Abstract A29: Community-based approach to developing a cervical cancer patient navigator program: A pilot

Abstract

Background: Patient navigation (PN) focuses on identifying and resolving logistical, emotional, and health system barriers to obtaining cancer-related healthcare with the goal of increasing the number of patients who receive recommended cancer care services. Employing a community-based participatory research approach and building on an existing Patient Navigation Research Program, the Tampa Bay Community Cancer Network (TBCCN) Cervical Cancer Patient Navigator Program (CCPNP) was developed based on needs identified by a TBCCN community partner, Catholic Mobile Medical Services (CMMS). CMMS is located in a rural area of central Florida and provides free health care to a population of primarily Spanish-speaking Hispanic farmworker families.

Methods: The TBCCN CCPNP targets the prevention of cervical cancer by facilitating access to care and providing education about cervical cancer prevention and early detection. To date, the focus of the TBCCN CCPNP has been improving the provision of timely cervical cancer screening and follow-up for women who have abnormal Pap tests. The TBCCN CCPNP is implemented at the CMMS clinic and evaluated using both process (navigator activity logs) and outcome (patient medical record) data. Using a pre-post design, outcome data are collected from medical records before and after the PN intervention. It is expected that, compared to women who received care at CMMS prior to the PN intervention, women who receive care at CMMS that included the PN intervention: (1) will be more likely to receive the results of their Pap test; (2) will receive the results of their Pap test in less time; (3) will be more likely to adhere to all recommended follow up diagnostic tests and treatment after receiving an abnormal pap test; (4) will obtain all recommended diagnostic and treatment care in less time following an abnormal pap test; and (5) will be more likely to adhere to a recommended surveillance Pap test following an abnormal Pap test.

Results: Data from the process evaluation of the Spanish-English bilingual patient navigator's activity logs indicate that since completing navigator training in February 2010, the patient navigator has provided PN services through 323 patient encounters, and has coordinated the follow up care of 12 patients with an abnormal Pap test. The majority of the navigator's services entail: addressing communication barriers [i.e., making calls to schedule (42 calls), reschedule (21 calls), and remind patients about appointments (60 reminders) and mail Pap test results (133 results)]. The navigator also provides education about cervical cancer and Pap tests and accompanies patients to appointments for specialty care. Baseline data collected from 82 medical records of patients who received gynecological care at CMMS in 2007 and 2008 (99% Hispanic, mean age = 39.6; mean years of education = 8) indicate that 6.1 % of patients had an abnormal pap. The average length of time it took to mail Pap test results to patients was 69.16 days (SD: 38.33). Undeliverable mailed results were returned for 12.5% of patients because their address was incorrect.

Conclusions: The implementation of a PN program in a rural, Hispanic farmworker population is feasible and may be effective in reducing barriers to cancer care. Future areas of development of the PN intervention include the provision of educational sessions about HPV and cervical cancer.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A29.