Addressing Unmet Basic Needs to Improve Colposcopy Adherence Among Women With Abnormal Cervical Cancer Screening

Abstract

Objectives The aims of the study were to identify unmet basic needs (BNs) among women referred to colposcopy, to assess patient acceptability/satisfaction with assistance from a navigator to address unmet BNs, and to estimate adherence to colposcopy. Methods Women were recruited between September 2017 and January 2019 from 2 academic colposcopy centers, one serving a rural and one an urban area. Basic needs were assessed by phone before colposcopy appointments and considered unmet if unlikely to resolve in 1 month. Colposcopy adherence prestudy and poststudy implementation was abstracted over 4–6 months from administrative records. After a lead-in phase of 25 patients at each site, a BN navigator was offered to new participants with 1 or more unmet BNs. Primary outcome was adherence to initial appointment. Results Among 100 women, 59% had 1 or more unmet BNs, with similar prevalence between urban and rural sites. Adherence to initial colposcopy was 83% overall, 72% at the rural clinic, and 94% at the urban clinic (p = .006). These adherence rates were improved from 4 months before study launch (30/59 [51%] rural clinic and 68/137 [50%] urban clinic). Although acceptability of BN navigation was greater than 96% and women felt that it helped them get to their colposcopy visit, having a navigator was not associated with adherence. Women reporting no unmet BNs had the lowest adherence compared with women with 1 or more unmet BNs, regardless of navigator assistance (p = .03). Conclusions Disadvantaged women who need colposcopy have unmet BNs and value navigator assistance for initial appointments. However, when appointment scheduling includes telephone reminders and inquiring about BNs, a navigator may not add value.

Interventions to increase follow-up of abnormal cervical cancer screening results: A systematic literature review and meta-analysis

“…Many of the studies focused on the follow-up of women in low-resource populations/settings. Of the 28 studies included for data extraction, 10 focused on interventions directed towards low-income populations [ 20 , 22 , 23 , 26 , 31 , 34 , 35 , 38 , 42 , 46 ], five addressed follow-up for racial minorities [ 21 , 24 , 30 , 40 , 43 ], one focused on addressing follow-up of women older than 65 years of age [ 33 ] and three served a combination of minority and low-income populations [ 28 , 32 , 39 ]. Nine of the studies did not describe a specific patient population group [ 19 , 25 , 27 , 29 , 36 , 37 , 41 , 44 , 45 ].…”

“…The majority of the studies focused on addressing follow-up for women with abnormal Pap test results (cytology) and two focused on women who had abnormal HPV testing results [ 37 , 40 ]. Two did not specify the type of abnormal result [ 26 , 33 ] and one focused on abnormal VIA results [ 29 ].…”

Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

“…Six studies focused on participant perceptions. Patients from underserved populations with unmet basic needs reported highly valuing their patient navigator during initial appointments because they provided key information, were person‐centered, and brought comfort to patients 127–129 . Commonly reported unmet needs included housing, financial, legal, and transportation issues 130 .…”

“…Patients from underserved populations with unmet basic needs reported highly valuing their patient navigator during initial appointments because they provided key information, were person-centered, and brought comfort to patients. [127][128][129] Commonly reported unmet needs included housing, financial, legal, and transportation issues. 130 Participants highlighted the need for patient navigation to address institutional barriers by setting recruitment goals for minority participation in clinical trials and ensuring that interventions are accessible to minorities and that community outreach is used to build awareness.…”

Racial and ethnic differences in cervical cancer screening barriers and intentions: The My Body My Test-3 HPV self-collection trial among under-screened, low-income women

“…Community outreach is necessary to inform uninsured women about the existence of preventative medical screenings and to link them to affordable care. Prior studies have shown that patient navigation can increase screening uptake [42][43][44]. Helping patients move through the complex healthcare system might make the process less daunting.…”