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Meta-Analysis
. 2016 Aug;158(3):523-34.
doi: 10.1007/s10549-016-3887-8. Epub 2016 Jul 18.

The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis

Tracy A Battaglia  1 , Julie S Darnell  2 , Naomi Ko  3 , Fred Snyder  4 , Electra D Paskett  5 , Kristen J Wells  6 , Elizabeth M Whitley  7 , Jennifer J Griggs  8 , Anand Karnad  9 , Heather Young  10 , Victoria Warren-Mears  11 , Melissa A Simon  12 , Elizabeth Calhoun  13
Affiliations
Meta-Analysis

The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis

Tracy A Battaglia et al. Breast Cancer Res Treat. 2016 Aug.

Abstract

Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screening test among a national sample. A prospective meta-analysis estimated the adjusted odds of achieving timely diagnostic resolution at 60, 180, and 365 days. Exploratory analyses were conducted on the pooled sample to identify which groups had the most benefit from navigation. Clinics from six medical centers serving vulnerable populations participated in the Patient Navigation Research Program. Women with an abnormal breast cancer screening test between 2007 and 2009 were included and received the patient navigation intervention or usual care. Patient navigators worked with patients and their care providers to address patient-specific barriers to care to prevent delays in diagnosis. A total of 4675 participants included predominantly racial/ethnic minorities (74 %) with public insurance (40 %) or no insurance (31 %). At 60 days and 180 days, there was no statistically significant effect of navigation on achieving timely diagnostic care, but a benefit of navigation was seen at 365 days (aOR 2.12, CI 1.36-3.29). We found an equal benefit of navigation across all groups, regardless of race/ethnicity, language, insurance status, and type of screening abnormality. Patient navigation resulted in more timely diagnostic resolution at 365 days among a diverse group of minority, low-income women with breast cancer screening abnormalities. Trial registrations clinicaltrials.gov Identifiers: NCT00613275, NCT00496678, NCT00375024, NCT01569672.

Keywords: Breast cancer; Care delivery; Disparities; Patient navigation.

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Figures

Fig. 1
Fig. 1
CONSORT diagram for selection of study centers and participants
Fig. 2
Fig. 2
Meta-analysis of impact of patient navigation on diagnostic resolution 60 days after breast cancer screening abnormality: Patient Navigation Research Program
Fig. 3
Fig. 3
Meta-analysis of Impact of Patient Navigation on Diagnostic Resolution 180 Days after Breast Cancer Screening Abnormality: Patient Navigation Research Program
Fig. 4
Fig. 4
Meta-analysis of impact of patient navigation on diagnostic resolution 365 days after breast cancer screening abnormality: Patient Navigation Research Program
Fig. 5
Fig. 5
Proportion of participants with abnormal breast cancer screening who completed diagnostic evaluation between 180 and 365 days: the Patient Navigation Research Program. N = 1252
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