient-navigator partnership. Both participants who were navigated and those who were not felt that navigation did or could help address their emotional, informational, and communicational needs. The benefits of logistical support were cited less often. CONCLUSIONS Findings underscore the salience of personal relationships between patients and navigators in meeting patients' emotional and informational needs.
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Patterns of task and network actions performed by navigators to facilitate cancer care. Health Care Manage Rev 2014; 39:90-101. [PMID: 23478753 DOI: 10.1097/hmr.0b013e31828da41e] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient navigation is a widely implemented intervention to facilitate access to care and reduce disparities in cancer care, but the activities of navigators are not well characterized. PURPOSE The aim of this study is to describe what patient navigators actually do and explore patterns of activity that clarify the roles they perform in facilitating cancer care. METHODOLOGY/APPROACH We conducted field observations of nine patient navigation programs operating in diverse health settings of the national patient navigation research program, including 34 patient navigators, each observed an average of four times. Trained observers used a structured observation protocol to code as they recorded navigator actions and write qualitative field notes capturing all activities in 15-minute intervals during observations ranging from 2 to 7 hours; yielding a total of 133 observations. Rates of coded activity were analyzed using numerical cluster analysis of identified patterns, informed by qualitative analysis of field notes. FINDINGS Six distinct patterns of navigator activity were identified, which differed most relative to how much time navigators spent directly interacting with patients and how much time they spent dealing with medical records and documentation tasks. Navigator actions reveal a complex set of roles in which navigators both provide the direct help to patients denoted by their title and also carry out a variety of actions that function to keep the health system operating smoothly. PRACTICE IMPLICATIONS Working to navigate patients through complex health services entails working to repair the persistent challenges of health services that can render them inhospitable to patients. The organizations that deploy navigators might learn from navigators' efforts and explore alternative approaches, structures, or systems of care in addressing both the barriers patients face and the complex solutions navigators create in helping patients.
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Fernandes R, Riklon S, Langidrik JR, Williams SN, Kabua N. Collaboration between a US Academic Institution and International Ministry of Health to develop a culturally appropriate palliative care navigation curriculum. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2014; 2:275-9. [PMID: 26250636 DOI: 10.1016/j.hjdsi.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 08/10/2014] [Accepted: 08/13/2014] [Indexed: 11/18/2022]
Abstract
Implementation lessons: (1) The development and testing of a culturally appropriate palliative care navigation curriculum for countries facing high cancer and non-communicable diseases burden requires collaboration with the local Ministry of Health. (2) Lay volunteers from non-governmental and faith-based organizations are potential candidates to provide patient navigation services.
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Affiliation(s)
- Ritabelle Fernandes
- The Pacific Islands Geriatric Education Center and the John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, Division of Palliative Medicine, John A. Burns School of Medicine, University of Hawaii, United States.
| | - Sheldon Riklon
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, United States
| | | | - Shellie N Williams
- Division of Geriatric Medicine, Department of Medicine, University of Chicago Medical Center, United States
| | - Neiar Kabua
- National Comprehensive Cancer Control Program, Ministry of Health, Republic of the Marshall Islands
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Corrigan PW, Druss BG, Perlick DA. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychol Sci Public Interest 2014; 15:37-70. [PMID: 26171956 DOI: 10.1177/1529100614531398] [Citation(s) in RCA: 626] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.
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Meade CD, Wells KJ, Arevalo M, Calcano ER, Rivera M, Sarmiento Y, Freeman HP, Roetzheim RG. Lay navigator model for impacting cancer health disparities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:449-57. [PMID: 24683043 PMCID: PMC4133280 DOI: 10.1007/s13187-014-0640-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This paper recounts experiences, challenges, and lessons learned when implementing a lay patient navigator program to improve cancer care among medically underserved patients who presented in a primary care clinic with a breast or colorectal cancer abnormality. The program employed five lay navigators to navigate 588 patients. Central programmatic elements were the following: (1) use of bilingual lay navigators with familiarity of communities they served; (2) provision of training, education, and supportive activities; (3) multidisciplinary clinical oversight that factored in caseload intensity; and (4) well-developed partnerships with community clinics and social service entities. Deconstruction of healthcare system information was fundamental to navigation processes. We conclude that a lay model of navigation is well suited to assist patients through complex healthcare systems; however, a stepped care model that includes both lay and professional navigation may be optimal to help patients across the entire continuum.
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Affiliation(s)
- Cathy D Meade
- Division of Population Science, Moffitt Cancer Center, 12902 Magnolia Drive, Fow-Edu, Tampa, FL, 33612, USA,
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Samaras AT, Murphy K, Nonzee NJ, Endress R, Taylor S, Hajjar N, Bularzik R, Frankovich C, Dong X, Simon MA. Community-campus partnership in action: lessons learned from the DuPage County Patient Navigation Collaborative. Prog Community Health Partnersh 2014; 8:75-81. [PMID: 24859105 DOI: 10.1353/cpr.2014.0005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Using community-based participatory research (CBPR), the DuPage County Patient Navigation Collaborative (DPNC) developed an academic campus-community research partnership aimed at increasing access to care for underserved breast and cervical cancer patients within DuPage County, a collar county of Chicago. Given rapidly shifting demographics, targeting CBPR initiatives among underserved suburban communities is essential. OBJECTIVES To discuss the facilitating factors and lessons learned in forging the DPNC. METHODS A patient navigation collaborative was formed to guide medically underserved women through diagnostic resolution and if necessary, treatment, after an abnormal breast or cervical cancer screening. LESSONS LEARNED Facilitating factors included (1) fostering and maintaining collaborations within a suburban context, (2) a systems-based participatory research approach, (3) a truly equitable community-academic partnership, (4) funding adaptability, (5) culturally relevant navigation, and (6) emphasis on co-learning and capacity building. CONCLUSIONS By highlighting the strategies that contributed to DPNC success, we envision the DPNC to serve as a feasible model for future health interventions.
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Brenner AT, Getrich CM, Pignone M, Rhyne RL, Hoffman RM, McWilliams A, de Hernandez BU, Weaver MA, Tapp H, Harbi K, Reuland D. Comparing the effect of a decision aid plus patient navigation with usual care on colorectal cancer screening completion in vulnerable populations: study protocol for a randomized controlled trial. Trials 2014; 15:275. [PMID: 25004983 PMCID: PMC4100055 DOI: 10.1186/1745-6215-15-275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/23/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Screening can reduce colorectal cancer (CRC) incidence and mortality. However, screening is underutilized in vulnerable patient populations, particularly among Latinos. Patient-directed decision aids can increase CRC screening knowledge, self-efficacy, and intent; however, their effect on actual screening test completion tends to be modest. This is probably because decision aids do not address some of the patient-specific barriers that prevent successful completion of CRC screening in these populations. These individual barriers might be addressed though patient navigation interventions. This study will test a combined decision aid and patient navigator intervention on screening completion in diverse populations of vulnerable primary care patients. METHODS/DESIGN We will conduct a multisite, randomized controlled trial with patient-level randomization. Planned enrollment is 300 patients aged 50 to 75 years at average CRC risk presenting for appointments at two primary clinics in North Carolina and New Mexico. Intervention participants will view a video decision aid immediately before the clinic visit. The 14 to 16 minute video presents information about fecal occult blood tests and colonoscopy and will be viewed on a portable computer tablet in English or Spanish. Clinic-based patient navigators are bilingual and bicultural and will provide both face-to-face and telephone-based navigation. Control participants will view an unrelated food safety video and receive usual care. The primary outcome is completion of a CRC screening test at six months. Planned subgroup analyses include examining intervention effectiveness in Latinos, who will be oversampled. Secondarily, the trial will evaluate the intervention effects on knowledge of CRC screening, self-efficacy, intent, and patient-provider communication. The study will also examine whether patient ethnicity, acculturation, language preference, or health insurance status moderate the intervention effect on CRC screening. DISCUSSION This pragmatic randomized controlled trial will test a combined decision aid and patient navigator intervention targeting CRC screening completion. Findings from this trial may inform future interventions and implementation policies designed to promote CRC screening in vulnerable patient populations and to reduce screening disparities. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02054598.
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Affiliation(s)
- Alison T Brenner
- Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590, USA
| | | | - Michael Pignone
- Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590, USA
- Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert L Rhyne
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Richard M Hoffman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - Andrew McWilliams
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, USA
| | | | - Mark A Weaver
- Departments of Medicine and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hazel Tapp
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, USA
| | - Khalil Harbi
- Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590, USA
| | - Daniel Reuland
- Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590, USA
- Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Freund KM, Battaglia TA, Calhoun E, Darnell JS, Dudley DJ, Fiscella K, Hare ML, LaVerda N, Lee JH, Levine P, Murray DM, Patierno SR, Raich PC, Roetzheim RG, Simon M, Snyder FR, Warren-Mears V, Whitley EM, Winters P, Young GS, Paskett ED. Impact of patient navigation on timely cancer care: the Patient Navigation Research Program. J Natl Cancer Inst 2014; 106:dju115. [PMID: 24938303 DOI: 10.1093/jnci/dju115] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness. METHODS The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center- and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided. RESULTS The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73%) and publically insured (40%) or uninsured (31%). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95% confidence interval [CI] = 1.23 to 1.84; P < .001)) and treatment initiation (aHR = 1.43; 95% CI = 1.10 to 1.86; P < .007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care. CONCLUSIONS Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up.
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Affiliation(s)
- Karen M Freund
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Tracy A Battaglia
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Elizabeth Calhoun
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Julie S Darnell
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Donald J Dudley
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Kevin Fiscella
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Martha L Hare
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Nancy LaVerda
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Ji-Hyun Lee
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Paul Levine
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - David M Murray
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Steven R Patierno
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Peter C Raich
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Richard G Roetzheim
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Melissa Simon
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Frederick R Snyder
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Victoria Warren-Mears
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Elizabeth M Whitley
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Paul Winters
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Gregory S Young
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
| | - Electra D Paskett
- Affiliations of authors: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center (EDP), and Center for Biostatistics (GSY), The Ohio State University, Columbus, OH; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (KMF); Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA (TAB); Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL (EC, JSD); Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX (DLD); Department of Family Medicine and Public Health Sciences and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY (KF); Center to Reduce Cancer Health Disparities, National Cancer Institute (MLH), and Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (DMM), Rockville, MD (MLH); George Washington University School of Public Health and Health Services, Washington, DC (NL, PL); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J-HL, RGR); George Washington Cancer Institute, Washington, DC (PL. SRP); Duke Cancer Institute, Durham, NC (SRP); Denver Health, Denver, CO (PCR, EMW); University of Colorado Denver, Aurora, CO (PCR); Department of Family Medicine, University of South Florida, Tampa, FL (RGR); Department of Obstetrics and Gynecology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (MS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (MS); Clinical Research Ser
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Josiah Willock R, Mayberry RM, Yan F, Daniels P. Peer training of community health workers to improve heart health among African American women. Health Promot Pract 2014; 16:63-71. [PMID: 24891525 DOI: 10.1177/1524839914535775] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Training community health workers (CHWs) builds a workforce that is essential to addressing the chronic disease crisis. This article describes a highly replicable CHW training program that targets heart disease risk among African American women. BACKGROUND African American women suffer disproportionately from heart disease mortality and morbidity. Well-trained CHWs are uniquely positioned to close this disparity gap. Method. We used a Learning Circle approach to train CHWs in heart health education. The curriculum blended web-based, self-directed learning and in-person peer coaching. CHWs learned through (a) peer-to-peer sharing, (b) problem solving and brainstorming, and (c) leadership and experiential activities. Training evaluation measures were CHWs' (a) self-confidence, (b) heart health knowledge, (c) satisfaction with training, (d) training retention, and (e) replication of training within 90 days after training. RESULTS This training resulted in appreciable effects on four of five outcome measures. Heart health knowledge increased significantly among experienced CHWs (p = .011). CHWs were satisfied with training and retention was 100%. CHWs initiated and subsequently delivered 122 person hours of community heart health education and CHW training in their communities. DISCUSSION/CONCLUSION CHW heart health training using Learning Circles is a practical and replicable method of training CHWs and holds significant potential for building capacity in resource-poor community organizations.
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Affiliation(s)
| | | | - Fengxia Yan
- Morehouse School of Medicine, Atlanta, GA, USA
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Newman SD, Gillenwater G, Toatley S, Rodgers MD, Todd N, Epperly D, Andrews JO. A community-based participatory research approach to the development of a Peer Navigator health promotion intervention for people with spinal cord injury. Disabil Health J 2014; 7:478-84. [PMID: 25224988 DOI: 10.1016/j.dhjo.2014.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 04/03/2014] [Accepted: 04/24/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent trends indicate research targeting outcomes of importance to people with disabilities, such as spinal cord injury (SCI), may be best informed by those individuals; however, there are very few published rehabilitation intervention studies that include people with disabilities in the research process in a role beyond study participant. OBJECTIVE To describe a community-based participatory research (CBPR) approach to the development and pilot testing of an intervention using community-based Peer Navigators with SCI to provide health education to individuals with SCI, with the goal of reducing preventable secondary conditions and rehospitalizations, and improving community participation. METHODS A CBPR framework guides the research partnership between academic researchers and a community-based team of individuals who either have SCI or provide SCI-related services. Using this framework, the processes of our research partnership supporting the current study are described including: partnership formation, problem identification, intervention development, and pilot testing of the intervention. Challenges associated with CBPR are identified. RESULTS Using CBPR, the SCI Peer Navigator intervention addresses the partnership's priority issues identified in the formative studies. Utilization of the framework and integration of CBPR principles into all phases of research have promoted sustainability of the partnership. Recognition of and proactive planning for challenges that are commonly encountered in CBPR, such as sharing power and limited resources, has helped sustain our partnership. CONCLUSIONS The CBPR framework provides a guide for inclusion of individuals with SCI as research partners in the development, implementation, and evaluation of interventions intended to improve outcomes after SCI.
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Affiliation(s)
- Susan D Newman
- Medical University of South Carolina (MUSC), College of Nursing, 99 Jonathan Lucas St, MSC 160, Charleston, SC 29425, USA.
| | | | - Sherwood Toatley
- Medical University of South Carolina (MUSC), College of Nursing, 99 Jonathan Lucas St, MSC 160, Charleston, SC 29425, USA; South Carolina Spinal Cord Injury Association, USA
| | - Marka D Rodgers
- Medical University of South Carolina (MUSC), College of Nursing, 99 Jonathan Lucas St, MSC 160, Charleston, SC 29425, USA; Center for Spinal Cord Injury, MUSC College of Nursing, USA
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