Evaluation of Patient Needs and Patient Navigator Communication About Cervical Cancer Prevention in Appalachian Kentucky

Abstract

Few studies describe the way patient navigation processes may address disparities in treatment and follow-up care for medically underserved populations. Using a social ecological framework, we analyzed survey assessments of 519 patients completing a randomized navigation trial in Appalachia Kentucky to examine patient-reported barriers to follow-up cervical cancer care. We also analyzed in-depth interview transcripts with four lay patient navigators in the trial to identify barriers to follow-up care and to learn what communication strategies navigators use to successfully (or unsuccessfully) help patients navigate around those barriers. Our analysis provides insight into how patient navigation may improve adherence to follow-up care through assisted uncertainty management. We also discuss opportunities for improving navigator training to address disparities in clinical outcomes.

Identifying Sociocultural Barriers to Mammography Adherence Among Appalachian Kentucky Women

“…Following standard approaches to qualitative data analysis (e.g., Cohen & Head, 2013; Cohen, Scott, White, & Dignan, 2013), after reading the transcripts, the researchers derived categories for content analysis by inductive reference. Transcripts were reviewed and annotated by the authors for key ideas and recurring themes.…”

Using communication to manage uncertainty about cervical cancer screening guideline adherence among Appalachian women

“…In general, patient uncertainty has been shown to significantly and negatively affect cervical cancer screening and follow-up behavior (Cohen, Scott, White & Dignan, 2013). For example, patients who have logistical, personal, or relational uncertainty related to follow-up care after receiving an abnormal Pap test result are often less likely to receive appropriate follow-up treatment.…”

“…For example, patients who have logistical, personal, or relational uncertainty related to follow-up care after receiving an abnormal Pap test result are often less likely to receive appropriate follow-up treatment. Cervical cancer-related uncertainty has been investigated with regard to risk perceptions (Garcés-Palacio & Scarinci, 2012), pre-diagnosis abnormalities (Juraskova, Butow, Sharpe, & Campion, 2007), and post-diagnosis (Cohen et al, 2013); however, to date no research has explored patient understanding and uncertainty related to cervical cancer screening guidelines.…”

“…Even in the absence of an explication of uncertainty in the literature, the appearance of uncertainty—and need for uncertainty management—is a common theme in research on patient-provider communication and lay understanding of cancer screening (Cohen et al, 2013). Not surprisingly, the reduction of uncertainty is frequently a goal of knowledge-based screening awareness campaigns and patient navigator programs to promote cancer screening.…”

“…In terms of practice, in order to improve cervical cancer screening rates and manage patient uncertainty about screening, we must focus on risk factors that are associated with higher screening rates (Hatcher, et al, 2011; Nelson et al, 2009). One modifiable risk factor that is feasible for intervention for producing more immediate outcomes is provider communication (Cohen, et al, 2013). In the context of new screening guidelines, new information can help patients manage uncertainty (Barbour, Ritamaki, Ramsey, & Brashers, 2012; Brashers et al, 2000) even if it fails to reduce the ambiguity of its outcome.…”