Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Drive, P.O. Box 8015, Statesboro, GA 30460, USA.
Cancer Epidemiol Biomarkers Prev. 2012 Oct;21(10):1691-700. doi: 10.1158/1055-9965.EPI-12-0535.
We evaluated the efficacy of a Chicago-based cancer patient navigation program developed to increase the proportion of patients reaching diagnostic resolution and reduce the time from abnormal screening test to definitive diagnostic resolution.
Women with an abnormal breast (n = 352) or cervical (n = 545) cancer screening test were recruited for the quasi-experimental study. Navigation subjects originated from five federally qualified health center sites and one safety net hospital. Records-based concurrent control subjects were selected from 20 sites. Control sites had similar characteristics to the navigated sites in terms of patient volume, racial/ethnic composition, and payor mix. Mixed-effects logistic regression and Cox proportional hazard regression analyses were conducted to compare navigation and control patients reaching diagnostic resolution by 60 days and time to resolution, adjusting for demographic covariates and site.
Compared with controls, the breast navigation group had shorter time to diagnostic resolution (aHR = 1.65, CI = 1.20-2.28) and the cervical navigation group had shorter time to diagnostic resolution for those who resolved after 30 days (aHR = 2.31, CI = 1.75-3.06), with no difference before 30 days (aHR = 1.42, CI = 0.83-2.43). Variables significantly associated with longer time to resolution for breast cancer screening abnormalities were being older, never partnered, abnormal mammogram and BI-RADS 3, and being younger and Black for cervical abnormalities.
Patient navigation reduces time from abnormal cancer finding to definitive diagnosis in underserved women.
Results support efforts to use patient navigation as a strategy to reduce cancer disparities among socioeconomically disadvantaged women.
我们评估了一个位于芝加哥的癌症患者导航项目的疗效，该项目旨在提高患者达到诊断明确的比例，并减少从异常筛查检测到明确诊断的时间。
我们招募了 352 名患有异常乳腺（n=352）和 545 名患有异常宫颈（n=545）癌症筛查的女性参与这项准实验研究。导航组的患者来自五个联邦合格的健康中心和一家安全网医院。基于记录的同期对照组患者则从 20 个站点中选取。从患者数量、种族/民族构成和支付方式等方面来看，对照组与导航组的站点具有相似的特征。采用混合效应逻辑回归和 Cox 比例风险回归分析比较了在 60 天内达到诊断明确的导航组和对照组患者，并调整了人口统计学协变量和站点。
与对照组相比，乳腺导航组的诊断明确时间更短（aHR=1.65，CI=1.20-2.28），而宫颈导航组中在 30 天后达到诊断明确的患者的诊断明确时间更短（aHR=2.31，CI=1.75-3.06），而在 30 天前无差异（aHR=1.42，CI=0.83-2.43）。与乳腺异常筛查相比，与更长的诊断明确时间显著相关的变量包括年龄较大、从未有伴侣、异常乳房 X 线摄影和 BI-RADS 3 以及年龄较小和为黑人。
患者导航缩短了弱势群体女性从异常癌症发现到明确诊断的时间。
结果支持利用患者导航作为减少社会经济弱势群体女性癌症差异的策略的努力。
