Use of Patient Navigation Helps Improve Rates of Cancer Screenings in High-Risk Patients

Patient navigation (PN) programs using a population-based information technology (IT)-enabled system within a primary care network can help improve screening rates for breast, cervical, and colorectal cancer (CRC) among patients at high risk for not adhering to screening recommendations, and may also improve equity of cancer care, according to a new study published in JAMA Internal Medicine. The findings are important because despite advances in screening, abnormal test follow-up, and treatment, cancer morbidity and mortality rates for screened cancers are still high--especially among low-income patients and racial/ethnic minorities.

The study by Sanja Percac-Lima, MD, PhD, of Massachusetts General Hospital, and colleagues was performed over 8 months in 2014 in the Massachusetts General Primary Care Practice-Based Research Network, which consisted of 18 primary care practices and 4 community health centers. The network uses TopCare to identify all patients eligible and overdue for breast, cervical, and/or CRC screening in near real-time and provides clinicians with real-time, relevant clinical information about screening.

The researchers developed an algorithm to identify patients at high risk for not completing screening. A total of 1956 patients were identified as high risk for nonadherence with cancer screening; 330 patients who received care at the community health center with the existing PN program were excluded from the total. After excluding patients who left the network or died, 1626 patients remained who were overdue for at least one screening. They were randomized to receive PN (792 patients) or usual care (820 patients).

Patients randomized to the PN intervention were contacted by patient navigators fluent in several languages and were trained in motivational interviewing, problem solving, goal setting, use of the IT system, electronic medical record documentation, and health modules on screening. The navigators used a patient-centered approach and the IT system to track patients, contact them in their own language, and provide intense outreach to help them complete cancer screening. Patient navigators helped educate and encourage patients, provide reminder calls, and if necessary, arrange transportation and accompany patients to visits.

Usual care consisted of visit-based reminders within the electronic health record and non-visit-based outreach by clinicians using the IT application to send patients reminder letters about overdue cancer screenings, or call to schedule overdue exams.

The percentage of patients up to date with screening was higher in the PN versus usual care group for all cancers combined (10.2% vs 6.8%), and for breast (14.7% vs 11%), cervical (11.1% vs 5.7%), and colorectal (7.6% vs 4.6%) cancer compared with the usual care group.

The percentages of patients overdue for screenings who completed any screening during follow-up was higher in the PN group (25.5% vs 17%). In the PN group more patients completed screening for breast (23.4% vs 16.6%), cervical (14.4% vs 8.6%), and colorectal (13.7% vs 7%) cancers.

In conclusion, the PN program was beneficial for all high-risk patients whatever their age, sex, language, or insurance.

“Future work should focus on improving the efficiency of patient navigators through better identification of high-risk patients unlikely to undergo screening through routine measures and with barriers that are amenable to PN,” the authors concluded. “Using patient navigators who are integrated into population health management activities for patients at high risk for screening nonadherence within a practice network may improve equity of cancer care.”