Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities

Abstract

Background: Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care. Methods: Data originated from 250 women in the intervention arm of the Chicago Patient Navigation Research Program (PNRP). The women had abnormal cancer screening findings and navigator encounters. Women were recruited from a community health center and a publicly owned medical center. After describing proportions of African American and Latina women experiencing particular barriers, logistic regression was used to explore associations between patient characteristics, such as race/ethnicity, and type of barriers. Results: The most frequent barriers occurred at the intrapersonal level (e.g., insurance issues and fear), while institutional-level barriers such as system problems with scheduling care were the most commonly recurring over time (29%). The majority of barriers (58%) were reported in the first navigator encounter. Latinas (81%) reported barriers more often than African American women (19%). Differences in race/ethnicity and employment status were associated with types of barriers. Compared to African American women, Latinas were more likely to report an intrapersonal level barrier. Unemployed women were more likely to report an institutional level barrier. Conclusion: In a sample of highly vulnerable women, there is no single characteristic (e.g., uninsured) that predicts what kinds of barriers a woman is likely to have. Nevertheless, navigators appear able to easily resolve intrapersonal-level barriers, but ongoing navigation is needed to address system-level barriers. Patient navigation programs can adopt the PNRP barriers framework to assist their efforts in assuring timely follow-up care.

Multiple Barriers Delay Care Among Women with Abnormal Cancer Screening Despite Patient Navigation

“…These findings support our previously published analyses documenting the relationship between multiple social service barriers, such as lack of adequate housing or income supports, and timely resolution. 28 Half of our navigated population had documented barriers to care, similar to some navigation programs 17,27 while other navigation programs have found a greater frequency of barriers 29 using the same methodology in barrier identification. Such differences between sites reinforces the importance of tailoring navigation training and implementation to the local needs and barriers of the community served.…”

Participants' barriers to diagnostic resolution and factors associated with needing patient navigation

“…Previous research has found that having at least one barrier to care significantly increases the chance of loss to follow-up. 9,10 PN has been shown to reduce barriers, 23,24 as well as loss to follow-up. 25 Thus, knowing who is more likely to have a barrier to recommended care can allow medical facilities to direct scarce PN resources to those patients, increasing compliance with CoC mandates while improving the receipt of timely and quality care.…”

Predictors of resolution in navigated patients with abnormal cancer screening tests

“…That patient-focused barriers to care (which included comorbidities and fear 23 ) affected diagnostic resolution in patients with breast abnormalities was not surprising because those patients were more likely to have comorbidities and fear is a common finding in patients with abnormal breast tests or clinical findings. 3,26 In patients with cervical abnormalities, it is likely that other-focused barriers affected resolution because that barrier grouping included issues related to employment and child care. Those issues are likely more problematic for younger patient populations, such as the patients with cervical abnormalities in this study.…”