Effect of Patient Navigation on Breast Cancer Screening Among African American Medicare Beneficiaries: A Randomized Controlled Trial

Abstract

BACKGROUND:There is growing evidence that patient navigation improves breast cancer screening rates; however, there are limited efficacy studies of its effect among African American older adult women. OBJECTIVE: To evaluate the effect of patient navigation on screening mammography among African American female Medicare beneficiaries in Baltimore, MD. DESIGN: The Cancer Prevention and Treatment Demonstration (CPTD), a multi-site study, was a randomized controlled trial conducted from April 2006 through December 2010. SETTING: Community-based and clinical setting. PARTICIPANTS: The CPTD Screening Trial enrolled 1905 community-dwelling African American female Medicare beneficiaries who were ≥65 years of age and resided in Baltimore, MD. Participants were recruited from health clinics, community centers, health fairs, mailings using Medicare rosters, and phone calls. INTERVENTIONS: Participants were randomized to either: printed educational materials on cancer screening (control group) or printed educational materials + patient navigation services designed to help participants overcome barriers to cancer screening (intervention group). MAIN MEASURE: Self-reported receipt of mammography screening within 2 years of the end of the study. KEY RESULTS: The median follow-up period for participants in this analysis was 17.8 months. In weighted multivariable logistic regression analyses, women in the intervention group had significantly higher odds of being up to date on mammography screening at the end of the follow-up period compared to women in the control group (odds ratio [OR] 2.26, 95 % confidence interval [CI]1.59-3.22). The effect of the intervention was stronger among women who were not up to date with mammography screening at enrollment (OR 3.63, 95 % CI 2.09-6.38). CONCLUSION: Patient navigation among urban African American Medicare beneficiaries increased self-reported mammography utilization. The results suggest that patient navigation for mammography screening should focus on women who are not up to date on their screening.

Capsule Commentary on Marshall et al., Effect of Patient Navigation on Breast Cancer Screening Among African American Medicare Beneficiaries: a Randomized Controlled Trial

“…2 Marshall et al report a randomized community-based intervention using patient navigators among African American women in Baltimore that increased breast cancer screening compared to receipt of printed materials. 3 These results add to the growing body of evidence supporting patient navigation as an effective tool for improving cancer screening rates among vulnerable populations. 4 The study is strengthened by randomization of the intervention, which enables the authors to avoid pre-and postintervention comparisons that can be biased by temporal trends.…”

A Survey of African American Men in Chicago Barbershops: Implications for the Effectiveness of the Barbershop Model in the Health Promotion of African American Men

“…Many practitioners have addressed medical issues within churches [14], community fairs, community organizations [15], beauty salons [16,17] and schools [18] embedded in AA communities. While these aforementioned efforts have been documented as effective, they have predominantly targeted women and children.…”

Patient Navigation in Medically Underserved Areas study design: A trial with implications for efficacy, effect modification, and full continuum assessment

“…One PNRP site was Chicago [6, 7], which exhibited increasing disparities due to differential access to technological advances in breast cancer care [8–10]. PNRP and other efficacy studies have subsequently demonstrated navigation is effective for improving breast cancer care uptake and time to diagnostic resolution [11–22]. …”

“…First, with the exception of the Denver PNRP [17], extant individual- level RCTs to evaluate the efficacy of navigation have been relatively small (<250 participants total) [19, 18, 21, 20] or have relied on self-report outcomes [22]. There is a need for more large individual-level RCTs, especially those relying on medical records, to confirm the effects of navigation.…”