Una Mano Amiga: Pilot Test of a Patient Navigator Program for Southwest New Mexico

Abstract

We conducted a pilot test of a patient navigation intervention (Una Mano Amiga) to address cancer health disparities in three rural counties in southwest New Mexico. We trained two bilingual lay health workers (promotoras) as patient navigators (PNs) to help adult cancer patients and their participating families in Grant, Luna, and Hidalgo counties "navigate" the health care system, including appropriate access to social and financial services. Our hypothesized outcome was a reduction in time from diagnosis to treatment initiation compared to the average time without PNs in each of the three counties (2000-2009). We enrolled 85 eligible patients and 43 eligible family members who had completed psychosocial and demographic forms in this PN intervention. Mean time from cancer diagnosis to treatment initiation among 41 study patients was 59.6 days across the three counties. Mean time from non-intervention comparison data was 47.1 days. In the intervention group, on a 0-10 satisfaction scale (higher = more), patient mean scores for three items ranged from 9.3 to 9.6, family members, 8.9-9.3. Caregiver stress as measured by a Caregiver Self-Assessment score ≥ 10 (highest stress = 16) decreased from 23.8% of caregivers at study entry to 14.3% at follow-up (not statistically significantly different). Although the PN intervention did not decrease time from diagnosis to treatment initiation compared to three comparison counties, positive reactions of patients and family members support further research with larger samples.

Systematic Review of Interventions Addressing Racial and Ethnic Disparities in Cancer Care and Health Outcomes

“…17 Across studies, most interventions were examined in individuals after a new cancer diagnosis. 6,7,18,19,22,23,[25][26][27]29,30,[32][33][34][35][40][41][42][43][44] Fifty percent of the included studies were conducted in breast cancer populations. 6,7,16,17,[19][20][21]23,24,26,31,[36][37][38][40][41][42]45,46 Among the 34 studies included, 15 used a randomized design, 6,7,15,16,[19][20][21][22][37][38][39]…”

“…6,7,16,17,[19][20][21]23,24,26,31,[36][37][38][40][41][42]45,46 Among the 34 studies included, 15 used a randomized design, 6,7,15,16,[19][20][21][22][37][38][39][40][41][42]45 while 14 adopted a nonrandomized intervention approach. 17,18,23,24,[26][27][28]30,31,[34][35][36]43,44 Two studies used a combination of both randomized and nonrandomized designs and recruited participants from multiple centers. 25,32 2020 or later 12 7...…”

“…17,18,23,24,[26][27][28]30,31,[34][35][36]43,44 Two studies used a combination of both randomized and nonrandomized designs and recruited participants from multiple centers. 25,32 2020 or later 12 7,[36][37][38][39][40][41][42][43][44][45][46] Sample size <50 5 6,16,21,23,26 50-99 9 15,24,28,30,34,35,42,45,46 100-199 7 [18][19][20]31,37,38,44 ≥200 13 7,17,…”

“…Studies examining the effect of interventions in specific racial/ethnic groups from underrepresented backgrounds or in samples where a minimum of 50% of the participants belonged to underrepresented racial-ethnic groups 30 studies, of which: 10 15,19,20,22,31,[38][39][40]42,46 targeted Hispanic populations 7 6,16,21,24,26,33,41 focused on African American (AA)/Black patients 4 18,28-30 targeted American Indian or Alaska Native (AIAN) populations 2 34,37 recruited only Asian patients 7 7,23,25,32,34,35,44 included diverse samples in which over 50% of patients were from racially/ethically minoritized backgrounds Studies examining the effect of interventions on the disparities in outcomes between various racial/ethnic groups 41 studies, of which: 3 27,36,43 studies evaluated intervention effects on Black/White disparities 1 17 study assessed the impact on disparities between White or Asian patients v Hispanic or White patients Insurance status Reported 14 7,[17][18][19]23,25,[28][29][30][31][32]36,…”

“…Study design Randomized 15 6,7,15,16,[19][20][21][22][37][38][39][40][41][42]45 Nonrandomized 14 17,18,23,24,[26][27][28]30,31,[34][35][36]43,44 Randomized and nonrandomized 2 25,32 Not reported 3 29,33,46 Cancer type Breast 17 6,16,17,[19][20][21]23,24,26,31,37,38,[40][41][42]45,46 Breast and lung 2 7,…”